In this issue:

• Upcoming Events with the Association for Weight and Size Inclusive Medicine (AWSIM)

• The Weight Inclusive Healthcare Guide

• Evidence-Based Archives

• Call for Abstracts: 11th Annual Weight Stigma Conference

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Upcoming Association for Weight and Size Inclusive Medicine (AWSIM) Events

Journal Club with Ragen Chastain

FREE for AWSIM Members and students, All are welcome! Reoccurs Second Tuesday of each month

$35 per session for non-members

1.5 AMA PRA Category 1 Credits pending

• (Completed) Tues. Jan 14th, 2025 at 5:30pm PT / 8:30pm ET

  • Topic: “The Usual Suspects of Weight Science Research”

  • Recording available to AWSIM Members

• Tues. Feb 11th, 2025 at 5:30pm PT / 8:30pm ET

  • Topic: GLP1 Agonists

  • Registration Form (Feb)

• Tues. March 4th, 2025 at 5:30pm PT / 8:30pm ET

  • Topic: TBA

  • Registration Form (Mar)

Speaker Series

FREE for AWSIM Members and students, $35 for non-members

• Wed. Feb 5th, 2025 at 5pm PT / 8pm ET

  • EDA Week: Nutrition Myths and Weight Inclusive Dietary Counseling with “Let Us Eat Cake” Podcast Hosts

  • Registration Form (EDAW Event)

• Thurs. April 3rd, 2025 at 5pm PT / 8pm ET

  • Speaker: Dr. Katarina Wind

• Thurs. May 22nd, 2025 at 5pm PT / 8pm ET

  • Speaker: Dr. Anna Whelan

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The Weight Inclusive Healthcare Guide

Check out this free resource created by the Weight Inclusive Healthcare Initiative through the Institute for Healing and Justice in Medicine!

Student Authors: Divya R. Alley, Divya Vemulapalli, Annika Ballantyne, Laurel M P Neufeld, Sophia Harris, Varsha Venkat (MD), Lenora Goodman (RDN), Ayomide Ojebuoboh (CPT)

From the Authors: This is an open access educational guide for patients, healthcare professionals and students that challenges healthcare’s weight centric approach to health created by the Weight Inclusive Healthcare Initiative through the Institute for Healing and Justice in Medicine. We explore racism and eugenics of BMI, the pathologization of size, weight stigma in healthcare, nutrition and eating disorders in a diet culture era and joyful movement. This guide is our offering to make healthcare a more just and healing place for those in larger bodies and historically marginalized people.

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Evidence-Based Archives

MSSI is excited to present our sixth installment of “Evidence-Based Archives,” our monthly column highlighting and summarizing seminal research in the field of size-inclusive healthcare. In this section, we hope to celebrate our scholars, empower each other with knowledge, and stock up on citations for the next time we’re called upon to justify size-inclusive healthcare in the classroom, clinic or wards! 

Content warning: Medicalized fatphobia, ob*sity, anti-fat language

Disclaimer: We use the terms “ob*sity” and “overweight” in our summaries when it is otherwise impossible to accurately describe findings from certain studies, due to the language and descriptors chosen by researchers. We acknowledge the inaccuracies and harms that these labels have perpetuated in medicine and society. Please keep your mental health in mind when reading, and feel free to reach out to us with any feedback or suggestions at any time!

This month’s highlight: 

This 2016 study breaks barriers as one of the first randomized controlled trials (gold standard of medical publishing!) to compare the physiological and psychological impacts of weight-neutral/weight-inclusive health programming to weight-loss/weight-centric programs. 

Motivations:

• Growing evidence that weight loss does not improve long-term health outcomes in people with high BMI (Køster-Rasmussen et al., 2016, Tomiyama et al., 2013, Wing et al., 2013)

• Existing health-promotion programs that employ weight-inclusive/weight-neutral approaches (e.g., Bacon et al., 2002, Bacon et al., 2005, Katzer et al., 2008, Leblanc et al., 2012)

• Few RCTs directly compare outcomes of weight-neutral and weight-centric approaches with regards to both physical and psychological parameters of well-being

Study Design:

• 80 participants from Southeastern Pennsylvania who met screening criteria (30–45 years old, female, BMI 30–45, physically inactive, practicing birth control if heterosexual and pre-menopausal) were randomly assigned to either a weight-neutral or weight-centric “healthy living” program.

• The weight-neutral program (HUGS Program for Better Health ) was facilitated by a psychotherapist and fitness professional with 15 years of experience working with high BMI clients from a HAES (Health At Every Size) framework. In this program, participants were taught intuitive eating strategies to recognize and respond to internal physiological signs of hunger and satiety, and size acceptance was promoted in lieu of weight-loss goals. 

• The weight-centric program (LEARN Program for Weight Management) was facilitated by a registered dietician with 15 years of experience working with bariatric populations and patients with type 2 diabetes. In this program, food intake recommendations were based on external prescriptions and caloric restriction, and weight loss was an explicit goal. 

• Each program ran for 6 months; participants met weekly for 90-minute sessions. Follow-up assessments occurred immediately after the program (6-month mark), as well as at 24 months post-randomization.

Key Findings:

Weight and BMI did not significantly change for participants in the weight-neutral program; however, they nevertheless experienced improvements in a range of standard “health indicators,” such as but not limited to LDL cholesterol, total cholesterol, dietary composition, physical activity, quality of life, self-esteem, and waist-to-hip ratio.

There were no instances where the weight-neutral program produced inferior outcomes relative to the weight-loss program. At the 24-month mark, participants in both programs were noted to have been successful in modifying health-supporting behaviors (i.e., physical activity, fruit and vegetable intake), certain parameters of psychological well-being (i.e., quality of life, self-esteem) and metrics of cardio-metabolic fitness (i.e., total cholesterol, waist-to-hip ratio). The programs did not differ from one another in terms of their relative impact on these variables. Neither program decreased blood pressure, fasting blood glucose, or triglyceride levels.

However, there were several metrics in which the weight-neutral program outperformed the weight-loss program:

1. Participants in the weight-neutral program reduced LDL cholesterol levels to a greater extent (-10 mg/DL) than participants in the weight-loss program. While participants in the weight-loss program sustained a reduction in weight and BMI over the follow-up period, they experienced no change in LDL cholesterol over the duration of the study. 

2. At 24 months, participants in the weight-loss program demonstrated negative changes in dietary risk (measured in terms of nutritional quality of foods consumed) compared to the 6-month mark. In other words, they did not sustain changes they made to their diet over the course of the program. On the other hand, participants in the weight-neutral program maintained their changes over the course of the post-intervention assessment period. This supports work demonstrating that dietary prescriptions of weight-loss programs are not sustainable in the long-term, which could explain why participants in the weight-loss program did not improve LDL cholesterol or many of the other cardio-metabolic factors thought to be a direct consequence of weight loss even though they lost weight. 

Finally, participants in the weight-neutral program demonstrated greater improvement in intuitive eating compared to the weight-loss program post-intervention, and they sustained improvements in intuitive eating over the follow-up. Research has shown that intuitive eaters benefit from greater body appreciation, emotional awareness, interoceptive sensitivity, self-compassion, and distress tolerance, while displaying less maladaptive behaviors and traits such as perfectionism, self-silencing, and disordered eating, compared to individuals who engage in eating restraint.

Limitations:

• Participants were excluded if they: were current smokers; did not speak fluent English; were taking medications known to affect weight; were presently participating in a weight-loss program or diet; were pregnant or intending to become pregnant; had or were planning to have bariatric surgery; had type 1 or insulin-dependent type 2 diabetes; had an active neoplasm; or had a history of myocardial infarction, congestive heart failure, cerebrovascular disease, renal disease, or cirrhosis. Participants were also excluded if they had a diagnosis of bulimia nervosa, anorexia nervosa, alcohol/substance abuse, or psychiatric disturbance that significantly disrupted daily functioning (e.g., suicide ideation, current manic episode, or schizophrenia). 

• Participants were predominantly White, non-Hispanic women within a narrow age range. Future studies should examine weight-neutral approaches with larger samples that include more people of color, as well as individuals across various developmental stages of life. 

• While the follow-up period of 24 months is a strength of this study, longer trials are nevertheless necessary to understand the enduring effects of weight-loss vs weight-neutral programs, and whether or not they truly differ from each other over time. 

• Only 50% of participants completed the 24-month assessment and only 50% of participants attended >⅔ of the program sessions. This pattern of attrition is not atypical in studies involving weight and health outcomes 🙁 While sensitivity analyses suggest that dropout did not impact the findings, results must nevertheless be interpreted with this in mind!

Have thoughts?
We are open to feedback and interested in the lived experiences of our MSSI members. Have you referenced this article in your clinical work, used it to guide patient counseling, or used it to communicate with your colleagues? How did it go? 

Feel free to share your stories, reflections, expertise, and advice using the link below. With your permission, we may publish reflections in future installments of this column.

If you have a favorite article you’d like us to highlight in our next installment, feel free to submit it for consideration, also by using the link below! We look forward to hearing from you.

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Call for Abstracts: 11th Annual International Weight Stigma Conference

6-7 JULY 2025 GOLD COAST, AUSTRALIA & ONLINE

Deadline for abstract submission: February 23, 2025 (and rolling)

The Annual International Weight Stigma Conference is an interdisciplinary event that brings together scholars and practitioners from a range of backgrounds (e.g., public health, government and public policy, psychology, medicine, sociology, anthropology, allied health professions, education, sports and exercise science, social sciences, media studies, business, law, activism, and the lay public) to consider research, policy, rhetoric, and practice around the issue of weight stigma.

Abstracts can be for oral presentations (10 mins, including time for questions), posters, or other formats (symposia, workshops, seminars, creative sessions, etc.).

They invite contributions across a wide range of disciplines and methodological and theoretical approaches. International voices discussing the situation in countries other than the US are particularly welcome. Equally so are intersectional approaches and perspectives from other marginalized groups. We encourage submissions from scholars, practitioners, policy makers, and activists. Students are especially encouraged to submit proposals.

Judges’ Choice and People’s Choice prizes will be awarded for the best oral presentation and best poster.

Note, accepted presenters will be required to register for the conference and pay the registration fee. Bursaries may be available on a case-by-case basis.

Visit the abstract submission page for more information.

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This newsletter was authored by Jay Liu and Sophie Lalonde-Bester, MSSI members and medical students (Stanford University and University of Alberta, respectively).