Do We Put Too Much Weight on Weight in Public Health?

The way most of us think about weight and and health

Public health, among other disciplines, largely operates under a weight-centered health paradigm, which puts body weight at the center of thinking and talking about health. Weight loss programs at the individual level and ‘obesity’ prevention programs at the group, community, and population levels have been largely ineffective in achieving significant and sustained weight-related outcomes.(1) Moreover, evidence suggests that the weight-centered health paradigm has social justice consequences because it furthers racial disparities and inequities.(2) So we ask: do we put too much weight on weight in public health?

Another way to think about weight and health

In December 2021, JSI’s Amanda Ryder, Deanna Lewis, and Laura Rios Ruggiero asked this question of their own work. JSI saw an opportunity to learn more about the weight-inclusive health paradigm as a way to provide more equitable care. The first phase of this work had four steps: 

1) Conduct key informant interviews with people advancing weight-inclusive efforts. 

2) Conduct internal staff interviews to gauge familiarity with the weight-inclusive paradigm and the extent to which it applies to JSI’s work.

3) Hire a weight-inclusive public health intern to support a literature review, resource development, and interview synthesis.

4) Present information gathered. 

The presentation for JSI staff was held in October 2022 and led by intern Kayla Lambright. The JSI team invited Ragen Chastain, a thought leader in weight science and stigma and weight-neutral health, to answer audience questions. 

Public health’s weight-centric paradigm, which emphasizes weight and weight loss, has numerous flaws, Kayla explained. Not only are its tools like the body mass index (BMI), which is rooted in racism and anti-Blackness, an ineffective measure of health,(3) it contributes to poor health outcomes by contributing to weight stigma, weight cycling, and eating disorders.(2) Moreover, the weight-centric paradigm tends to focus on individual-level factors like weight loss, instead of systemic factors that create inequalities in social determinants of health, and more.(4)

Kayla went on to describe the weight-inclusive approach to public health, which views health as multifaceted; challenges the belief that BMI reflects health status; acknowledges the benefits of healthy behavior changes on health markers regardless of weight loss; accepts diversity in body sizes; and aims to remove shame, blame, and stigma in public health and health care treatment and prevention efforts.(5,6) More importantly, as one key informant interviewee said, “Taking weight out of the picture enables us to focus on other stronger determinants of health: equity and exposure to stigma, oppression, [and] discrimination.”

How we’re applying what we’re learning

In recent months, the JSI team has continued to lead this change by integrating weight inclusivity into projects and creating internal working groups. We also prepared a short introductory webinar ‘Do we put too much weight on weight in public health?’ We hope that other practitioners, clients, and partners will use this webinar to generate interest and conversation on this topic so that  every one of us can provide more equitable and effective public health services. “We at JSI are on a learning journey, but our team believes that the current weight-centric paradigm is causing more harm than good. If we want to advance public health in an ethical, equitable, effective way, we must embrace change,” says Laura Rios Ruggiero. 

Access the webinar we recorded for practitioners, clients, and partners here (password: WIPH2022!). 

For questions or to connect with us about this work, email Amanda Ryder or Deanna Lewis. 

1. O’Hara L, Taylor J. What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. Sage Open 8, 2 (2018). https://doi.org/10.1177/2158244018772888.
2. Sabrina Strings, Fearing the Black Body (NYU Press, 2019).
3. Strings, S. (2019). Fearing the black body: The racial origins O’Hara L, Taylor J. What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. Sage Open 8, 2 (2018). https://doi.org/10.1177/2158244018772888. of Fat Phobia. New York University Press. 
4.  Montgomery, Amanda; Collaboratory for Health Justice (2021): Public Health Needs to Decouple Weight and Health. University of Illinois at Chicago. Educational resource. https://doi.org/10.25417/uic.16823341.v1 
5. Tylka, Tracy & Annunziato, Rachel & Burgard, Deb & Danielsdottir, Sigrun & Shuman, Ellen & Davis, Chad & Calogero, Rachel. (2014). The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. Journal of obesity. 2014. 983495. 10.1155/2014/983495. 
6.  Montgomery, Amanda; Collaboratory for Health Justice (2021): Public Health Needs to Decouple Weight and Health. University of Illinois at Chicago. Educational resource. https://doi.org/10.25417/uic.16823341.v1