In this issue:

MSSI Community Artwork Call for Submissions!

Save the Dates: Upcoming Events

Ask a HAES doc: Q & A with Dr. Katarina Wind

Evidence-Based Archives

Weight-Inclusive Online Learning Platform: Pratique Inclusive

Call for Art Submissions

We are excited to announce a new initiative aimed at celebrating the beauty and diversity of all bodies through art. MSSI invites you to submit your creative works—whether visual art, poems, reflective stories, or any other form of expression—that capture the essence of living in and caring for diverse bodies.

Our goal is to highlight the experiences and triumphs of individuals within the body liberation movement, and the unique perspectives of medical providers dedicated to inclusive and compassionate care. This is an opportunity to showcase the beauty, strength, and resilience found in all body types, and to inspire others within our community and beyond.

Submission guidelines:

Who can submit their art: MSSI members and advisors

Accepted formats: Visual art (paintings, drawings, photography), poetry, short stories, personal reflections and any other creative expressions!

Selected pieces will be featured in our upcoming newsletters, shared on our social media platforms, and potentially included in a special online gallery. We believe that your art can spark important conversations and bring a deeper understanding of the importance of size inclusivity in healthcare 🙂 

Please submit your work to the Google Form below. We look forward to seeing your beautiful and powerful contributions!

Save the Dates: Upcoming Events

MSSI Fall Advisor Meeting: Tuesday, October 1st at 8:00pm EST

Anti-Fatness and Medical Racism event with The National Association to Advance Fat Acceptance’s (NAAFA) Tigress Osborn:

Follow up discussion event Wed, Oct 9th, at 7:30-8:30pm EST (for medical students/residents/physicians). Registration Link

Ask a HAES Doctor

Dr. Katarina Wind is a family and hospitalist physician in Vancouver, Canada. She serves as the Vice President at the newly formed Association for Weight and Size Inclusive Medicine (check them out! https://weightinclusivemedicine.org/). She mentors medical students learning about weight-inclusive care, who have gone on to create modules, pamphlets, podcasts, and research articles. Outside of medicine she loves all things active and outdoors with friends and family, and catching up on sleep!

“Hey Dr. Wind, can you discuss any pushback you’ve received from patients, peers, or mentors regarding size-inclusive practices and how you handled it?”

This work goes against everything we’ve been taught in both society and medicine, and I get pushback from all these groups on a regular basis. I won’t lie, feeling like the whole world disagrees with you can be really tough! Below are a few things that help me stay anchored and positive in this work.

Firstly, I try to believe the best of all my colleagues. I know the fat-phobic training they went through, and where a lot of their belief systems come from. Instead of feeling nervous to disagree with them, I tell myself, “I am respecting them enough to share this knowledge with them, because I believe they can change their mind”. That framing is really helpful for changing the discussion from a “me versus them” scenario, to an “us together against fat-phobia” scenario. Don’t get me wrong, I don’t have it in me every day to be this gracious, and some colleagues are more open-minded than others, but this is the mindset I strive for. I’ve had a lot of positive interactions and changed opinions when I use this approach. 

The second framework that helps me is focusing on my patients. Although I do care, to a degree, what colleagues think of me, the absolute most important thing to me is how I take care of my patients. When I started this work, I was really afraid of invalidating patients by telling them that I don’t agree with weight loss, when they possibly have worked very hard on weight loss in the past or present. However, I have never had an interaction where the patient has told me, or has seemed to feel, invalidated by my approach. Most of my patients are still in a weight-centric mindset, and I always consider the purpose of the first interaction to be “planting a seed”.  I might say something like, “You’ve probably been told by both society and other doctors that you need to lose weight for your health, but I’ve reviewed the evidence behind that and I actually disagree.” I might go on to list a few reasons based on the encounter, for example that weight-loss isn’t sustainable in the vast majority of cases (1), and can in fact result in many long-term harms (2). The patient may agree with some things I’ve said, or may disagree; either is totally fine with me. However, when they come back for a second visit, they often have new thoughts and questions – maybe they want to learn more about the weight inclusive approach, or maybe they still plan to try to lose weight but they plan to do so in a less extreme manner (I consider this harm reduction), or they share that they feel validated in past “failed” attempts at weight loss. 

Finally, having a supportive group to vent to, ask questions of, or simply remind you that you’re doing a good job, is absolutely essential. I am so lucky to have met Dr. Lisa Erlanger early in this work. She introduced me to the many weight-inclusive colleagues she had brought together, and excitingly, we are now launching the Association for Weight and Size Inclusive Medicine. This will give all weight-inclusive physicians a “home” where they can get resources, ask questions, find community, and so much more! Importantly, this association was inspired by the fantastic community created by Jessica Mui and the MSSI.

Bacon L, Aphramor L. Weight science: Evaluating the evidence for a paradigm shift. Nutr J. 2011;10:9. DOI: 10.1186/1475-2891-10-9. 

Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: Who is really at risk? Obes Rev. 2015;16 Suppl 1:7–18. DOI: 10.1111/obr.12251.

Evidence-Based Archives

MSSI is excited to present our third 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

This month’s highlight: 

Studies charting a correlation between high weight and poor health outcomes have long been used to justify guidelines recommending weight loss as a viable “treatment” for a host of conditions as diverse as CVD, PCOS, arthritis, MASLD, T2DM, and HTN. Yet these studies almost uniformly fail to account for confounding variables like medical discrimination, socioeconomic stress, stigma, health literacy, or health-supporting behaviors in their outcomes analysis, significantly complicating their supposedly “obvious” conclusions! Hot tip for evaluating the next weight loss study you encounter: Pay attention to whether confounding variables are accounted for.

The article featured this month is a scientifically rigorous example of weight science research that actually isolates and examines physical activity as a variable that may impact CVD and all-cause mortality. While this is an older study, it’s well-done and well-known for its conclusions, which are validated by a large and (for the sake of minimizing other confounding variables) relatively homogeneous sample.

Methods:

The study design is prospective and observational. No causality can be inferred from the results.

Participants were recruited between 1970-1994. The average length of time between recruitment and follow-up assessment was 10 years.

Upon initial recruitment, participants engaged in an exercise test on a treadmill to determine their cardiorespiratory fitness (CRF). Their BMI was also recorded. 

Upon follow-up, mortality rates stratified by initial BMI were assessed. The results were independently adjusted for the presence/absence of 6 different confounding variables at baseline (CVD, T2DM, high serum cholesterol, HTN, current cigarette smoking, CRF)

Participant demographics:

The study employed a large sample size of 25,714 adult men (avg age 43.8 years, SD 10.1 years) from Texas

The participants overwhelmingly identified as white (95%) and well-educated (80% college graduates), with most participants identifying as executives or professionals

This study excluded patients with a history of cancer, BMI < 18.5, or age < 20

Results:

CRF emerged as an independent predictor of all-cause mortality in individuals of all sizes. 

“Overweight” and “obese” individuals with high CRF had a nearly identical mortality rate as “normal weight” individuals with high CRF

“Normal weight” individuals with low CRF experienced nearly 3x the risk of cardiovascular death as “overweight” or “obese” individuals with high CRF 

Tolerance for cardiovascular activity had a higher correlation with all-cause mortality than diabetes, high cholesterol, hypertension, or smoking, especially among higher weight individuals

This means that as physicians, we can dramatically help ALL our patients by NOT making assumptions about their health based on their body size! Higher weight individuals are not automatically at a higher risk for all-cause mortality. As this study conclusively demonstrates, the correlation between higher BMI and mortality virtually disappears once CRF is accounted for. 

What this article could have done better:

This study measures cardiorespiratory fitness as a proxy for exercise but does not evaluate or account for health benefits derived from other forms of physical activity (i.e. strength training, stretching). They also do not seem to account for possible changes in health behaviors between the initial evaluation of CRF and subsequent follow-up.

This study sample is extremely homogeneous. Additional research is needed to be able to draw conclusions in more diverse and disadvantaged populations, for which sociodemographic class and minority stress are also likely to negatively contribute to mortality. 

Closing thoughts:

Even though this study demonstrates a possible relationship between CRF and mortality, it is important to remember that we cannot conclude causation from a correlational study, and there are other possible contributors to mortality that this study does not account for! Health itself is a multifactorial concept (not an obligation), and CRF may not be accessible to everyone due to a range of social or physical limitations. That being said, it is always nice to see an article that appropriately isolates and independently assesses an important confounding variable that has been seriously under-appreciated in research that conflates high BMI with poor health. It is also a good reminder that exercise can be therapeutic—regardless of its impact (or lack thereof) on body weight. Finally, studies like this one help us make the case for taking the public health focus AWAY from weight-loss driven interventions, an approach that is so sorely needed!

Additional resources:

Maintenance Phase made a great podcast episode about this article and other related research that debunks the myth of a simple correlation between longevity and body size.

A meta-analysis inclusive of 9 similar studies conducted between 1980-2013 demonstrates that this article’s conclusions continue to hold true across more slightly more heterogeneous populations. However, more high quality research is definitely still needed to improve our understanding of the impact of CRF and other confounding variables on mortality in disadvantaged populations!

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.

Weight-Inclusive Online Learning Platform: Pratique Inclusive

A Comprehensive Weight-Inclusive Training for Health Professionals and Healthcare Students.

Are you looking to deepen your knowledge of the weight-inclusive approach?  

Do you feel ill-equipped to support clients who are concerned about their weight?  

Perhaps you know that diets do not work in the long term but aren’t sure of the alternatives? 

Are you wondering how to have a weight-inclusive practice that takes into consideration medical conditions?

We’ve designed an online, comprehensive course to answer these questions (and many more!).

Who are we? We are 3 passionate registered dietitians who have integrated a weight-inclusive practice into our work and want to help others integrate it through continuing education (https://pratiqueinclusive.com/english). We have over 40 years of experience as health professionals between us and have supported over 300 health professionals and students since we began hosting this training and webinars 4 years ago. We have even written a book on the topic- Au-delà de la grossophobie: redéfinir son bien-être et habiter son corps (https://editionslapresse.ca/products/au-dela-de-la-grossophobie).

What to expect: This is a live, online training consisting of 5 sessions of 2hrs (sessions will be recorded). It focuses on teaching the basics (and a little bit beyond) of the weight-inclusive approach to healthcare.

Themes to be discussed include weight science, systems of oppression and diet culture, practical advice for integrating weight-inclusive approaches into your practice, the science-based evidence for this approach, the nuances and limitations of intuitive eating, and other concrete intervention strategies.

Who is this for? This course is designed for all health professionals and students studying in a healthcare field. Whether you are new to the concept of weight-inclusive care or looking to understand the nuances, this course aims to suit all needs. 

Price: Student rates, group rates and equity pricing are available.

Visit our website for more information: https://pratiqueinclusive.com/english

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