Weight Neutral, Non-Diet

Written By Dawn White

As a dietitian, nutrition principles founded on science and evidence drive nutrition counseling and education. Two words that have come to define a method of providing nutrition care are weight neutral and non-diet approaches. So let’s break down what this method is and why it can be an important way to navigate food and weight.

A weight-neutral, non-diet approach refers to a method of nutrition counseling that focuses on overall health, well-being, and behavior change without the rigid rules of dieting or a focus on weight or weight loss. Principles of this approach include behaviors that focus on sustainable eating patterns supporting health, addressing nourishment needs and benefits, attunement to body signals, and respect and care for our bodies. Often a weight neutral approach will focus not only on eating, but also movement, stress, and sleep leading to a wholistic approach toward health.

Weight-neutral approaches acknowledge a potential for harm in a strictly weight loss focused approach. This harm has been shown as the effects of weight stigma, psychological distress caused by rigid eating patterns or weight loss and regain, and potential increases in disordered eating behaviors.

Instead of calorie counting or a rigid set of rules around food and movement, non-diet approaches may include education on nutrition, planning balanced meals, mindful eating, behavior therapy skills, and body attunement to support improvements in health. Here is a simple way to view the difference between counseling methods focused on weight loss and a non-diet, weight neutral approach:

Weight Centric or Weight focused approach:

  • Weight loss as the goal

  • Regular weigh ins

  • Food rules and restriction

  • Compliance driven

Weight neutral approach:

  • Health behaviors as the goal

  • Use of the scale is optional

  • Long term, realistic, flexible approaches determined in collaboration

  • Use of non-diet methods which may include intuitive eating principles, mindful eating, meal planning, nutrition education, and more

Who may benefit from this approach?

  • Individuals of all sizes who would like to improve their health and relationship with food

  • Those with a history of chronic dieting or weight cycling

  • Those with a history of disordered eating

  • Those aiming to improve digestive issues, cardiovascular health, metabolic health, improve blood sugar control, and maintain kidney function

  • This approach can also be helpful in those pursuing weight loss, including those using weight loss medications such as the GLP-1 medications. While weight neutral counseling will not emphasize weight, it can support nourishment and relationship with food while navigating weight loss with other providers.

What is the evidence for this approach?

Research on the benefits of weight loss may appear to be evidence that weight loss is indeed necessary. However, several studies demonstrate the benefits of movement as well as eating patterns including Mediterranean styles and DASH patterns for decreasing risks of illness and death independent of weight loss. There is also question in the research on how much weight or fat mass in itself contributes to disease. One meta-analysis of 82 studies published in 2024 recognized risk in weights at the very low or very high ends of the spectrum; however, the weights at the lowest risk of illness and death ranged from normal to mildly obese BMI (Nowak MM et al). This leads once again to question to what extent do we need to focus on weight loss as a means of improving health.

Other evidence points to the difficulty in sustaining long term weight loss. Evidence points to high percentages of weight regain after loss especially when looking at outcomes 2 years or more after a weight loss intervention. There is also concern in the research on the risk of weight cycling on health which may lead to increased risk of health related concerns. A review of the research in 2007 looked at the evidence for the use of diets for weight loss Researchers looked at both randomized controlled studies and observational data. Their conclusions were “It is clear that dieting does not lead to sustained weight loss in the majority of individuals, and additional studies of the effects of dieting on weight are not needed” (Mann T. et al). Researches however, did conclude that additional research is needed on how diets may improve health parameters.

In conclusion, the role of weight in health is complex as is our relationships with food. A viable, realistic option may be a weight neutral, non-diet approach for health and well-being. Nutrition counseling utilizing these methods may help improve overall well-being leading to physical and psychological improvements.

References:

Levinson JA, Clifford D, Laing EM, Harris CL, Slagel N, Squires ND, Hunger JM. Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift. J Nutr Educ Behav. 2024 Dec;56(12):923-930. doi: 10.1016/j.jneb.2024.07.007. Epub 2024 Aug 30. PMID: 39217533.

Nowak MM, Niemczyk M, Gołębiewski S, Pączek L. Impact of Body Mass Index on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis. J Clin Med. 2024 Apr 16;13(8):2305. doi: 10.3390/jcm13082305. PMID: 38673577; PMCID: PMC11051237.

Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007 Apr;62(3):220-33. doi: 10.1037/0003-066X.62.3.220. PMID: 17469900.

Dawn White