Fit and Fat: Why not to promote weight loss

Thin isn't in at hospital wellness program

If you want to promote a healthy lifestyle for your employees, maybe you should start by throwing away the scale.

The cycle of dieting, the guilt about eating certain foods, the quest for the "ideal" weight — those result in lower self-esteem and poor body image but rarely in sustained weight loss, contend the wellness experts at Mercy Medical Center — North Iowa in Mason City. That's why the hospital doesn't offer to help employees lose weight.

Instead, their motto is "Health for Every Body." The idea is to "help everyone be healthy regardless of weight," says Laura McKibbin, LISW, coordinator of Kailo for One, the hospital's employee counseling program. "This is not an approach that tells people to gain weight. This is not an approach that tells people to abandon health. This is not an approach that tells people to eat all they want and be sedentary. Do those things that are healthy for you, but don't attach it to weight loss."

It's tough to go against the prevailing dogma. Thin is in, not only as the ideal of beauty, but the image of health. Employees are naturally drawn to the goal of losing pounds as a way to boosting their esteem. Kelly Putnam, MA, who launched the Kailo wellness program and "Health for Every Body" program at Mercy Medical Center, understands that yearning. (Putnam recently was promoted to the hospital's parent organization, Trinity Health, where she is working on a "Culture Transformation Initiative" that will focus on creating a culture of "quality, safety, and customer satisfaction.")

A former dieter, Putnam once taught a weight loss program. But at Mercy Medical Center, she didn't want to make hollow promises. When employees ventured into the Kailo office asking about weight management, Putnam would point out that the wellness program doesn't even have a scale. "I almost feel like a dream killer," she says. "They're coming in with the dream of being thin."

She notes that the vast majority of diets don't work. The pounds may melt off initially, but some 95% of dieters will gain those back — and perhaps even more. "Would we be prescribing a pharmaceutical with a 95% failure rate?" Putnam wonders. "Weight loss is not a good place to put your precious budget dollars."

Overweight people live longer

"Health for Every Body" begins with the premise that you can be "overweight" and still be healthy. In fact, there is scientific evidence to bolster that assertion.

Being overweight is actually associated with a lower death rate, according to a Center for Disease Control and Prevention study that correlated the cause of death and body mass index of 2.3 million Americans. However, being either underweight or obese was associated with increased mortality. Obesity, but not being overweight, was associated with cardiovascular disease.1

However, CDC and others still lump together the problems of being overweight (a body mass index of 25 or higher) and obese (a body mass index of 30 of higher). The CDC web site lists the "health consequences" of obesity and overweight as increasing the risk of hypertension, stroke, Type 2 diabetes, coronary heart disease, and some cancers.

The Kailo message, however, is that someone can be fat and beautiful — and fat and fit. "Health for Every Body" provides seminars and services around six tenets: education, normal eating, movement for pleasure, self-acceptance, size tolerance, and social support.

It began in 2004 with a study group of 61 employees. They learned to stop thinking of certain foods as "bad" or taboo, and to eat in response to hunger rather than external cues. "When we promote weight loss, I also believe we're promoting, at some level, eating disorders," says Putnam.

They participated in "pleasurable movement," not exercise to burn calories. Their goal weight was "the weight at which a person settles while moving toward a more fulfilling, meaningful lifestyle" — a definition coined by Jon Robison, PhD, an assistant professor at Michigan State University in East Lansing, who developed the "Health at Every Size" philosophy that the Kailo program uses.2

After 12 months, the Kailo study group improved in eating patterns, physical activity, body image, and emotional well-being. "It's absolutely possible to improve our health without losing weight," says Putnam.

Wouldn't you naturally lose weight if you increased your physical activity and developed healthier eating habits? Not necessarily, says Putnam and McKibbin. While some may lose weight, others may find that their weight stabilizes. And those who have had chaotic eating or undereating may actually gain weight.

Releasing the goal of losing weight can be liberating. "It's a very hopeful message," says McKibbin. "But if people care more about losing weight than they care about any of those [health benefits], then the message can come across as hopeless."

Today, when employees come into the Kailo office, they may see a scale — but one without numbers. Step on it and it will deem you "smart and sassy" or "bright and beautiful." That gives the message that body image is more important than any number.

McKibbin cautions hospital wellness programs against a focus on dieting and weight management. "When we promote weight loss ... we're risking an increase in overall weight because of yoyo dieting [in which deprivation is followed by bingeing]," she says.

Instead, focus on healthy eating, physical activity, and a positive body image, she says. "It isn't necessary to lose weight in order to achieve an improvement in health," McKibbin says.

(Editor's note: More information about "Health At Every Size" is available from the web site, www.healthateverysize.info or www.jonrobison.net/FDNH/INDEX.HTM.)

References

1. Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298:2,028-2,037.

2. Robison JI, Putnam K, McKibbin L. Health At Every Size: A compassionate, effective approach for helping individuals with weight-related concerns — Part 1. AAOHN J Apr 2007; 55(4):143-150.