Written by Jennifer Bowden, registered nutritionist
It’s time to ditch the diet and instead create a balanced lifestyle you love. A healthy lifestyle that is easily maintained is more helpful for chronic conditions like arthritis, than the never-ending pursuit of weight-loss.
Weight-loss is often heralded as an essential treatment for arthritis, with reminders that being overweight can worsen arthritis symptoms, and that body fat can make joint inflammation worse. But this ignores the simple fact that diets don’t work; around 95-98% of weight-loss diets fail, and the weight is regained. What’s more, between one-third to two-thirds of dieters regain more weight than they lost; making them heavier after the diet, than before they started.
A registered nutritionist who has written a highly-regarded weekly nutrition column for the New Zealand Listener magazine for over 12 years, regularly appears on radio and has been a finalist in the Canon-Media Awards for health reporting.
Acknowledgement of the massive failure rates of weight-loss diets is seemingly not widespread. With many patients in healthcare settings reporting that weight-related advice from health professionals is delivered in a patronising manner, with health professionals implying there is a simple solution to patients’ excess weight.
While there isn’t a simple solution to weight loss for everyone, there is a simple solution to weight discrimination: it needs to stop. Because, as the Royal Australasian College of Physicians noted in 2018, weight bias not only causes mental and emotional distress but can also lead to patients avoiding healthcare and actively missing health appointments, to the detriment of their overall health and wellbeing.
The Health At Every Size (HAES) movement challenges the weight-based focus of the medical community. Instead of focusing on body weight, shape or size,
the HAES approach encourages us to create a “fulfilling and meaningful lifestyle” through intuitive eating, body acceptance (regardless of size or shape), adequate sleep and regular physical activity for movement, to optimise both our physical and mental health at any size.
HAES is not anti-weight-loss but instead doesn’t promote or focus on weight loss as a health strategy. A key reason why is that weight is not a behaviour, and HAES focuses on health-improving behaviours. What’s more, focusing on weight while discussing healthy lifestyles, perpetuates the myth that weight is modifiable and the ongoing weight stigma many people experience daily.
If someone loses weight while changing their health behaviours, that’s considered a side effect of HAES, but not the primary goal.
Interestingly, this focus away from weight and onto modifiable health behaviours has produced some intriguing results.
In one clinical trial those assigned to the HAES approach had improved metabolic health, with lower blood pressure and lipids; improved energy expenditure, eating habits and psychology (e.g. better self-esteem and body image, and less depression); while maintaining their body weight, for the duration of the 2-year trial.
In contrast, the group assigned to a weight-loss diet did lose weight and see health improvements to start with, but by the two-year mark they’d gained the weight back, and little of their health improvements were maintained.
A 2016 study, investigating the experience of patients with knee osteoarthritis who were obese, found health professionals who focused on helping patients to reduce pain, improve functionality and improve their health-related quality of life, naturally motivated those patients to make lifestyle improvements.
That research team mentioned the HAES approach as a possible means of improving the health-related quality of life for patients with arthritis, instead of fixating on weight-loss.
So, how do you create a diet-free healthy eating style, that honours the HAES approach?
Firstly, by focusing on and learning to trust your body’s signals for hunger, fullness, and satisfaction. Instead of focusing on external cues to direct your eating – such as meal plans, safe food lists, food rules, and set food portions.
All babies are natural intuitive eaters that listen to their body’s cues for hunger and fullness, crying when they’re hungry and turning away when they’re full.
But, most of us were taught to ignore those cues during childhood, by well-meaning caregivers who fed us by the clock and implored us to eat everything on our plate (even when we were full), for example.
TIP: Listen to your body’s hunger cues, rather than eating by the clock.
Possible hunger signs can start with rumbling tummies and lack of energy, through to light-headedness, difficulty concentrating, uncomfortable stomach pains, irritability, feeling faint or even a headache.
Ideally, eat when you’re comfortably hungry, rather than over-hungry. When we’re over-hungry, we tend to overeat past comfortable fullness.
TIP: Treat all food as equal – don’t label foods as ‘good’ or ‘bad’.
Nowadays it’s common to see ‘good’ and ‘bad’ food lists as part of diets. But the reality is, ALL foods can be part of a healthful lifestyle. One choice at one mealtime doesn’t make or break your health, so don’t feel guilty about enjoying a variety of foods.
Instead, think of food as being on a spectrum from “more nutritious foods” through to “play foods” and allow yourself to eat freely in a way that nourishes your body and still satisfies you.
The fact is, you’re more likely to crave permit yourself if you tell yourself you can’t have it or are ‘bad’ if you eat it. Removing the “restricted” label from foods typically reduces cravings in the long-term.
TIP: Eat more of the nutritious foods you enjoy.
Yes, eating more whole foods such as fruits, vegetables, whole grains, lean meats, seafood, nuts, legumes, low-fat dairy and good fats (such as olive oil, avocado and oily fish) will improve your health and potentially reduce the inflammation associated with arthritis.
But instead of forcing yourself to eat foods you don’t like, think about which of those whole foods are your favourites. Which vegetables and fruits are your favourites? Eat those! How do you prefer your vegetables: steamed, roasted, stir-fried or raw? Do you prefer chicken or beef tonight? Remember, your opinion matters.
TIP: Eat until you are comfortably full, instead of eating everything on the plate.
Forget those old family food rules about eating everything on your plate. Instead, listen to your tummy – when it says it’s full – stop eating. Save leftovers for another meal or snack-time, rather than eating past full and not enjoying those last over-stuffed mouthfuls of food.
The key is to eat in a way that is satisfying for you. You’re much more likely to stick with lifestyle habits that nourish your health and wellbeing long-term if they honour your tastes and are truly satisfying for you.
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