For these overweight women, not focusing on weight loss may actually be the best path to good health
By Marjorie Ingall
The pulse of tribal drumming fills the air. Jeannie Troy, 48 and 220 pounds, dances wildly, pogo-ing like a punk rocker at a Green Day concert and shaking her sweaty hair. All around her, women–whose body sizes range from average to well over 300 pounds–grin as they get their groove on.
This is what fitness looks like at Green Mountain at Fox Run, a center in Vermont for women determined to end their weight struggles. As the class breaks up, applause erupts and Troy grabs a towel. Her face is bright red and her extralarge purple T-shirt is blotched with sweat, but she’s beaming. “I’ve finally learned to take to heart that saying ‘Dance like nobody’s watching,’ ” she says.
Before coming to Green Mountain, Troy had spent countless days–and dollars–dieting. She isn’t alone: At any given time, 53% of Americans are trying to lose weight. So why, then, are so many women overweight? Many experts believe it’s because diets simply don’t work for keeping weight off long term. “If we had a 95% failure rate with a medication, it would never get approved by the FDA. Yet that’s dieting’s record,” says Michelle May, MD, founder of Am I Hungry? Mindful Eating Workshops.
After decades of yo-yo dieting that only leaves them heavier than they were to start with, many women lose the will to work out and watch what they eat, and they begin dodging doctors who make them feel fat. Some ultimately give up on dealing with health issues such as high blood pressure or elevated cholesterol, believing that without dramatic weight loss, it’s useless.
But according to a controversial new movement, it is possible to break this cycle of failed diets and poor health, even if you never end up in a pair of skinny jeans or in the safety zone of the BMI chart. It’s known as Health At Every Size (HAES), and its principles are so radically simple that they can be difficult to grasp after a lifetime of trying to follow complicated plans full of rules, stages, calories, grams of fat, points, scales, and math.
The basic premise is that healthy behaviors can improve your life regardless of whether they result in weight loss. You abandon diets in favor of “intuitive eating,” which means paying close attention to what you crave and how the foods you eat make you feel, as well as gradually learning to distinguish emotional hunger from the physical kind. For exercise, you identify any activity that provides enough fun that you don’t need to force yourself to do it regularly. HAES also demands that you love and respect your body just as it is, whatever size it is right now. At its core, HAES is about stripping away rigid ideas about food and fitness.
For most doctors, it’s still hard to believe health improvements are possible without weight loss. Wahida Karmally, DrPH, RD, director of nutrition at the Irving Institute for Clinical and Translational Research at Columbia University Medical Center, points out:
“The research is very compelling that as your weight increases, your risk for several diseases increases also.”
Yet a growing body of evidence suggests the HAES camp may have it right. One study sponsored by the National Institutes of Health randomly assigned 78 women to either a HAES program or a conventional diet program. The HAES women were coached in adopting healthy food, activity, and lifestyle choices but were given no rigid rules or restrictions. They also participated in support groups, in which they dealt with issues regarding body acceptance and feelings that tied self-worth to their size. The women in the HAES program saw improvements (based on measures of blood pressure, cholesterol levels, activity levels, and depression) both at 6 months and at 2 years. The women in the dieting group lost weight and had improvements initially but went back to their old behaviors, weight, and blood measures within 2 years.
Troy, who lives in Thornton, CO, is a stalwart disciple. She calls herself a “roundy girl.” (“I’m not curvy,” she says. “I don’t go in and out. I just go out!”) Before coming to Green Mountain, she hated her body. A culinary school graduate, she worked for years in the food industry and then in the family business–a candy store. And for more than 2 decades, she was bulimic. “I opened those bags of candy, and I stuffed down my feelings of resentment,” she says quietly. Purging never caused her to lose weight–it was more about ridding herself of bad feelings than unwanted pounds.
She knew that bulimia could weaken the heart muscle, erode tooth enamel, damage the esophagus, foster stomach ulcers, and burst blood vessels in the eyes. “But I convinced myself those things wouldn’t happen to me,” she says. “Then I went to the eye doctor, and the exam was taking a little longer than usual. Finally he said, ‘The retina is slightly detaching.’” It was a direct result of her habitual vomiting. Her eyes fill with tears at the memory. “I thought, Oh my God, I did this to myself.”
Troy realized at that moment something had to change. Her therapist suggested she try Green Mountain; she’s now on her third visit since 2008. By following the HAES practices, she’s lost about 40 pounds and slashed her cholesterol by more than 100 points, from 254 in 2008 to 152 at her most recent blood test. Her triglycerides have gone from 123 to 78. She says her body composition has shifted, with more muscle and less flab. Despite her weight loss, she’s still considered morbidly obese. But her cholesterol is now in the normal range, and her blood sugar indicates she isn’t diabetic. Even more important, she no longer lives with a life-threatening eating disorder.
For Troy, shifting the focus from weight to health has been transformative. She’s now training to be a fitness instructor, catering to other overweight and obese women–something unimaginable before she encountered HAES. “When you’re focused on weight, your whole life is consumed–pardon the pun–by what food is good or bad and what food is allowed,” she says.
After her last visit to Green Mountain, she went white-water rafting for the first time, and to celebrate her upcoming 50th birthday, she’s planning a tandem skydive. “I intend to do all the things I was waiting until I was thin to do,” she says.
Food is now something she enjoys instead of worries about. “I still love to cook,” she says. “I just made a lasagna chock-full of veggies and ground turkey.” She’s learned that she feels the most energized for her adventures when she eats meals made up of about half fresh vegetables, so generally that’s what she has. “The more I move and the better I feel, the more I want to move and feel even better,” she says. “I want to make healthy meals for myself.” This cycle of positive reinforcement is the opposite of the guilt-and-shame feedback loop created by years of failed diets.
Some experts believe that the negative effects of yo-yo dieting go beyond the physical and emotional tolls of being overweight or obese. According to Linda Bacon, PhD, associate nutritionist at the University of California, Davis, nutrition professor at City College of San Francisco, and author of Health at Every Size (the bible of the HAES movement), many studies suggest that yo-yo dieting itself increases the risk of high blood pressure, insulin resistance, and high blood cholesterol. Studies also show that a vast majority of dieting ends up being yo-yo dieting: Up to two-thirds of people who lose weight regain it within 1 year, and nearly all the rest regain it within 5 years.
Though most women understand that dieting can be destructive, it’s hard to give up the dream of getting thin. Even at Green Mountain, some clients continue to calculate calories and fixate on the scale, which the staff keeps under lock and key to discourage the obsession. Some have histories of eating disorders, and many have trouble learning to respond to real hunger cues as a signal to eat, which is among the most important skills you’ll need to develop if you want the HAES approach to produce results. “Intuitive eating tunes you in to your body so you know when you’re really hungry and when you’ve had enough,” says Marsha Hudnall, RD, the program director at Green Mountain. And it’s not all candy, ice cream, cheese, chips, and fries. “Some do end up eating more of those foods initially,” Hudnall says. “But as you truly give yourself permission to eat what you want, you naturally gravitate to healthier choices.”
Green Mountain’s program does encourage women to eat more whole foods by showing them how satisfying and delicious these foods can be. Its kitchen turns out meals like walnut-pesto- encrusted Vermont-raised chicken with roasted butternut squash and arugula salad, lemon-soy grilled flank steak with garlicky mashed potatoes and lemony asparagus, and bean-and-veggie wraps with chipotle-cucumber salad and carrot bisque. There are cooking classes to teach women the skills that they need to make food like this when they return home.
Other classes help women uncover the emotional basis for many food cravings. Part of intuitive eating is realizing that sometimes you’re hungry for things besides food, and there are ways other than eating to satisfy those needs.
At the end of one water aerobics class, while the other women are still panting from exertion, Rachel Peterson, 48, bellows, “I am going down that slide! Who’s with me?” She quickly cheerleads several into lining up behind her. One by one they hurtle down the twisting blue chute, screaming. Peterson, an international development consultant from Leverett, MA, slides again and again and shoots up out of the turquoise water with a whoop! She has reclaimed her childhood love of the water through this program. Before coming to Green Mountain, Peterson had been sedentary for years.
“I didn’t want those wonderful-looking gym-goers to see me jiggling,” she says. When she arrived at Green Mountain at 170 pounds, her knees ached–another disincentive to working out. While there, she made the connection that fitness isn’t just about treadmills, weight machines, and gyms–it can be the kinds of outdoor walks and swims she truly enjoys. Today, Peterson can’t believe how much better she feels, both in her bones and in her spirit. “For the past few years, I didn’t want to put on a bathing suit,” she says. But here, in the pool, that self-consciousness and body shame have evaporated: “I feel like I’m six again.”
Though she hasn’t focused on weight loss, Peterson has dropped from a size 14 to a size 10 since her 4-week stay at Green Mountain earlier this year. She can’t say how many pounds she’s lost because, thanks to the HAES training she got there, she has ditched the scale. “I have a few more inches to go before I feel like I’m in my ideal body,” she says. If she does shed more weight, it won’t be through dieting.
Many doctors fear that though HAES has helped women such as Troy and Peterson make important health improvements and lifestyle changes, other participants will take the movement’s love-yourself-as-you-are mentality to mean it’s okay to eat a half gallon of ice cream in one sitting or limit workouts to lifting the TV remote.
“We can’t allow the effort to improve people’s self-image to interfere with efforts to combat a serious medical concern,” says David L. Katz, MD, MPH, director of Yale University’s Prevention Research Center and Prevention advisory board member. “I agree that not everybody can be an underwear model. But when 65% of American adults are overweight or obese, a landslide majority is failing.”
However, a growing number of professionals believe that a paradigm shift is overdue. Deb Burgard, PhD, a San Francisco Bay area?based psychologist specializing in eating disorders, agrees that it’s time to stop the single-minded focus on diets. “Studies show that ‘even losing a little weight helps,’ but I think it’s the things you do that help–the physical activity and nutrition intervention, not the weight loss itself,” she says.
Even the detractors concede that if the message is articulated clearly and followed in good faith, HAES has its place for those who are determined to hop off the diet treadmill. “If we can talk people into pursuing health, especially people who have given up on it, HAES can do a lot more good than harm,” says Dr. Katz. “Besides, most people who truly focus on eating well and exercising will find that the weight eventually takes care of itself.
Copyright August 2011, Prevention
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