Integrated Approach:
Health at any Size

by Frances M. Berg, MS

 The traditional ways of dealing with weight and eating needs to be replaced by a new paradigm that helps children and does not harm them. 
 An integrated approach considers overweight, eating disorders, dysfunctional eating and size prejudice together as interrelated issues. These four major eating and weight problems are not separate issues. They re all part of the same problem and they re all influenced by today's unnatural obsession with thinness. We need to understand how these four problems affect each other, and be wary of the harm so easily done to vulnerable youth.
 In the new paradigm, we can deal with these issues in healthy ways. The goal of the new approach is the health and well-being of all children of all sizes. 
 To achieve the goal of healthy children of all sizes, a comprehensive health approach is needed, whereby all children receive consistent messages that encourage eating well, living actively, and feeling good about themselves and others (as shown in the diagram). If family, friends, teachers, the media and health care providers give these messages to all children, the four major weight and eating problems can be prevented or diminished.
 This new paradigm is about being healthy at the size we are. It's about wellness and wholeness for each individual, including intellectual, physical, emotional, social and spiritual development. It s about eating in normal, healthy ways, being well nourished, and living actively, each in our own way. It's about self-acceptance, self-respect, feeling good about who we are. And it's about acceptance and respect for others, and an appreciation of their size diversity.
 This is an approach that does no harm. Rather, it prevents problems. It's an integrated effort that acts on and responds to negative aspects of culture in positive and effective ways. It keeps a healthy perspective while challenging the detrimental effects of traditional thinking and health politics aimed at size alone.
 Emphasizing single issues, on the other hand, sets one policy against another, and violates the principle to do no harm. Healthy living is distorted when a single problem is the focus, and others ignored. For example, focusing on obesity intensifies other problems and self-esteem is damaged. When self respect is ignored, when we can t accept people who differ from the norm, when the power of society is brushed off, then some will be desperate and act desperately.
 We can help young people develop self respect, assertiveness and healthy coping skills. We can help them find their unique potential as lovable, capable, valuable individuals, so they will take pride in themselves and their bodies at whatever size they are.
 This paradigm shifts the focus away from thinness to being healthy and active at our natural or normal weight. This is within everyone s reach. 
 The health at any size paradigm grows out of the nondiet movement and the Health Canada Vitality program. This new health paradigm unites the work of visionary people from many fields: nutrition, eating disorders, medicine, exercise science, obesity, sociology, psychology, the size acceptance movement, and others. It is research based and practical. Leaders in the health at any size paradigm advocate normal eating, active lifestyles, and stable weight, and reject the traditional thinking that everyone should be thin and large people should always be trying to lose weight. 
 By taking this integrated approach, we put all the issues on the table, recognizing that today s problems are not simple. They include obesity and its risks, the failure of weight loss treatment, pressures to be thin, the high rates of dysfunctional eating, malnutrition, dangerous weight loss methods, eating disorders, the stigmatizing of larger kids, and women s issues which impact body image for young girls. All these factors are in the mix when we consider the complex areas of weight and eating, and what they mean in our culture.
 Health professionals, educators and parents who are willing to look carefully at all the problems will find positive ways of working together to build strengths in all these areas. 

Reprinted with adaptations from Afraid to Eat: Children and Teens in Weight Crisis, by Frances M. Berg. Copyright, 1997. All rights reserved. Published by Healthy Weight Network, 402 S. 14th Street, Hettinger, ND 58639 (tel 701-567-2646; fax 701-567-2602; website www.healthyweight.net.