1. These slides answer the question “why use the Well Now way?” Well Now promotes wellbeing and body respect for all. It does this by fostering compassionate self-care, integrating the bigger picture of health, and using a teaching style that enhances deep change.

2. It’s very fashionable to talk about weight when talking about health. I asked dieters how they felt about weight control messages. Their answers show why we need to switch focus.

3. “You end up feeling crap about yourself... because you then just get that public label about how you are a problem.” “I’ve had it said to me that fat people are just a drain on the health service.” “I retreat into myself and I feel that I am worthless”

4. There are lots of other voices that explain the damage being done by focusing on weight control as a route to health, e.g. Rothblum ED and. Solovay S (Eds.), (2009) Fat Studies Reader. New York: New York University Press.

5. When should I use an approach linked to shame & stigma, like weight control?

6. Never Based on Politics of Health Group slide regarding healthcare for migrants

7. So, weight control is out then. But while we’re on the subject here’s the evidence on the effectiveness of weight control. Or should I say the evidence on ineffectiveness:

8. Synthesis of systematic reviews of obesity treatment and prevention Jain A: Treating obesity in individuals and populations. BMJ 2005, 331:1387-90. “Although these were the best studies available according to the principles of evidence based medicine, many did not fulfil its requirements…. These flaws bias the results and can exaggerate the effects….. Rather than showing what does work for preventing and treating obesity, research to date shows us clearly what does not.”

9. In fact, focusing on weight control is not only ineffective it is harmful:

10. RCT Evidence on Weight Control Mann et al 2007 Am Psyc Vol. 62, No. 3, 220–233 “one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change... The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity. © Lucy Aphramor 10

11. Note, intentional weight loss is unachievable even when people stick to a reduced calorie intake:

12. Women’s Health Initiative A high quality dietary intervention (RCT) 20,000 women followed for over 7 years of “healthy eating” In both the control group and the experimental group people’s weight hardly changed Showing that the 360 kcal daily deficit and increased activity level of the experimental group was no match for set-point Howard, JAMA, 2006, 295(1), p 969.

13. The focus on weight loss is a bit of a red herring to start with. This is because it assumes losing weight is a good thing because it makes people healthier but there’s not actually any evidence for this.

14. But there is evidence that promoting weight loss is harmful even beyond stigma and shame:

15. SIGN (2011) ( p. 18) “ Weight cycling is a common condition as only a minority of people who lose weight through weight management interventions are able to maintain their weight loss. 115,116... Weight cycling is a risk factor for all-cause mortality and cardiovascular mortality (hazard ratio (HR) approximately 1.8 for both). 118,119 © Lucy Aphramor 15

16. The final nail in the coffin for weight control is it ignores social factors. There is no such thing as society with BMI, yet social factors impact health. Ignoring relevant data is just bad science. Here’s what happens when I use my data to calculate my BMI and risk of heart problems:

17. My risk of heart problems 0.9% In a crowd of 100 people with the same risk factors as me 1 is likely to have a heart attack or stroke within the next 10 years.

18. Then I pretend my weight doubles 1.1% In a crowd of 100 people with the same risk factors as me 1 is likely to have a heart attack or stroke within the next 10 years.

19. I slim down again and move house 1.7% I am back at my original weight again and change my postcode. In a crowd of 100 people with the same risk factors as me 2 are likely to have a heart attack or stroke within the next 10 years.

20. So, weight increase has no effect on my health. But social status does. That’s weight control ditched. What’s this about social status? Even if we all followed lifestyle guidelines, people in wealthy areas would still enjoy better health than people in poorer areas.

21. Status Syndrome Status syndrome states that ‘if you are treated like a second class citizen your health will suffer’. There is a health gradient between people in wealthy areas and those in deprived areas. It is not fully explained by access to healthcare or lifestyle behaviours. It is mostly explained by how people get treated by society. Inequality is an independent health hazard. Marmot, M. (2006) Status Syndrome A Challenge to Medicine. Vol 295, No. 11 1304- 1307

22. That’s not the same as saying lifestyle makes no difference. Yes, we need social change. And yes let’s help people find ways to optimise their wellbeing whatever their circumstances. Time to drop this rather pointy-finger ‘lifestyle change’ in favour of self-care. That’s better, it feels more equal already. Self-care is strongly tied to self-worth and both make a big difference to our quality of life.

23. The Well Now way forward promote compassionate self-care help people make sense of their experiences (critical thinking) of eating, body shame, health etc. use a wide range of research from public health, activism and creative learning so your teaching style is effective

24. The Well Now way is built from evidence that shows what works in promoting self-care and advancing fairness. This includes: internal regulation, size acceptance, compassion, mindfulness, embodied and relational nutrition, body awareness, critical pedagogy, liberation psychology, relational-cultural therapy, praxis and a politics of social justice.

25. One last thing Well Now uses a critical pedagogy. This means its teaching style (pedagogy) helps people value all forms of knowing and find new perspectives. This is important for self-care and social change.

26. The Well Now 4 Ps This framework can help remind us to take different view points and make links between them, which supports critical thinking. I find it useful when figuring out how to answer questions in a way that helps people discover things for themselves.

28. Thanks for reading. I hope the information has supported you in what you do or stimulated your appetite for change.

29. This work is Open Access, which means you are free to copy, distribute and display the work as long as you clearly attribute the work to the author, that you do not use this work for commercial gain in any form whatsoever, and that you in no way alter, transform, or build upon the work outside of its normal use in academic scholarship without express permission of the author. For any reuse or redistribution, you must make clear to others the licence terms of this work. First published in February 2016, by Lucy Aphramor, Shropshire, England.