When Sarah, a healthy young woman in a larger body, consulted her doctor about itchy hives all over her body, he told her to lose forty pounds — and so she contacted me for weight-loss support. Not seeing how weight loss might cure hives (it can’t), I suggested she consult an allergist; she was diagnosed with a corn allergy. Sarah’s hives cleared up after eliminating corn from her diet. Sarah didn’t need to lose weight; she needed to avoid corn.

Don, a man in his early 60s, was told by his doctor to lose fifteen to twenty pounds since his BMI was elevated. Don ate a nutritious diet, exercised regularly, and his cardio-metabolic biomarkers were excellent. I suggested he get a body composition scan, and this showed that he carried a large amount of muscle. Don didn’t need to lose weight; he had a high weight because he was muscular.  

Linda, a woman in her late 50s with a BMI in the “normal” range, came to see me for weight loss advice. “My HbA1c is elevated and my doctor said losing ten pounds might help.” Reviewing her labs, I noticed that her iron levels were very low, a common nutritional deficiency that can contribute to elevated HbA1c (the average glucose level of the previous 2-3 months). With dietary changes and an iron supplement, her iron levels recovered and her HbA1c normalized. Linda needed more iron, not a lower body weight.

I relate these stories to illustrate the extent to which weight loss permeates not only the fashion and beauty world, but healthcare, too — despite mounting evidence indicating that intentional weight loss can do more harm than good. 

My Shift to Weight-Neutral Healthcare

I, too, used to believe that helping my clients lose weight would improve their health. However, I witnessed a consistent and troubling pattern: while many of my clients initially lost weight when they followed my nutrition and exercise recommendations, they eventually plateaued and often regained some or all the weight they lost. Everyone felt like they had failed: my clients for not keeping off the weight, and me for not advising them correctly. 

Alas, this cycle of weight loss and regain is common, and nobody’s fault (other than Mother Nature’s, who does whatever she can to save us from starvation). Research shows that less than 20% of people maintain weight loss after one year, and most regain all the weight within five years. My clients didn’t fail the diets; the diets failed them.

Eventually, I could no longer bear to impose restrictive regimens on my clients, only to watch them experience repeated disappointment, stress, and loss of self-trust. And so I decided to shift to a compassionate, weight-neutral approach, which prioritizes sustainable health behaviors and self-compassion over the pursuit of weight loss.

The Harms of Intentional Weight Loss and Dieting

Decades of research show that dieting and weight-loss efforts can backfire, physiologically and psychologically:

• Weight cycling and metabolic risks: Repeated weight loss and regain, known as weight cycling or yo-yo dieting, is linked to increased risks of heart attack, stroke and death from heart disease and diabetes and hypertension. A meta-analysis found that intentional weight loss in healthy individuals was associated with an 11% rise in mortality.
  
• Dieting and eating disorders. Dieting is a leading predictor of eating disorders. Restrictive eating patterns can escalate into disordered behaviors like binge eating or chronic malnutrition. The stress of calorie counting and food rules also exacerbates anxiety and depression.
  
• Weight stigma’s toll. Weight discrimination and bias, both internalized and societal, correlates with higher rates of metabolic syndrome, cardiovascular disease, and avoidance of healthcare. Studies show that weight stigma itself, not body size, drives many health risks attributed to fat.

The Shaky Link Between Weight and Health

The assumption that higher weight equates to poor health is oversimplified and often inaccurate.

• Metabolic health varies widely. Up to 40% of individuals classified as “obese” are metabolically healthy. Conversely, many individuals with “normal” BMIs develop cardio-metabolic imbalances like insulin resistance, heart disease or diabetes. A person’s genetics, chronic stress, and lifestyle habits like smoking and physical activity are better predictors of health outcomes than their weight or BMI.
  
• Non-weight factors affecting health. Assessing somebody’s health based on their weight overlooks the impact that social factors, such as income, education, employment, food availability, and access to healthcare, have on well-being. These have a profound effect, often far exceeding the influence of a person’s weight. For example, low socioeconomic status alone is associated with a 42% greater risk of all-cause mortality compared to high socioeconomic status. Having just one unfavorable social determinant can double a person’s risk of early death, and having six or more can increase the risk eightfold. 

A Weight-Neutral Approach to Well-Being

I now help my clients cultivate sustainable habits that honor their bodies, such as mindful eating, enjoyable movement, restorative sleep, and self-compassionate stress management skills. These approaches are tailored to each individual, taking into account their biochemistry, body history, any physical or emotional impairments, their budget, and more.  

Skeptics may grumble that this gentle approach isn’t powerful enough to address metabolic imbalances, but a growing body of research indicates otherwise. This study, for example, found that when people with a BMI over 30 engaged in four simple behaviors (physical activity >12 times a month, being a nonsmoker, consuming ≥5 servings of fruit and vegetables a day, and drinking alcohol in moderation), their mortality risk was virtually the same as that of people with a BMI in the “normal” range. 

Instead of weight and BMI, here’s what my clients and I now focus on:

• Eating foods that balance nutrition and pleasure. Since the dawn of mankind, we have consumed foods that provided the nutrients we needed to thrive. Traditional foodways emphasize nutritious plant foods like fruits, vegetables, legumes, whole grains, nuts and seeds, herbs and spices. They are supplemented with modest portions of animal foods, such as fis, seafood, meat, eggs and dairy.
  Treats are welcome, too; after all, we only live once! And when people tell me they don’t have time to cook every meal from scratch, we come up with simple, tasty meals comprising prepared ingredients (no, processed foods are not the work of the devil). Traditional eating patterns typically involve eating relaxed meals with other people; this convivial way of eating helps to reduce stress and further supports health.
• Enjoyable, sustainable movement. After years of trying to lose weight with the help of draconian exercise regimens, many people have developed a deep-seated aversion to physical activity. And yet, research shows that movement supports health and reduces mortality risk regardless of weight change. That’s why I help my clients find physical activities they enjoy, like dancing, gardening, walking, and hiking, and organize monthly Savoring Walks that foster connection and movement via my community, Savor. Once the sense of dread is removed, many folks learn to love moving their bodies and develop consistency without burnout.
• Restorative sleep and stress management. Chronic stress and poor sleep disrupt hormones like cortisol and insulin, increasing metabolic risks. Gentle physical activity, relaxed meals, mindful self-compassion practices, and improved sleep hygiene can counteract this. It takes time to change sleep patterns and stress responses, and some people benefit from working with therapists to address stressors with deeper roots, such as adverse childhood experiences or PTSD. 

Self-Care Works; Shame and Perfectionism Don’t

The evidence shows shame and restriction are poor motivators for lasting health. On the other hand, weight-neutral interventions, like nutritious food, gentle activity, mindful eating (find out about my mindful eating programs here) and stress management tools, can help improve blood pressure, cholesterol, glucose levels, immune function, and psychological outcomes as effectively as weight-loss programs — without the risks.

As a weight-neutral nutritionist, my goal is to help my clients reclaim their well-being from diet culture and yo-yo dieting. By nurturing their bodies with kindness, respect, and science-backed practices, they build resilience that no number on a scale could ever reflect.