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Health at every size

2 April, 2012

Despite what the media and diet industry tells us and contrary to popular opinion, being skinny doesn’t equal being healthy, explains keen rider and nutritionist Jo Chambers.

Food and eating plays an integral role in our social, work and family life. It is a critical contributor to our physical well-being, a source of pleasure and a major topic of conversation. Shopping, preparing and eating food occupies a vast amount of our waking time and chews up (pun intended) a significant proportion of our incomes. We eat when we are bored, when we are sad, when we are happy and when we want to celebrate. We eat to show love, to feel part of a group and when we’re grieving. You get the message: food is a big deal!

In Australia in 2012, the majority of us are living in abundance, surrounded by an unprecedented array of food and drink choices. Food is available anywhere and at any time and the food industry is incredible successful at making us want to eat it.

Because we are constantly faced with food, we must be able to make decisions about what and how much we should eat. However, for many people this need to choose causes great worry and stress. As a nutritionist and public health advocate I am frequently asked ‘what should I eat?’ and ‘what do I have to do to lose weight?’ It saddens and alarms me so many people feel confused and anxious about food and their weight. Not that I blame them- I sometimes still feel confused and anxious despite having spent six years studying nutrition.

When it comes to food and health, there is a wealth of inconsistent and conflicting information available. Every day there are reports in the media about the latest diet and weight loss crazes. One minute it’s all about low fat diets, before switching to the message that fat is good and carbs are bad. High protein, low fructose, gluten-free…it’s never ending. Food is as much seen as a poison as it is a source of pleasure and nutrients. It frustrates and annoys me that you have to fight to get good quality, consistent information about food and health.

Fat and fit

We are told that our waistlines are expanding at epidemic rates at the expense of health. A war on obesity has been declared and great efforts are being made to encourage people to lose weight. We are fed shows like The Biggest Loser, where people are tortured and humiliated in the name of ‘better health’ and entertainment. There are many other examples from the media that contribute to the commonly-held belief that being thin equals being healthy and happy, and being fat equals being lazy, slovenly, unattractive and unhealthy.

Despite the continual focus on weight loss and ‘healthy eating’ we are losing this war on obesity. Fighting fat has not made the fat go away; instead, it has resulted in extensive collateral damage: eating disorders, body dysmorphia, yo-yo dieting, general poor health and weight discrimination. Few of us are at peace with our bodies and have a healthy relationship with food.

Much of the information that the public is fed (pun intended again) about weight management fails to meet the standards of evidence-based medicine. The field is full of speculative claims that do not present accurate data. However, there is good evidence that the assumption that overweight and obese people are unhealthy and will die sooner is false. It is also untrue that anyone can lose weight if they are determined and work hard, and that if they lose weight it will prolong their life. It is perfectly possible and acceptable to be fat and fit!

This doesn’t mean that you have a free pass to eat whatever you like without consequence. If you frequently binge on foods high in fat, sugar and salt you will definitely feel low in energy and eventually become unwell. When it comes to food and eating, our focus is all wrong. Instead of focussing on losing weight, we should be focussing on changing our diet and lifestyle to ensure that we get all the nutrients that we need so that our blood chemistry and blood pressure are within a healthy range.

The “Health at Every Size” approach to weight management, developed by American nutritionist Linda Bacon, is a system that acknowledges that well-being and health habits are more important than your actual weight. Bacon promotes a sensible approach to eating that involves accepting your size; trusting you own internal signals, such as hunger, fullness and appetite; adopting healthy lifestyle habits, such as becoming more physically active, stop eating when you’re full and eat satisfying, nutritious food and embracing size diversity.

The reason Bacon’s approach works is that it removes the blame and shame that is usually associated with eating and weight loss. In fact, it doesn’t even involve weight loss! This tactic sets people up to empower themselves to make healthy choices and to adopt a healthy lifestyle for the sake of their health. It also does not involve any stupid fad diets, expensive pre-packed home delivered microwaved foods in plastic bags, soy protein shakes, or weight loss pills.

Now to come back to my most frequently asked questions, ‘what should I eat?’ and ‘what do I have to do to lose weight?’ Nutrition is a vast and complex topic, but there are some key points to remember.

  1. Follow a ‘health at every size’ approach. Be kind to yourself and ditch the scales.
  2. Listen to your body.
  3. Avoid all diets – especially if it involves paying ridiculous amount of money to a company that will give you something expensive and tasteless to replace real food that will take all the joy out of eating.
  4. Eat real, fresh food. Your body likes and knows how to process it: vegetables, fruits, nuts and seeds, lean meat, grains, eggs, dairy and so on.
  5. Buy the best quality food you can afford – organic is great but it’s not the only answer.
  6. Everything in moderation (alcohol, fast food, sweets…you know the drill), including moderation!
  7. Make sure you are calm when you eat. Try to sit down and focus on your food and surround yourself with people that make you feel happy.
  8. Get active! Physical activity has so many benefits. I love bike riding because it regulates my appetite. I get to ride interesting places to eat interesting food with interesting people and more than anything, it makes me feel strong and fit and less focussed on weight. People of all shapes, sizes and fitness levels can enjoy riding a bike as it is low-impact, accessible and easy to do. It’s also a great way to get active without focussing entirely on your calorie expenditure, which is easy to do when slogging it out on a treadmill at the gym. Riding is a great way to simply get from A to B, with added health benefits.
15 Comments leave one →
  1. Nigel Morris permalink
    3 April, 2012 5:02 pm

    can you provide some links to refereed research that says “However, there is good evidence that the assumption that overweight and obese people are unhealthy and will die sooner is false.”, please?

    Are you suggesting no link between obesity and detrimental effects on health, or that increasing weight outside an optimum BMI has no effect on health risks and outcome probabilities? Or are you saying that the quoted statement is too absolute, and that healthy eating is a good focus and aiming for a specific weight or BMI rather than just somewhere within the optimum band is a good idea.

    The heading, and some of the text, seems to reject any link between obesity and poor health outcomes.

    • 11 April, 2012 12:12 pm

      Hello Nigel,

      Thank you for your response. I am more than happy to provide you with some links to evidence-based articles that support the claims made in my article. Unfortunately I did not have the space to provide a reference for all the studies that I read when I prepared the article. It was also a challenge to say everything that I wanted and needed to. It is such a complex and controversial topic.

      You are right; I was not trying to say that there is no link between obesity and detrimental effects on health. From an epidemiological perspective it would appear that there are some health risks associated with being overweight. As a nutritionist I definitely do not claim that you can eat whatever you want without consequence. However, there are plenty of overweight people out there that are healthy. I think it is important that we focus on health and the related bio-markers that we can use to measure a person’s disease risk, rather than focus on weight itself. It is also essential that we question the dominant discourse that currently surrounds obesity and that we explore the damaging effects of dieting, stigmatising overweight individuals and so on. As you say, our current way of thinking about and dealing with weight gain is way too simplistic.

      Here are some interesting and recent links from reputable journals that support my claims.

      If you have any further questions or comments please let me know.

      Kind regards

      Jo Chambers

    • 15 April, 2012 10:38 am

      It is a breath of fresh air to see a health professional actually go agasint the flow and go with the science for once!

      As an amatuer researcher on this topic I have been putting a challenge out (mostly on for anyone to find a randomised clinical study that supports the hypothesis that losing weight can make you live longer. Despite offering a slab of beer, no-one (including myself) has yet found such a study. Until this research arrives, recommendations to lose weight for health reasons are not “evidence-based medicine” (a term the health professionals love to say but rarely practise!)

      Nigel, you have every reason to be confused by this! The “evidence” used by the dieticians is population statistics, these statistics show a relationship between BMI and mortality. In general the realtionships is not strong and generally show that being overweight BMI(25-30) gives the best mortality outcomes (another fact the dieticians generally ignore or try to explain away). Such relationships do not prove causation, and there is plenty of reason to not assume causation.

      I believe the best place to understand how weight works is to look at the clinical studies into weight-gain and weight-loss conducted nearly 50 years ago:

      Once you realise that weight is a physical attribute like hair colour of height, it starts to make sense that trying to defy one’s physical attributes is just a pointless exercise, and that the statistical relationships between weight and health mean very little.

  2. John Edwards permalink
    11 April, 2012 9:55 pm

    Why the emphasis in BMI in almost anything one reads on weight/size matters? It cannot be a good measure because it assumes we are two-dimnsional objects. There should be a cubic factor in any equation relating weight and height. I would welcome comments and any better equation.

  3. 12 April, 2012 11:05 am

    Hi Jo I came to know RideOn via “BicycleNetworkVictoria” when searching for information on kerb ramps which affect “My Wheelies” in the nursing home where our quadraplegic son lives and i volunteer as Resident’s Advocate. I am currently “battling” our local council to improve footpaths etc to remove the impediments my Wheelies find every day. I am also interested in your discipline as despite being an ex Fitness & CPR Instructor, and “Fitness Freak” and “Gym Junkie” so my family say, the family heart attack curse finally caught up with me at age 69 and has left me with 30% heart function. Fortunately my Sports Nutrition training has been a great help but at age 75 i now find it difficult to exercise hard enough to keep my BMI within bounds. It is currently 26 and both I and my Cardioligist would prefer if it was lower and i see an adjustment to my nutrition as the only avenue to follow to get my BMI back where it should be. I operate an organic No-Dig garden as my kidney function is compromised and i have a GFR of <30 due to the lack of blood flow and can manage an low G.I. and my dietitian recommended seven fruit/vegetable servings a day to aid elimination an as my wife is Asian and diabetic I have all the right precursors for a healthy diet, or as I call it; "Eating Smarter". BUT, I cant get rid of the "extras". Do you have any ideas ?

    • 12 April, 2012 1:02 pm

      Hello George.Thanks so much for your comments, I would be very happy to offer you some advice. First of all though, I want to congratulate you on all the wonderful and positive things that you are already doing for your health. It sounds like you know a lot about health and it’s great that you’re seeing a Dietician to get some further guidance. All the vegetables that you eat from your no-dig, organic garden are without a doubt doing you a great deal of good. I bet they taste great too and there is nothing better than feeling the satisfaction of growing things yourself!
      I think it is important to acknowledge that your situation is challenging and that there are many factors involved; your genes, your mobility, your kidney function and the stresses in your life; they all play a significant part in your overall health outcome. Again, it is great that you are working so hard to be healthy.
      When it comes to food, I would suggest that you continue to follow your dietician’s advice and that you eat your seven delicious servings of fruit/vegetables per day. Other things to consider and to discuss with your dietician are your serving sizes, the GI (as you mentioned) of the foods that you are eating and the amount of protein and fibre that you are getting in your diet. I recommend having protein at every meal to keep your blood sugar stable and to keep you feeling full. As you probably know, protein can be found in meat, dairy, nuts, seeds and legumes (beans and lentils). You will have to discuss the amounts you can eat with your dietician as this may be less due to your kidney function. You may like to have oats for breakfast; oats are low GI, high in fibre, filling and they have a substance in them called Beta Glucan, which is good for you heart health. Garlic is also a super food and blood tonic that supports your immune system. It would be a great thing to include in your diet if you like it. As you probably already do, avoid processed foods, take away, cakes, sweets etc. Exercise is also a really important part of the equation. Gentle, low-impact exercises such as walking, bike riding, gardening, swimming and tai chi could be really great options for you.
      If you want to read some more articles by a Nutritionist that follows a Health at Every Size approach I would highly recommend this website. It’s full of really interesting and sensible information;
      I hope I’ve been helpful, good luck with everything. Kind regards, Jo

    • Matthew permalink
      12 April, 2012 11:03 pm

      Hi George

      Read the book The China Study, Prof – oops Dr. Campbell….

      Be interesting for you I would think.

      Hope you get better.


  4. Matthew permalink
    12 April, 2012 10:57 pm

    Hi Jo,

    Thanks for the article. Bit curious about some of the claims you have made, particularly those in regard to meat, dairy and eggs. Very passionate myself about food and just finished reading a life changing text. The China Study. Prof Campbell.

    Be interested to hear your perspective on this work. The essence of what he says, after a life time as a nutritionist is that we must give away all animal protein. Period. Then eat fresh what ever else we eat – fruit, veg, wholegrains, nuts.


  5. 2 May, 2012 7:39 pm

    Hi Jo, food is a major reward system and stuffing around with it is dangerous.

    The challenge is to exercise in such a way that it is rewarding. For me riding to work, getting there faster than driving (in peak hour) and saving on fuel fits my world view and is rewarding. I don’t lose much weight but I am fitter, less stressed and less sedentary. If I was focusing on food I would be stressed and yo-yoing around.

    The obesity epidemic is starting to be a bit like cigarettes. Obesity is being blamed for all sorts of ailments even though there is little evidence because the “ends justifies the means”. This is unhelpful and dishonest. It places additional stresses when people are tackling their food reward system.

    Improved fitness has well documented benefits and can tap positively into reward systems rather than fights against them.

    BTW last year I concentrated on getting my cadence up. I had bulked up muscle by pedalling hard – thought this would provide strength. When I upped my cadence and was light on the pedals, a lot of the bulk went but I was getting up hills much faster. I think that I must have developed more lean muscle.

    David Bernard

    • James Bennett permalink
      13 March, 2013 7:41 pm

      Hi David. you’ve likened the obesity epidemic to cigarettes – are you suggesting that they are not as bad as made out to be? Perhaps I misunderstood, so wanted to check…..

  6. Christine permalink
    7 March, 2013 9:48 pm

    Thanks Jo, I think this article is plainly common sense. I read recently that the AMA or someone, is now saying we need to exercise an hour minimum a day, and to eat way less if we’re not all going to become obese, based on current stats. My immediate thought was that people will give up before they’ve even started. I think the focus on eating well, good nutritious food, being mindful of eating and enjoying our food, and on doing healthy stuff will help people so much more than the focus on weight. Besides this, weight loss will occur for a lot of us as a side effect. Much easier to lose weight when you’re not focussed on it – and are focused on being healthy and enjoying life… living a sustainable, natural lifestyle. It’s good for the planet and the hip pocket too – despite the rhetoric, I think junk food is ‘weigh’ more expensive than fresh when you consider dollars spent per kilo.

  7. 13 March, 2013 5:55 pm

    Hi Jo,

    This was a really good read for someone like myself. I am one of the ‘big boned’ (if you like) woman. I have tried the extreme diets and even got my waist down to under a size 12, but I felt terribly ill, never had any energy and despite external appearances, I was not fit or healthy in any way.

    I have had two children since then and as a result I put on a lot of weight during my pregnancies.
    As someone who has always ridden a bike, here there and everywhere, and raced at National level in Pro/Elite Woman’s Downhill to be ‘obese’ due to overeating when pregnant was just terrible. The thought processes and the loss of self esteem and confidence is far worse than the weight itself. The judging from other people because of your size is just ridiculous.

    I returned to cycling full time a few years ago, and just being active again returned me to my pre baby weight, but my fitness and overall health are much better due to simple lifestyle changes without being radical.

    I have always felt my best around a size 12-14 and yet my most recent medical check for work had my BMI in the Obese range. I cycle on average between 200 and 300km’s a week, do not drink or smoke and my aerobic fitness is fantastic. Yet because of the BMI chart, and the Dr’s rigid belief in that two dimensional system, I am considered medically obese.

    Despite my excellent health, having no medical pre-disposition to some more serious health problems (have had DNA testing due to a pregnancy complication) Dr’s are insistent that I lose more weight and my waist needs to be reduced as “waist size is indicative of risk of diabetes in my age group – late 30’s early 40’s”

    Its refreshing to see that how I have been living the last couple of years is also considered acceptable by a professional nutritionalist!

    I stopped the low carb, high protein diets, the raw food diets, all the fads and pills I was trying, more so out of desperation to get the baby fat shifted and regain my self confidence, and returned to listening to my body and just riding my bike.

    I have the added problem now of anaemia and require a diet high in iron and protein to deal with that, I know when my diet is lacking as after a ride on the bike (between 50-100k ride) I am feeling lightheaded, irritable and have a loss of energy. Nothing a good meal of steak and vege’s doesn’t fix!

    If I feel like sugary foods or drinks I have them, but in moderation. If I crave salad’s and fruits, I have them, so on and so forth. By living like this not only have I shifted weight due to riding more and more as my fitness returned to what it used to be, I am generally happier, my stress levels are a lot more manageable, I do not feel guilty if I eat cake, and my self confidence has been boosted just from feeling good about myself.

    All this despite not being skinny, and being classed as medically obese because of my weight vs height. (I suspect that my thighs and legs contribute to my weight as they are rather muscular, yet the Dr who told me I was obese didn’t want to take that into consideration – a shame really when I am the layperson and they are supposed to be knowledgeable)



  8. Ruth permalink
    15 March, 2013 12:07 am

    Reply to Matthew, from April 12 re The China study and the work of Dr Campbell attracted me about 12 months ago to give it a try. It had the effect of getting me off Statins by halving my cholesterol and I reduced 10 kg in 4 months. My daughter had elevated BSL’s and they too became normal and a son with hypertension since teens, on antihypertensives was able to cease medication. We all lost weight and felt energised. RW

  9. kingerz permalink
    17 March, 2013 4:47 pm

    Fat and Fit? No matter how healthy you might think you are, someone lugging around 20 or 30KG of fat packed in around their internal organs will be better off without it.


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