position on health, weight and obesity · northern health position on health, weight and obesity...

Position on Health Weight and Obesity An Integrated Population Health Approach Version 1 July 27 2012 10-420-6051 (0812)

For further information about this position statement please contact

Christine Glennie-Visser Regional Coordinator HEAL Network Northern Health Telephone 250-565-7455 Email christineglennie-vissernorthernhealthca

Flo Sheppard Population Health Team Lead Northwest Health Services Delivery Area Northern Health Telephone 250-631-4258 Email flosheppardnorthernhealthca

Northern Health Corporate Office Suite 600 299 Victoria Street Prince George BC Canada V2L 5B8 General enquiries 1-866-565-2999 or 250-565-2649 wwwnorthernhealthca

Acknowledgements We would like to acknowledge and thank the people who have helped to compile this position statement Christine Glennie-Visser Flo Sheppard Chelan Zirul Julie Kerr Kelsey Yarmish and Dr Ronald Chapman and numerous others who also provided direction and information which assisted us to compile the document

ldquohellip Sometimes it feels like this There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man So I jump into the river put my arms around him pull him to shore and apply artificial respiration Just when he begins to breathe there is another cry for help So I jump into the river reach him pull him to shore apply artificial respiration and then just as he begins to breathe another cry for help So back in the river again reaching pulling applying breathing and then another yell Again and again without end goes the sequence You know I am so busy jumping in pulling them to shore applying artificial respiration that I have no time to see who is upstream pushing them all inrdquo

McKinlay J 1979

Northern Health Position on Health Weight and Obesity

July 27 2012 of 34

10 Introduction This report outlines the position of Northern Health regarding health weight and obesity Body weight may influence an individualrsquos risk for poorer health outcomes or multiple risk factors Using a population health approach we will engage with communities and individuals to promote a health-focused approach to weight and obesity This will be accomplished by promoting that health can be achieved at a variety of body weights We will work with local regional provincial and federal partners to improve the health well-being and quality of life of those living working learning playing and being cared for in Northern BC

20 Background

It is generally accepted that excess body weight may detract from health and wellness Research shows that excess body weight is a risk factor for some individuals it may lead to the development of chronic disease such as hypertension heart disease stroke diabetes arthritis cardiovascular conditions and cancersi ii However the issue is complex For example other research demonstrates that some levels of excess body weight (overweight not obese) may be protectiveiii Of importance is the messaging that health can be achieved at a variety of body weights The focus on excess weight alone can have negative public health consequences as will be explored in this paper

Many factors contribute to excess body weight A complete review of the complex contributing factors is beyond the scope of this position paper The intent of this paper is to provide a brief introduction of evidence-informed key concepts from current literature and to present Northern Healthrsquos position on health weight and obesity

To better understand the complexity and connections between health weight and obesity it is important to provide working definitions of some key terms For the purposes of this position statement the following definitions will be used

Health A state of physical mental and social well-being a resource for daily lifeiv

Weight Body weight is a combination of bones muscle fat water and other components in the bodyv A change in weight typically reflects a change in muscle fat andor water Weight is one marker of health

Overweight and Obesity Overweight and obesity are defined as excessive fat accumulationvi

It is important to be aware of how others define these terms as this may impact our understandings Measuring and classifying body weight will be reviewed in the next section

When you treat diabetes you treat diabetes when you treat heart disease you treat heart disease when you treat osteoarthritis you treat osteoarthritis but when you treat obesity you treat

all of the above and more -- Dr Arya Sharma on Albertarsquos Obesity Initiative 2011

Northern Health Position on Health Weight and Obesity July 27 2012 Page 2 of 34

21 Classifying Body Weight A personrsquos body weight is commonly classified using body mass index (BMI)vii BMI is a screening tool that compares weight to height in a standardized formula1 The weight classifications and associated risk of developing health problems (Table 1) are developed by the World Health Organization (WHO) and adopted by Health Canada

Table 1 Adult Health Risk Classification According to BMIviii

BMI Category Classification Risk of Developing Health Problems

lt 1850 Underweight Increased 1850 ndash 2499 Normal Weight Least 2500 ndash 2999 Overweight Increased 3000 ndash 3499 Obese class I High 3500 ndash 3999 Obese class II Very High

ge 4000 Obese class III Extremely High

BMI is a useful tool as a population measure but is not a conclusive indicator of health at the individual level At the individual level BMI is used as a surrogate measure for body fat or body fatness however BMI has limitations (Appendix A) even those within the normal BMI range are not necessarily healthyix x Further obese individuals may be metabolically healthyxi xii BMI is not the only way to classify body weight and health risk 2 other ways of understanding how a personrsquos weight may affect their health outcomes are discussed in the following section

22 Body Weight and Health Too much or too little body weight can place people at increased risk for multiple risk factors and poorer health outcomes Health problems for those who are underweight may differ from those who are overweight however the implications of both are seriousxiii Being underweight and overweight may place individuals at increased risk for morbidity (Table 2) and mortalityxiv By demonstrating that both those who are underweight and overweight are at increased health risks the intent is to replace the focus on weight with a focus on achieving health

Table 2 Some Health Implications Related to Body Weight

Underweightxv Overweightxvixvii xviii Reproductive challenges infertility

High blood pressure

Weakened immune system Heart disease

Low muscle mass Type 2 diabetes

Osteoporosis Stroke

Hair loss Osteoarthritis

Co-morbidities (eg sleep apnea)

Cancers

1 BMI is calculated by dividing an individual‟s body weight (in kilograms) by their height (in metres) squared It is not recommended for use with

pregnant and lactating women those over the age of 65 years persons less than 3 feet (0914 metres) tall or greater than 6 feet 11 inches (2108 metres) tall individuals who are extremely muscled or those who are naturally lean

2 Waist circumference is another way to assess health risk This is discussed in Appendix A

Gallbladder disease Hormonal imbalances Weight cycling (or ldquoyo-yordquo dieting)3

Depression amp other mental health concerns Disordered eating4


3 4 Research indicates that there are greater health risks with excess weight depending on where the excess weight is stored on the body There are increased health risks associated with body types that tend to store excess weight at the waist (eg the abdominal or apple body type) as opposed to body types that tend to store excess weight at the hips (eg the gynoid or pear body type)xix

xx This is particularly relevant when considering men and women (see Section 45) Although not exclusively males tend to store excess weight in their abdomen and women tend to store excess weight more widely across their bodyxxi xxii Worldwide being overweight or obese has more than doubled since 1980 and the majority of the worldrsquos population lives in countries where more people die from being overweight than underweightxxiii Given this Northern Health is undertaking the development of this position the remainder of this document will focus on overweight and obesity5 Obesity is correlated with a number of different weight- and body-related issues including disordered eating weight cycling nutrient deficiencies poor body image low self esteem and size discrimination To effectively address obesity these issues must be addressed comprehensively in ways that avoid harm and reduce weight stigma These topics provide the framework for our discussion of health weight and obesityxxiv

23 Stigma and Assumptions about Body Weight As part of understanding a population health approach to body weight it is important to differentiate between approaches that focus on body weight and those that focus on health (Appendix B)xxv Approaches that focus on body weight typically also focus on the individual and assume that lifestyle modifications and behaviour change will result in weight loss andor the achievement of a normal weight as defined by BMI This approach may not achieve its goal and may not result in improved healthxxvi more often than not it may harm a personrsquos physical emotional and social health This approach has underlying assumptions and stigmatizes individuals who are obese (Table 3)

3 Weight cycling is a repeated loss and regain of body weight it has serious physical and psychological implications for the individual Physical

implications include changed metabolic rate increased cardiovascular risk factors alterations in body fat distribution and increased cardiovascular mortality Psychological implications include decreased self-esteem food or body pre-occupation depression anxiety and other negative outcomes From ldquoWeight Science Evaluating the Evidence for a Paradigm Shiftrdquo by l Bacon amp L Aphramor 2011 Nutrition Journal 10(9) pp 1-13 ldquoConsequences of Dieting to Lose Weight Effects on Physical and Mental Healthrdquo by S A French amp R W Jeffery 1994 Health Psychology 13(3) pp195-212 retrieved from httpwwwnutritionjcomcontent1019 and ldquoWeight Cyclingrdquo by US Department of Health and Human Services National Institutes of Health 2008 retrieved from httpwinniddknihgovpublicationsPDFswtcycling2bwpdf

4 Disordered eating includes a wide range of abnormal eating (eg anorexia bulimia chronic restrained eating compulsive eating habitual dieting and irregular and chaotic eating patterns) From National Eating Disorder Information Centre 2011 retrieved from httpwwwnediccaknowthefactsdefinitionsshtml

5 From this point on in this paper obese will be used to collectively refer to overweight and obesity if the terms need to be differentiated for a technical purpose it will be highlighted

As public health messages about obesity reduction become increasingly prevalent the incidence of eating disorders and disordered eating will increase

-- Provincial Health Services Authority amp BC Mental Health and Addictions 2011


The goal of weight loss should not be just to reduce numbers on a scale but to reduce health risks and improve quality of life

-- Freedhoff amp Sharma 2010

Table 3 Assumptions Regarding Body Weight xxvii xxviii xxix

Carrying excess body weight poses significant mortality risk

Carrying excess body weight poses significant morbidity risk

Weight loss will prolong life Being thin means one is healthy Anyone who is determined can lose weight and keep it off through appropriate diet and exercise

The pursuit of weight loss is a practical and positive goal

The only way for overweight and obese people to improve health is to lose weight

Obesity-related costs place a large burden on the economy and this can be corrected by focused attention to obesity prevention and treatment

Obese individuals are to blame for their weight (eg resulting from lack of personal control in eating and exercise)

Obese individuals are lazy Obese individuals are weak-willed Obese individuals are unsuccessful andor unintelligent

Assumptions regarding body weight form the basis of weight bias and stigmatize people Considered a form of bullying weight bias is discrimination or prejudice against an individual or group of people based on their weightxxx xxxi Weight bias occurs in a variety of settings including employment health care education inter-professional relationships media and advertizing television and entertainment legislation and other daily living settingsxxxii xxxiii Weight bias contributes to poor psychological well-being for individuals including increasing vulnerability to low self-esteem poor body image depression and other mental health concerns The impacts of weight bias affect many groups in society including those of normal weights as it is noted that disordered eating usually begins as an attempt to control weight or because of a fear of becoming obesexxxiv

Converse to the weight-focused approach introduced above a health-focused approach to body weight may be more effectivexxxv This approach such as that outlined in Health at Every Size6 (HAES) does not emphasize a weight outcome but promotes health as the outcome HAES is associated with improved physiological outcomes health behaviours and psychosocial outcomes Similar to other population health approaches HAES assumes a do no harm ethic promotes intuitive eating meaningful and positive physical movement body acceptance and may work to overcome stigma and assumptions typically associated with obesity HAES is also correlated with improvements in risk factors (eg lipids blood pressure) and has better long-term outcomes in weight controlxxxvi

6 This is not the same as the Size Acceptance Paradigm For clarification see Appendix B


30 Rates of Being Overweight and Obese Statistics Canada collects and reports data on health conditions including rates of being overweight and obese7 This information can help us to understand how Northerners compare to provincial and national rates and rates from other comparable regions (Table 4) Overall the weight of the average Canadian has increased8 by about 7kg between 1981 and 2007xxxvii

When considering the total population (both male and female) the national rate of being overweight or obese is higher than the BC provincial rate However rates in all of the Northern Health service delivery areas (HSDAs) are above the national rate Within Northern Health the Northern Interior HSDA has the lowest rate and the Northwest HSDA has the highest rate (55 and 62 respectively)

Rates should also be considered in the context of regions with similar socio-economic characteristics (ie cultures age gender and living and working conditions) Following national standards Northern Health is more comparable to the Northwest Territories Yukon northern Alberta northern Ontario northern Quebec and Labrador These rates are presented as Peer Group E and Peer Group H (Table 4) Regarding rates of being overweight and obese for the total population the Northwest and Northeast HSDAs are comparable to their peer groups (the Northwest HSDA compares to Peer Group H and the Northeast HSDA compares to Peer Group E) The Northern Interior is slightly lower than its peer group (Peer Group H)

Table 4 Adult Overweight or Obese Weight Status in Selected Regions Total Population 2011

Total Male Female Canadaxxxviii 520 600 438 BCxxxix 447 545 349 Northern Health Northwest HSDAxl 621 686 553

Northern Interior HSDAxli 549 670 416 Northeast HSDAxlii 582 683 468

Comparison Regions9 Peer Group E xliii 587 656 507

Peer Group H xliv 612 681 539

7 In this section overweight and obese are used to draw attention to their different technical definitions Statistics Canada classifies overweight

and obese using BMI Measures in the Canadian Community Health Survey are self-reported and bias is corrected for using calculations from the Canadian Health Measures Survey From ldquoMeasures in the Canadian Community Health Survey are Self-Reported and Bias is Corrected for Using Calculations from the Canadian Health Measures Surveyrdquo by M Shields S C Gorber I Janssen amp M S Tremblay 2011 ldquoBias in Self-Reported Estimates of Obesity in Canadian Health Surveys An Update on Correction Equations for Adultsrdquo by Statistics Canada 2011 [Catalogue No 82-003-XPE] Health Reports 22(3) 1-10

8 This increase in average weight is not proportionate relative to the average increase in height From ldquoMean Body Weight Height and Body Mass Index United States1960ndash2002rdquo by C Ogden C D Fryar M D Carroll amp K M Flegal 2004 Advance Data 347 1-18 US Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics Retrieved from httpwwwcdcgovnchsdataadad347pdf

9 Peer Group E comparable to the Northeast HSDA is comprised of the following health regions Central Zone (AB) North Zone (AB) Northeast HSDA (BC) Northwest Territories South Eastman Regional Health Authority (MB) and the Yukon Peer Group H comparable to the Northwest and Northern Interior HSDAs is comprised of the following health regions Labrador-Grenfell Regional Integrated Health (NFLD and Labrador) Nor-Man Regional Health Authority (MB) Northern Interior HSDA (BC) Northwest HSDA (BC) Northwestern Health Unit (ON) Parkland Regional Health Authority (MB) Prairie North Regional Health Authority (SK) Prince Albert Parkland Regional Health Authority (SK) Region de la Cote-Nord (QC) and Region du Nord-du Quebec (QC)


It can also be beneficial to consider how males and females compare this can tell us if segments of the population are challenged more than others In all regions listed in Table 4 rates for males are higher than for females Thus more men than women are overweight or obese in these regions In Northern Health rates for males are between 24 and 60 higher than the rates for females (Northwest HSDA and Northern Interior HSDA respectively) When compared to peer groups rates for males in all Northern Health HSDAs are higher than the highest peer group rate rates for females are generally lower than peer group rates with the exception of the Northwest HSDA

40 Populations At Risk

Some populations are at increased risk when considering the issue of obesity including those who are of lower socioeconomic status (SES) children and youth Aboriginal peoples men and those who live in northern rural and remote communities It is important to consider these groups to be aware of their unique challenges Each of these populations is discussed in the following sections Although they are presented separately it is important to recognize that these populations are not discrete where they overlap individuals may be in particularly challenging situations

41 Lower Socioeconomic Status While the causes are not fully understood those of lower SES are at greater risk of being obese than those of higher SESxlv xlvi xlvii Individuals with low SES buy more energy (calories) per dollar than nutrients per dollar as energy-dense foods are cheaper and more readily available (eg refined grains added sugars and fats)xlviii xlix Also lower SES is correlated with food insecurity Those without food security typically do not receive sufficient nutritionl li The quality of food offered by emergency programs like food banks and soup kitchens may not provide for diets based on recommended guidelineslii Regarding physical activity Canadians with lower SES are more likely to report barriers to participating (eg access to safe places to walk cost of recreation not getting communication about opportunities limited resources and equipment)liii

liv

42 Children and Youth Rates of childhood obesity are increasing more than one in four children and youth in Canada are labeled as overweight or obeselv Children and youth are increasingly being diagnosed with a range of health conditions that were previously thought to be adult problems such as hypertension high cholesterol Type 2 diabetes sleep apnea and joint problems Being overweight in childhood increases the risk for being obese in adolescence and adulthood which increases the risk for compromised health

Weight is one aspect of health10 While the risks of excess weight in childhood is a concern due to immediate and long-term health implications it is necessary to approach health of children and youth at the population- and individual-levels Weight seems to dominate current initiatives directed at children and youth and the long-term impacts of a weight-focused approach must be considered against those of a health-focused approachlvi In a weight-focused approach there is potential to do more harm than good (eg long-term risk for developing disordered eating impacts on body image and self-esteem)lvii lviii lix Moreover normal weight children may also have unhealthy behaviours while obese children may have healthy behaviours The Canadian

10 Other components of child health include sound nutrition for growth development immunity and brain function physical activity for health and

well-being social support safety immunization and the prevention of injuries


Measurements Survey does not support that obese children are any less active than their normal weight counterpartslx

The surveillance and screening of children and youth in schools and other community settings can be problematic While information collected may be shared with parents to motivate them to take action on their childrsquos lifestyle andor seek support from the health care system as appropriate andor motivate educators and communities to support healthy lifestyles the benefits of this practice are not clearlxi lxii lxiii Schools and communities may not have the necessary resources to support children identified as being at risk they may not be adequately resourced for data collection information dissemination or to help interpret or apply the data (eg appropriate techniques and equipment ethical and sensitive communication)lxiv It is also unclear if this practice is effective for determining abnormal or normal growth lxv

Harms are also documented with screening in settings such as schools Harms may include the adoption of a dieting mentality increased stigmatization of obesity lowered self-esteem increased body dissatisfaction and disordered eatinglxvi Health messaging to children youth and their parents must focus on supporting optimal growth development and health rather than a weight-based approach for the purposes of avoiding obesity

Finally it is suggested that the rising prevalence of childhood overweight and obesity is rooted in factors external to a childrsquos personal control (Appendix C)lxvii For example children and youth do not have the same decision-making authority as adults and some authors suggest that the crisis of childhood obesity is rooted in poor feeding and parenting practiceslxviii As well where children live learn play and are cared for impact opportunities for (and the practice of) healthy lifestyles For example removing playground privileges for poor classroom behaviour limits a childrsquos opportunity to play actively

43 Aboriginal Peoples In Northern BC Aboriginal-identity people11 make up approximately 18 of the total populationlxix Aboriginal peoples face unique challenges regarding obesity trends Through colonization tremendous cultural shifts have significantly affected recent generations Traditional lifestyles were centred on subsistence through hunting trapping fishing or gathering As Western lifestyles have been adopted by or forced on Aboriginal peoples there has been a loss of traditional lifestyles this is correlated with a decrease in physical activity and increase in the consumption of poorer quality foodslxx This is documented in recent national health surveys which report that Aboriginal populations in Canada have higher rates of obesity than non-Aboriginal Canadianslxxi These rates are consistent with the high rates in the Northwest HSDA (Table 4) where the majority of Northern Healthrsquos Aboriginal population resides In considering rates of obesity among Aboriginal populations responses must be culturally appropriate and capacities of (often) rural or remote communities must be considered (eg the availability of quality food or accessible activity opportunities)

44 Northern Rural and Remote Communities Many communities in Canada and in Northern Health are considered rural or remote When compared to more Southern metropolitan areas Northern rural or remote communities tend to have higher rates of obesitylxxii Many factors affect these outcomes but these communities may

11 Census records of Aboriginal peoples should be treated as an undercount as content or reporting errors exist ndash potentially due to question

misinterpretation particularly related to Aboriginal identity


specifically face challenges when trying to access healthy foods and activity choices For example these communities may be faced with challenges when trying to access fresh healthy affordable food choices year-round (food deserts) Some communities (even some in Northern Health) do not have a grocery store Even where a grocery store may exist quality and fresh produce may be difficult to obtain and prices can be much higher than in metropolitan settings12 Similarly regarding opportunities for safe and active living access to support services and programs recreation facilities and equipment and organized recreation opportunities may be problematiclxxiii Some barriers in rural and remote places may include travel for organized sports lack of public transportation cold weather unsupportive infrastructure (eg sidewalks streets no community centrepublic programming) wildlife may pose risks challenges securing qualified volunteers proper equipment or other resourceslxxiv

45 Men Table 4 demonstrates that men in all regions demonstrate a higher rate of being overweight or obese and this highlights a potential concern As men tend to store excess body weight in their abdomen (eg apple body type) they are at increased risk for cardiovascular disease risk factors such as impaired glucose tolerance and hypertensionlxxv Further health behaviours and lifestyle choices place men at the crossroads of other factors which increase their risk for obesity (eg increased per capita rates of alcohol and tobacco use lower rates of high school completion)lxxvi While little research is available anecdotal experiences suggest that being male in Northern BC is correlated with the resource-based economy with boom and bust cycles Anecdotes suggest that men are disproportionately exposed to long work hours increased stress from living away from families for long periods of time and a poor diet lead to a ldquohectic lifestylerdquo and one which may detract from making healthier lifestyle choices that could support healthy eating and active livinglxxvii Adding to this concern is that men are not as likely to address health issues until they have escalated to a health incident (eg development of hypertension diabetes cardiovascular incident)lxxviii These reasons suggest that men may be a population at risk when considering obesity

50 Causes of Being Overweight or Obese Overweight or obese is caused by the interplay of multiple biological environmental social and cultural factors Research continues to help us understand what (and how) factors may contribute to obesity The sections below are not a comprehensive review of all factors the intent is to summarize those that are commonly agreed upon

51 Energy Imbalance It is generally accepted that excess body weight is the result of energy imbalance that is more calories consumed (energy-in) than expended (energy-out)lxxix Calories are taken into the body by consuming food and beverages calories are expended by the body through normal body functions (metabolism) and physical activitylxxx In this sense if calories consumed equals calories expended a personrsquos body weight will be stable Weight gain occurs when more calories are consumed than expended Conversely weight loss occurs when more calories are expended than consumed

12 Since 2009 Northern Health has partnered with the Government of British Columbia and Northern communities to support the Produce

Availability Plan that was developed to increase the availability of fresh local food in Northern BC and has increased the volume of food production and food preservation in targeted communities


Obesogenic originates from the words obese and genic to describe something that creates or leads to obesity

-- Lee McAlexander amp Banda 2011

Genes load the gun the environment pulls the trigger -- Reid 2011

While energy imbalance is the most commonly agreed upon reason for carrying extra body weight evidence supports that there are many factors that influence this seemingly simple equation The factors that determine energy-in and energy-out are complex and differ between individuals For example biological genetics impact how bodies recognize use and respond to food and activity food and physical activity choices are largely influenced by the environments in which we live and food and activity choices are influenced by chemical and hormonal processes Each of these influences will be explained in the following sections

52 Genetics

At the individual-level the role of genetics must be consideredlxxxi Among different populations evidence supports that 6 to 85 of obesity may be attributed to genetics as such genetics may be a weak or a strong determinant of obesitylxxxii lxxxiii Genes regulate a number of biological factors that affect body weight including hormone production appetite metabolic rate distribution of body fat (eg apple vs pear body shape see Section 22) and how the body responds to food intake and physical activity Genes also play a role in internal regulation (hunger fullness and satiety) and food preferenceslxxxiv Genes may cause obesity even in cases where there is an energy balance It is estimated that over 40 sites on the human genome may be linked to the development of obesity lxxxv

53 Obesogenic Environments The environments in which we live work learn play and are cared for may contribute to obesity rates lxxxvi lxxxvii lxxxviii An obesogenic environment promotes increased energy intake and is not conducive to energy expenditurelxxxix xc Obesogenic environments are influenced by physical social cultural emotional and political factors and there is benefit to outline them at a population-level

Physical factors that contribute to obesogenic environments include built environments and infrastructure particularly when they do not promote energy expenditure through physical activity xci For example active transportation (eg walking running bicycling) is important for an energy balance but our built environment may promote sedentary transportation choices (eg elevators vehicles) Infrastructure that impacts this includes road or sidewalk quality bike lane availability and accessible stairways even onersquos sense of safety impacts their decision for or against active transportation At the population-level as sedentary transportation choices become more prevalent functional movement is reduced and this has long-term implications for health at the individual- and population-levels

Socio-cultural factors that contribute to obesogenic environments include the choices and pressures presented to us in our surroundings xcii For example increasing demands on our time and resources may erode a healthy work-life balance This imbalance can promote eating foods that may be energy dense affordable and palatable but are low in nutrition In this process


people may also lose food preparation skills develop distorted perceptions of appropriate food portions and have limited opportunities for family meals Additionally media and marketing messages affect perceptions of health healthy lifestyles and healthy bodies

Food choices happen in a number of settings (eg stores restaurants schools institutions worksites) xciii It is important for those who are responsible for these settings and those who participate in these settings to be aware of the role of these settings in obesogenic environments and to consider what is available and not available (in quantity and quality) (eg food deserts and food swamps13) Finally political systems (from international agreements to local governments) influence food systems and the other factors which contribute to obesogenic environments

xciv For example changing food system policies support over-production and over-consumption of low-cost energy-dense foods (eg those with added fats and oils and caloric sweeteners) Community infrastructure and the built environment in community infrastructure is influenced by municipal policies which may promote sedentary behaviours (eg poor quality sidewalks sidewalks without letdowns) Other policy areas which influence obesogenic environments include health transport urban planning environment and educationxcv xcvi

By understanding what contributes to an obesogenic environment it becomes clear that individual choices are influenced by larger and complex social cultural and political systems When faced with these larger systems it is plausible that obesity at the population-level may only be addressed when obesogenic environments are addressed

54 Chemicals and Hormones Chemical impacts are important to consider as an increasing number of manufactured chemicals are emerging as potential obesogensxcvii Obesogens disrupt regular functioning and production of normal body chemicals and hormones and may contribute to obesityxcviii Also known as endocrine disruptors these chemicals target a number of biological factors that impact obesity including hormonal signalling pathways involved in fat cell quantity size and function metabolic set points energy balance and the regulation of appetite and satietyxcix c For example heavy smoking increases insulin resistance and is associated with centralized fat accumulation (ldquotobacco bellyrdquo)ci This example illustrates how chemicals may negatively interact with naturally occurring hormones in the body (eg ghrelin leptin and insulin) These naturally occurring hormones are key factors in obesity alone they play roles in feelings of hunger satiety (fullness) and regulate blood sugarcii Research is emerging on the complex relationship between these hormones and how they impact body weight a complete review of this is not the intent of this paper

13 The term food desert is used to describe an area where there is limited access to healthy and affordable food (eg no grocery store) The term

food swamp is used to describe an area where there is easy access to poor-quality convenience foods (eg fast food or convenience stores) From ldquoFood deserts or food swampsrdquo by J E Fielding amp P A Simon 2011 Archives of Internal Medicine 171(13) 1171-1172


55 Addiction and Mental Health As with any substance there may be beneficial and problematic use of foodciii Evidence supports that certain food components (eg sugars and fats) stimulate the same chemical response in the body as other more recognized addictive substances (eg alcohol tobacco)civ cv When considering factors that may contribute to obesity problematic use of food must be considered Foods containing high concentration of added sugars and fats are typically energy dense and thus affect the energy imbalance This is a particular challenge with food because it is a requirement of life Therefore it can never be removed from onersquos daily lifecvi Further people may engage in other (unhealthy or maladaptive) behaviours in attempt to control weight (eg tobacco or other substance use excessive exercise)cvii Other components of mental health that are negatively correlated with obesity and dieting include stress depression anxiety mood disorders and other mental health concernscviii cix However the HAES approach is positively correlated with improved quality of life reduced body dissatisfaction and reduced binge eatingcx A full exploration of these issues is beyond the scope of this paper

56 Sleep Preliminary research suggests that sleep deprivation may play a role in obesity through its effects on appetite and physical activitycxi cxii Sleep as a potential cause of obesity is connected to other causes including chemicals and hormones and our environments For example sleep is affected by the increasing connection to technology (eg TV computers handheld devices)14 Device emissions can disturb natural sleep cyclescxiii Chronic sleep deprivation may lead to feeling fatigued and this may lead to reduced physical activitycxiv Moreover sleep deprivation may affect hormonal balances that affect caloric intakecxv Independent of caloric intake increases sleep deprivation may affect how the human body stores or gains weightcxvi Some evidence suggests that the correlation between sleep deprivation and obesity may be more prevalent in different age groups (eg younger people) However this concept is still being explored in the research as studies commonly face design limitationscxvii

60 Obesity Prevention Approaches

From a population health perspective it is important to understand how obesity can be prevented as prevention is an effective means of avoiding treating or managing obesitycxviii Fundamental to the prevention of obesity is promoting and supporting eating competence (Appendix D) a regular and enjoyable active lifestyle and positive body image (Appendix E) As more lessons are learned about what is effective in reducing and preventing obesity it is important to ensure that no harm is done That is prevention approaches must be underpinned by the philosophy of supporting and improving health first not focused on weight or weight loss Evidence suggests that targeted programs are effective in preventing obesity specifically programs targeted along the life cycle and across settings and generationscxix A life cycle perspective can be used to develop comprehensive interventions that address the multiple

14 Further in using technological devices sedentary behaviours increase and detract from opportunities for healthy lifestyle choices From

ldquoCanadian Sedentary Behaviour Guidelines Background Informationrdquo by Canadian Society for Exercise Physiology 2011 retrieved from httpwwwcsepcaCMFilesGuidelinesSBGuidelinesBackgrounder_Epdf


determinants of obesity while supporting optimal growth and development in children weight stability in adults and positive body image Evidence for obesity prevention opportunities across the lifespan is reviewed in the sections below

61 Prenatal Maternal obesity may pose risks for the mother and the child including gestational hypertension pre-eclampsia birth defects Caesarean delivery fetal macrosomia perinatal deaths postpartum anemia and childhood obesitycxx Given that such risks are present the American Dietetic Association and the American Society for Nutrition recommend that ldquoall overweight or obese women of reproductive age should receive counselling prior to pregnancy during pregnancy and in the interconceptional period on the role of diet and physical activity in reproductive healthrdquo Health Canada and the BC Ministry of Health have adopted the Institute of Medicinersquos guidelines for gestational weight gains These guidelines are based on a womanrsquos pre-pregnancy BMIcxxi By gaining weight within the recommended guidelines maternal fetal and newborn risks may be minimized However gains that exceed or fall short of recommended weight gain may still produce a healthy pregnancy as other risk factors also affect pregnancy outcomes (eg smoking and maternal age) A womanrsquos propensity to gain more weight in pregnancy is correlated with a pre-pregnancy history of restrained eating dieting or weight-cyclingcxxii Within a framework of eating competence pregnant women should obtain adequate nutrition and calories to support fetal growth and maternal health as well as supply enough energy to support daily life including activity

62 Infant In this stage it is apparent that breastfeeding plays a role in the immediate and long-term growth and development of the childcxxiii cxxiv Population data sets support that when compared to formula-fed babies breast-fed babies grow better in the first few months of life and then the rate of growth slows yielding a leaner taller population of toddlers and children There is also evidence to support that no breastfeeding or short breastfeeding is a factor that is associated with obesity later in lifecxxv Moreover breastfeeding is the biological norm for infant feeding and is considered the best example of food security an important part of healthy eating Exclusive breastfeeding for the first 6 months of life and once nutrient-rich solid foods are added continued breastfeeding to 2 years and beyond is recommendedcxxvi

Eating competence can be supported through stage-appropriate feeding In the first 6 months of life regardless of the feeding modality (breast or bottle [expressed breast milk or formula]) on-demand feeding for the purpose of infant-led feeding so that parents can recognize and respond to the infantrsquos hunger appetite and fullness cues is recommendedcxxvii

621 Principles for Infants Toddler Preschooler and School-Age Children

When considering children obesity and fat it is important that fat intake not be managed out of fear of developing obesity Fat is a necessary nutrient for optimal growth and development and providing adequate energy and nutrients are the most important considerations in the nutrition of childrencxxviii There is no evidence to support that a fat-reduced diet is a benefit to the child or reduces illness later in life Children are active and depend on fat to get the calories they need fat also makes food appealing to them Often when children are provided with low fat diets they seek other energy-dense foods which may not be high in nutrients (eg sweets)cxxix As such nutrient-dense foods should not be omitted or restricted from childrens diets because of fat content As per the Canadian Paediatric Society as children grow into their adult height the


percent of fat calories may gradually be reduced from the high of 55 of calories in the first two years of life to 25-35 of caloriescxxx Surveillance and screening15 to monitor the growth of children and youth are important health-focused tools (eg measuring height weight and calculating BMI-for-age)cxxxi It is recommended that children are weighed and measured by their health care provider16 within 1-2 weeks of birth and then at regular monthly intervals (2 4 6 9 12 18 and 24) In Canada BMI-for-age is not recommended for use in children under 2 years of age After the age of 2 years it is recommended that the child then be measured once per year through adolescencecxxxii Serial measurements on a growth chart provide longitudinal information about a childrsquos growthcxxxiii The direction and relative consistency of the numbers over time is more important than the actual percentile Most childrenrsquos growth tracks along a consistent percentile with the exception of when crossing percentiles may be normal (eg the first 2-3 years of life and at puberty) Monitoring for weight acceleration may be a more effective measure of weight issuescxxxiv Weight acceleration is an abnormal upward divergence for the individual childcxxxv In this the integrity and consistency of the childrsquos growth is monitored over time rather than their absolute weight or weight percentile

63 Toddler Preschooler and School-Age Children Children are born with a natural ability to regulate energy intake but this ability may be lost as a result of poor feeding practices and the obesogenic environmentcxxxvi To sustain inherent internal regulation the use of stage-appropriate feeding practices is recommended These are framed by a division of responsibility in feeding (Appendix C)cxxxvii Parental control even with positive intent to prevent weight or nutrition concerns undermines energy regulation Restricting eating is associated with child weight gaincxxxviii Evidence suggests that children whose parents exerted the most control showed the weakest ability to regulate energy intake and increased responsiveness to the presence of palatable foodcxxxix Parental control of childrenrsquos eating can include both restriction of certain forbidden foods such as sweets and high fat foods using certain foods to reward behaviour and encouraging consumption of healthy foodscxl Interventions that are proven to be effective include family-based strategies educating parents in child-feeding behaviours increase positive feeding practices (eg modeling and monitoring) decrease negative practices (eg restriction and pressure to eat) and promote authoritative17 parentingcxlicxlii Therefore it is recommended that to prevent obesity in toddlers preschoolers and school-aged children restricted eating not be promoted (potential for long-term adverse effects) promote family-based strategies educate parents about the roles of healthy eating and physical activity in the prevention of obesity and promote good health for life Parents can be supported to understand this approach with the division of responsibility in feeding and activity

15 Surveillance refers to a population-level collection of BMIs to identify the percentages of a population at each weight benchmark Screening

determines the health status of an individual to identify those at risk for weight-related health problems with the intent to intervene to prevent or reduce obesity

16 For discussion on surveillance and screening of children and youth in schools please see Section 42 17 Authoritative parenting is characterized by high parental affection and responsiveness as well as high expectationsrespectful limit setting

which leads to increased independence and self-control in children In a food context authoritative parents balance concerns for healthful intake with the child‟s food preferences In practice authoritative parenting can encompass the division of responsibility From ldquoParental Feeding Practices Predict Authoritative Authoritarian and Permissive Parenting Stylesrdquo by L Hubbs-Tait T S Kennedy M C Page G L Topham amp A W Harrist 2008 Journal of American Dietetic Association 108(7)1154-1161


(Appendix C) interventions should be tailored to reflect the individualrsquos SES family size levels of education (parents) and motivation to changecxliii

64 Adolescent Similar to the rapid growth rate of the first 2 years puberty brings significant body changes as a result of hormonal processes It is normal for girls to add up to 20 of their body weight in fat in the year before menstruation begins and boys often add body fat before the height and muscle growth of pubertycxliv Further adolescence is when activity levels generally begin to decrease In the current social constructions around body weight and rising public health concerns about childhood weight such normal body changes may be perceived negatively Unhealthy practices like dieting cigarette smoking and excessive exercise may ensuecxlv

In following an approach that promotes health the focus should be on supporting adolescents to continue (or start) developing eating competence (Appendix D) enjoy regular activity and foster positive body image Guidance to parents and adolescents about anticipated body changes as well as media literacy may support optimal growth and development and positive body image It may also be helpful to explain to teenagers who are concerned about their weight that weight reduction strategies will put them at risk for weight gain over time rather than promote weight loss cxlvi It is documented that adolescent dieters may be up to twice as likely to be overweight later in lifecxlvii Evidence supports that adolescents may be highly susceptible to being set-up for future body-based challenges including disordered eating overweight status body dissatisfaction and extreme weight control behaviourscxlviii

65 Adult Prevention approaches for adults both at the individual and population levels are different than in earlier life stages The goal is to help adults establish and maintain a stable weight in the context of a healthy lifestyle A healthy weight is a natural weight that the body adopts when given a healthy diet and meaningful levels of physical activitycxlix This implies competent eating functional movement positive body image and the absence of significant disease risk Addressing obesity in this age group is expected to have ripple effects on other generations Successful interventions in this age group will affect the broader population through familial ties both older and youngercl

66 Older Adult Senior

Obesity in older adults and seniors is a complex issue This population may be faced with various health issues competent eating and physical activity are part of the complexity and should be addressed in view of their individual health situation as part of their primary care environment

While this population is at increased risk for chronic disease energy intakes decrease with age and nutrient deficiencies are more likely In fact the 1999 BC Nutrition Survey found that the intake of some men and all women of the four food groups of Canadarsquos Food Guide was compromised intakes of folate vitamins B6 B12 and C magnesium and zinc were all lowcli Consequently weight loss may be harmful in this population as there is risk for the loss of bone or muscle mass As weight loss could indicate a reduction in various body components weight loss is not recommended in older adults unless functional impairments or metabolic complications are present and could be mitigated by weight lossclii As with any age evidence supports that competent eating and regular functional movement supports improved quality of life it is never too late to build a healthier lifestyle


It is important to emphasize and build awareness of sedentary behaviours and their potential to increase due to aging and lifestyle changes Functional limitations (or the risk of developing them) can be reduced through flexibility strength and stability training Older adults and seniors can continue to build muscle mass through resistance training and the addition of muscle mass may help to stabilize skeletal framescliii There are additional benefits of increased attention on healthy eating and active living (eg impacts for depression and other mood disorders)cliv clv clvi

70 Managing and Treating Obesity in Adults18

Traditionally weight reduction strategies were recommended to manage or treat obesity for the individual Subscribing to a weight-focused approach the intention was that if the individual lost weight their health would improve However as highlighted in Section 21 this is not always true Moreover Section 5 highlights that there are systemic causes for obesity Therefore individual and collective actions are required to manage and treat obesity As health can be achieved at a variety of weights the Edmonton Obesity Staging System is a potentially valuable tool to predict mortality independent of BMI This transition of recommended management and treatment options will be described below

71 Weight Reduction Strategies vs Adopting a Healthy Lifestyle Diet andor exercise are the most commonly advised methods for weight loss in those who are overweight or obese particularly those who are at risk for cardiovascular disease or Type 2 diabetes However physical activity and structured exercise rarely result in significant and sustained loss of body fat and weight loss diets have high relapse rates clvii clviii Thus these recommendations are not effective solutions for long-term fat loss in the absence of adopting habits for a healthier lifestyle

Moreover weight reduction strategies can be dangerous to physical and mental health Most weight-reduction strategies are not sustainable may lead to increased weight rebound weight cycling and commonly restrict macronutrients (proteins carbohydrates and fats) and micronutrients that are integral to normal body functions For example adverse effects of restricting dietary carbohydrates include constipation dehydration halitosis nausea increased cancer risk and othersclix

While weight reduction strategies are ineffective and dangerous promoting the adoption of a healthy lifestyle (eg competent eating pleasurable activityfunctional fitness and a healthy body image) can produce health benefits (Appendix F)clx These health benefits result from lifestyle adaptations which promote health and occur independently of changes in body weight or body fat Thus those who are at increased health risk and lead a sedentary lifestyle have a poor diet or have excess body fat should be encouraged to adopt a healthy lifestyle While these changes may not lead to weight loss they will realize health benefitsclxi clxii clxiii

However it is important to be aware that there is a dichotomy between current eating and activity practices and recommended healthy lifestyle practices and this may challenge the sustainable adoption of these recommendationsclxiv Concerns regarding obesity have influenced the development of healthy lifestyle recommendations moving them closer to weight reduction strategiesclxv For example mindful eating has emerged as a commonly recommended strategy The weight reduction interpretation of this strategy is that one should stop eating when full The

18 Management and treatment of pediatric obesity is beyond the scope of this paper Pediatrics are a very specific group within obesity

management and treatment and while some messages in this section may be applicable the specific niche is not explored


competent eating interpretation suggests that satisfaction should be the natural end of eating (most of the time this may be when fullness is reached but it may also include a conscious decision to enjoy another bite)clxvi The focus of any treatment must be on establishing and maintaining healthy lifestyle habits rather than weight goalsclxvii

72 A Phased Approach Long-term health goals require a collaborative and supportive relationship between the individual their primary care providers and supportive environments that are conducive to reducing health risks While there are many ways to manage or treat obesity in adults approaches should be phased over three stages

Stage 1 Stabilize weightclxviii Explore identify and address the causal pathways for the excess weight The goal of this stage is to stop weight gain (stabilize weight) rather than reduce weight19 Physicians may use tools such as the Canadian Obesity Networkrsquos 5 Arsquos of Obesity Management to approach patients to discuss their weight Further it is important to consider the drivers and consequences of excess weightclxix Stage 2 Address excess weightclxx When weight has stabilized address if medically necessary the excess weight to reduce health risks that are precipitated and exacerbated by the excess weight For some this may involve targeted goals and invasive procedures to balance energy intake and energy expenditures To achieve long-term success in Stage 3 efforts in Stage 2 must be based on individual lifestyle changes Specifically these should not lead to a dieting mentality but rather lifestyle changes supported by the development of eating competence and an increasingly active lifestyle

Stage 3 Maintain weight lossclxxi

Long-term success in addressing health risks of excess weight requires permanent lifestyle changes While these changes will not happen overnight it will be necessary for permanent changes to occur in order for the individual to maintain their state of improved health and reduced risks

73 Edmonton Obesity Staging System One limitation of the BMI is that it does not reflect the presence of underlying obesity-related health concerns such as reduced quality of life or functional abilities From a clinical perspective the physical physiological and emotional factors are important for assessing patients with excess body weightclxxii

Documented to be a better indicator of mortality risk than BMI in overweight and obese adults the Edmonton Obesity Staging System (EOSS) is premised on improving health in all stages it is an effective system to assess and guide management of obesity in adult patients20 The system prioritizes management to reduce mortality An EOSS stage (0-4) is assigned to a person with a BMI of 30 or higher The five stages are based on the presence of risk factors co-morbid issues and functional limitations (Table 5) In higher stages where the risk of mortality is increased

19 Many obese people may have already stabilized their weight (weight gain may have been in the past andor may currently be below their

highest weight) These people may already be at their best weight 20 The Treatment and Research of Obesity in Paediatrics in Canada is currently working to adapt the adult EOSS for use in children and youth

From ldquoMeasuring Obesity Related Risks in Kidsrdquo by A M Sharma 2012 retrieved from httpwwwdrsharmacameasuring-obesity-related-risks-in-kidshtml


treatment andor weight reduction strategies are recommended The EOSS emphasizes that the intent is to resolve the risk factor or issue independent of obesity stage21 Recommended treatments are beyond the scope of this paper however professionals should follow evidence-based examples Table 5 Edmonton Obesity Staging System ndash Clinical and Functional Staging of Obesityclxxiii

Stage Description Management

0 No apparent obesity-related risk factors (eg blood pressure serum lipids fasting glucose etchellip within normal range) no physical symptoms no psychopathology no functional limitations andor impairment of well-being

Identification of factors contributing to increased body weight Counselling to prevent further weight gain through lifestyle measures including healthy eating and increased physical activity

1

Presence of obesity-related subclinical risk factors (eg borderline hypertension impaired fasting glucose elevated liver enzymes etchellip) mild physical symptoms (eg dyspnea on moderate exertion occasional aches and pains fatigue etchellip) mild psychopathology mild functional limitations andor mild impairment of well-being

Investigation for other (non-weight related) contributors to risk factors More intense lifestyle interventions including diet and exercise to prevent further weight gain Monitoring of risk factors and health status

2

Presence of established obesity-related chronic disease (eg hypertension type 2 diabetes sleep apnea osteoarthritis reflux disease polycystic ovary syndrome anxiety disorder etchellip) moderate limitations in activities of daily living andor well-being

Initiation of obesity treatments including considerations of all behavioural pharmacological and surgical treatment options Close monitoring and management of comorbidities as indicated

3 Established end-organ damage such as myocardial infarction heart failure diabetic complications incapacitating osteoarthritis significant psychopathology significant functional limitations andor impairment of well-being

More intensive obesity treatment including consideration of all behavioural pharmacological and surgical treatment options Aggressive management of comorbidities as indicated

4 Severe (potentially end-stage) disabilities from obesity-related chronic diseases severe disabling psychopathology severe functional limitations andor severe impairment of well-being

Aggressive obesity management as deemed feasible Palliative measures including pain management occupational therapy and psychosocial support

74 Pharmacological and Surgical Approaches Although beyond the scope of this paper there is validity in addressing pharmacological and surgical approaches for the management and treatment of severe morbid obesity This area of obesity management and treatment is growingclxxiv clxxv clxxvi Typically recommended for those individuals who are in the higher EOSS stages the immediate issue of morbid obesity will benefit from a health-focused approach to weight However these treatments are largely beyond the scope of a population health approachclxxvii clxxviii

21 Proposed treatments are beyond the scope of this paper but professionals should follow evidence-based approaches


80 Northern Health Position Northern Health seeks to optimize health and wellness and improve quality of life by promoting healthy lifestyles among all Northern residents With attention to Northern Healthrsquos Position on Healthy Eating and the Position on Sedentary Behaviour and Physical Inactivity Northern Health will work with internal and external partners to support and promote a health-focused approach to body weight across the life cycle

Health can occur at a variety of sizes o Support the development and maintenance of eating competence across the life

cycle

o Promote enjoyable active lives and support building lifestyles that integrate active transportation active play and active family time

o Support the achievement of positive body image for all

o Support the message that healthy bodies exist in a diversity of shapes and sizes

Weight is not a complete and inclusive measure of health o Support a health-promoting approach prioritizing the reduction of risk factors and

weight-related complications

o Support optimal growth and development of children and youth

o In children and youth support longitudinal growth monitoring as part of primary care Weight divergence particularly weight acceleration (rather than an absolute weight or percentile) requires further investigation

o Promote that all sizes are accepted and treated with respect

o Support that weight bias is a bullying issue it may be overcome using awareness education and other supportive measures

o Promote a do no harm approach in measures to support health at all sizes to prevent increases in negative body image disordered eating and disordered activity

Obesity should be prevented treated and managed using a do no harm approach o Support and promote healthy eating make the healthy eating choice the easy

choice

o Support and promote active lifestyles make the active choice the easy choice

o Support drawing attention to obesogenic environments where people live work learn play and are cared for

o Support a graduated approach to healthy lifestyles encourage actions toward improved health and well-being at all weights

o Support and promote the use of the Edmonton Obesity Staging System as a medical approach to manage obese patients

o Promote success as improved health and stabilized weight with attention to competent eating active living and positive body image


Healthy public policy is coordinated action that leads to health income and social policies that foster greater equity It combines diverse but complimentary approaches including legislation fiscal

measures taxation and organizational change -- The Ottawa Charter 1986

90 Strategies to Achieve this Position The Ottawa Charter for Health Promotion is an international resolution of the World Health Organization Signed in Ottawa Canada in 1986 this global agreement calls for action towards health promotion through five areas of strategic action build healthy public policy create supportive environments strengthen community action develop personal skills and reorient health services In concert these strategies create a comprehensive approach to addressing health weight and obesity

This section presents examples that support the five strategic action areas of the Ottawa Charter to achieve the goals outlined in this position paper Examples are evidence-based and come from an environmental scan of strategies proven to be effective in other places

91 Build Healthy Public Policy

A broad range of local regional provincial and federal organizations have a role in building healthy public policies that promote the health-focused approach to weight and obesity Some examples include

Regulate the marketing and practices of the weight loss industry

Regulate marketing to children particularly for energy-dense nutrient-poor foods and beverages and foods and beverages that are high in fat sugar and sodium

Support realistic messaging in the media (eg do not endorse dieting tips unrealistic anecdotal success stories not promoting Biggest Loser type interventions)

Continuationexpansion of financial incentives and funding supports to promote the reduction of sedentary behaviour and increased physical activity (eg Childrenrsquos Fitness Tax Credit BCrsquos Prescription for Health Northern Healthrsquos HEAL and HEAL for your HEART seed grants KidSport etc)

Seamless and transferable standards (eg guidelines) for food and physical activity available in all settings (eg preschool school workplaces recreation centres hospitals long-term care facilities) These standards should be supported with education toolkits evaluation and enforcement

o These policies will support make the healthy eating choice the easy choice and make the active choice the easy choice

Policy that promotes a national food supply that is both healthy in composition safe to consume and with equitable access to foodclxxix

Policies to prevent hunger and childhood obesity in the face of poverty (eg Making the Connection Linking Policies that Prevent Hunger and Childhood Obesity)

Acknowledge that Aboriginal peoples and children live play eat and drink and spend leisure time with different historical social cultural economic and environmental determinants policies should be developed that recognize how these factors impact active living healthy eating body image and weightclxxx


Changing patterns of life work and leisure have a significant impact on health Work and leisure should be a source of health for people The way society organizes work should help create a

healthy society Health promotion generates living and working conditions that are safe stimulating satisfying and enjoyable

-- The Ottawa Charter 1986

Policy to support breastfeeding including legislation to support full adoption of the International Code of Marketing of Breast Milk Substitutes

Support and promote the Guidelines for Food and Beverage Sales in BC Schools

Support community planning processes for systemicstructural interventions required to promote healthy eating and active living (eg Official Community Plans transportation planning community infrastructure)

92 Create Supportive Environments

People interact daily with a variety of settings where they live work learn play and are cared for in Northern BC These settings should be carefully considered when seeking to create supportive environments particularly given the contribution of obesogenic environments to overweight and obesity Within each of these environments there is opportunity to promote the health-focused approach to weight and obesity using examples such as

921 Home

Frame child feeding training in the context of parenting courses (eg Five Keys to Raising Healthy Happy Eaters ndash a course offered by the Childhood Feeding Collaborative in Santa Clara California)

Anticipatory guidancesupport for parents of girls to recognize and support pubertal growth and development (this acknowledges that body fatness increases for girls) efforts to prevent the development of dieting mentality

Support on-demand feeding for the first six months for an infant by educating parents how to recognize and respond to the infantrsquos appetite hunger and fullness cues

Support the development of eating competence (eg Northern Health Position on Healthy Eating)

Support the development of active lifestyles (eg Northern Health Position on Sedentary Behaviour and Physical Inactivity)

Support advocate and educate promote the benefits of active transportation active play and active family time particularly in the long northern winter months (eg ParticipACTIONrsquos Fun Tips Healthy Living for Families Booklets (BC) Screen Smart childnatureca)

Limit recreation screen time to no more than two hours per day lower levels are associated with additional health benefitsclxxxi


922 Work

Workplace wellness polices programs and strategies that focus on health and wellness improvement rather than dieting and weight loss (eg messaging and competitions) comprehensive programs could include counselling education flexible work scheduling equipment incentives and access to supportive facilities such as locker rooms showers and gyms

Encourage work-life balance so employeesfamilies and individuals have more time for food procurement preparation and physical activity

Adopt and implement the Eat Smart Meet Smart guidelines and enforce worksite policies to make the healthy eating choice the easy choice in all work-related settings

Denormalize current vending mentality and supportenforce the Nutritional Guidelines for Vending Machines in BC Public Buildings

Recognize and reduce obesogenic customs and practices in the workplace (eg coffee and doughnuts at meetingsworkplace celebrations bake sale fundraisers public candy dishes staff weight loss competitions long and inactive meetings)

Workplace policy to support women to breastfeed their children (eg flexible schedules onsite childcare space to pump and store breast milk etc)

Support and promote active transportation to and from work

923 School

Advocate that student weightheightBMI are not collected at school andor included in health report cards This practice creates stigma and does harm Surveillance activities should be considered in the context of a do no harm approach (eg screen for healthy behaviours such as eating breakfast enjoying family meals getting enough sleep)

Specific training in healthy food preparation for cafeteria cooks and for school meal programs

Specific training for facilitators to encourage and promote physical activity across the life stages (eg Healthy Opportunities for Preschoolers (HOP) ndash a learning resource for early learning practitioners discourage weight loss competitionschallenges)

Support physical education specialists in schools

Policies and practice to ensure adequate time at school to eat and be active during the day (eg a reverse recess where play is encouraged first and then allocated time to eat at times of job action ensure that recess is not considered an optional activity or that recess is removed as punishment)

Recognize weight-based bullyingfatism22 in anti-bullying efforts to promote size acceptance

Include media literacy training regarding body image food and nutrition and active lifestyles

Build a whole-school approach to foster health nutrition and physical activity and prevent disordered eating overweight and obesity develop curriculum and provide resources for teachers with a focus on all aspects of health including

o Positive body image resilience and the prevention of disordered eating (eg Action Schools BCrsquos Being Me Promoting Positive Body Image)

22 Fatism is discrimination or prejudice based on a persons weight From ldquoFatismrdquo by Fatismorg 2008 retrieved from httpfatismorg


o Healthy eating and support healthy relationships with food (eg Action Schools BCrsquos Classroom Action Bins amp Action Packs - Healthy Eating)

o Physical activity and physical literacy (eg Hip-Hop to Health Jr Program)

o Preventing disordered eating (eg Family FUNdamentals Project)

o Everybodyrsquos Different A positive approach to teaching about health puberty body image nutrition self-esteem and obesity prevention

o Ensure that children who come to school hungry or without food have access to nutritious food that is received in a non-stigmatizing way

Look at ways to increase the availability and accessibility of nutritious foods

Highlight the value of school-based interventions that focus on behaviours (eg not weight or body fat) and are comprehensive (eg lifestyle curriculum media literacy parental involvement supportive school environments)

Promote breastfeeding as the norm within school curriculum like BCrsquos Health and Career Education

Support and promote active transportation to and from school

Support schools to provide safe healthy environments that encourage active play


924 Leisure

Design the built environment to promote walking and active transportation (eg clean and safe streets quality sidewalks (eg level and well maintained) traffic calming congesting charging pedestrian crossings cycle routes lighting and walking schemes policingcrime reduction)

Recognize and accommodate a diversity of body sizes

Stay Active Eat Healthy program

Provide leisure programs which promote preparing healthy food (eg gardening programs cooking programs such as Cooking Fun for Families or Food Skills for Families community kitchens)

Support for further discussion planning development and implementation of Every Coach a Winner a Northern Health concept to promote vitality messaging across Northern BC in a variety of settings across the life course

Point-of-purchase programs (eg Informed Dining grocery store education for healthy food selection)

Clean and safe spaces in public places to breastfeed

Support clean and safe spaces in public places for active play

Support opportunities for activity by populations with unique circumstances (eg reduce barriers and be inclusive such as KidSport)


Health promotion works through concrete and effective community action in setting priorities making decisions planning strategies and implementing them to achieve better health At the heart of this

process is the empowerment of communities ndash their ownership and control of their own endeavours and destinies


93 Strengthen Community Action

Successful actions to promote a health-focused approach to weight and obesity are planned and implemented through partnerships and collaborations Public private and non-governmental organizations may be involved at local regional provincial and federal levels Examples of partnerships that foster community capacity and support health-focused approach to weight and obesity include

In the framework of the Northern Health Position on Healthy Communities engage with partners at the community level to promote the health-focused approach to weight and obesity

Develop resources to engage the Northern Health Position on Healthy Eating

Develop resources to engage the Northern Health Position on Sedentary Behaviour and Physical Inactivity

Support the vision of Northern Healthrsquos HEAL Network to Connect-Support-Share-Inspire healthy eating active living and food security in community-based partnerships between health and community

Build on community successes and shared learning continue to support existing partnerships and build new partnerships through Northern Healthrsquos HEAL and HEAL for Your Heart seed grants

Translate evidence-based learning to information that is accessible by communities (a knowledge-to-action approach) This approach premises that communities have knowledge that can contribute to the existing research In the promotion of a health-focused approach to weight and obesity this may be community workshops about what health weight and obesity mean to the community and what the community sees is the best path to improvement

Community-based population health interventions to address systematic issues that are obesogenic at the regional municipal and community levels (eg Calgary Health Regionrsquos Toolbox for Community Action)

Address the needs of populations with unique circumstances (eg food access and quality on reserve access to leisure and recreation [eg comprehensive interventions recognize that reduced fees do not solve the issues related to equipment procurement such as appropriate shoes or safety equipment])

Make optimizing growth and development a collective priority for action among government and other sectors

Increase awareness of the benefits of breastfeeding using social marketing

Support partnerships to normalize breastfeeding

Advocate for increased community breastfeeding supports and resources (eg peer groups lactation specialists etc)

Advocate for increased opportunity and support to provide safe recreation environments and equipment particularly in high-risk populations and communities (eg community grants for recreation infrastructure support schools to maintain or improve playground equipment and sports programsequipment)


The responsibility for health promotion in health services is shared among individuals community groups health professionals health service institutions and governments They must work together towards a health care system which contributes to the pursuit of health


94 Develop Personal Skills

A variety of resources and systems are available to support individuals and families to improve health outcomes through awareness engagement education and capacity building Stakeholders should focus on the various levels of behaviour change and construct programs accordingly Examples of programs and campaigns that may encourage the development of personal skills for a health-focused approach to weight and obesity include

Continued promotion of free support resources such as Healthy Families BC PAL Physical Activity Line The Best Chance Child and Youth Mental Health Resources and Better Together BC

Support the development of a publicly available evidence-based and comprehensive health promotion resource that integrates healthy eating active living and addresses other factors which contribute to obesity A gap currently exists for consolidated free publicly available resources that are specific to obesity current resources are disparate and do not specifically address obesity

Develop weight management programs in primary care that are sensitive to delivery across wide geographic spaces different cultures and across literacy levels (eg Lifestyles Program in Cardston AB)

Support enhanced Public Health attention and service delivery towards developing eating competence and reducing sedentary behaviours (eg identify skill development opportunities and best practices in tools for preventing and managing overweight and obesity such as focused eating food tracking food label reading etc)

Develop programming and resources which teach literacy about health and healthy weights including nutrition and food skills (eg cooking shopping gardening) physical activity skills (eg running jumping throwing) and media

Parenting education to support practices that enable the development of healthy relationships with foodeating competence and physical activity

Support initiatives that increase new parents knowledge and skills regarding breastfeeding

95 Reorient Health Services

A broad range of people are available to assist with reorienting health services For example health professionals local government community planners sport and recreation professionals general practitioners allied health professionals and volunteer groups can all work to promote

Enabling people to learn throughout life to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential This has to be facilitated in school home work and community

settings Action is required through educational professional commercial and voluntary bodies and within institutions themselves



the health-focused approach to weight and obesity Examples of these strategic approaches could include

Share materials which support the Edmonton Obesity Staging System (eg EOSS Staging Tool [Appendix G])

Supports including decision support tools and care pathways that support a health-focused approach to weights (eg similar to electronic health records but with diagnostic criteria that promote a health-centric approach such as weight acceleration versus an absolute percentile on growth charts for children and weight stability for adults)

Develop comprehensive guidelines so that all health measurements account for a range of variables that influence health (eg health behaviours fitness levels SES body image satisfaction and weight cycling)clxxxii

Train the Trainer for example provide leadership and training in Northern Health for clear messaging about weight bias (especially among health care providers eg Fraser Health Authority Weight Bias Training) understanding a health-centric approach and the differences of this approach and a weight-centric approach

Integrate ecSatter and ecSatter Inventory in care

Develop community-based support programs and education (eg Lifestyles Program in Cardston AB)

Integrate weight management resources in primary care (eg Best Weights UK Solutions for Public Healthrsquos Brief interventions for weight management Canadian Obesity Networkrsquos 5 Arsquos for Obesity Management 4 Mrsquos of Obesity Assessment)

Promote health-focused messaging about weight and demote messaging for a weight-centric approach the goal is to develop consistent health messages in communities and between organizations

Systematic nutrition and physical activity reminders and training for health care providers and peer educators (eg community-based groups)

In addition to Dietitian Services at Health Link BC help community members and groups gain access to registered dietitians for local nutrition expertise before they are diagnosed with a condition (eg hypertension diabetes hypercholesterolemia allergy etc)

Promote publicly available evidence-based health promotion resources that are provided free (eg Dietitian Services at Health Link BC Healthy Families BC Physical Activity Line)

A gap currently exists for consolidated free publicly available and evidence-based resources that are specific to obesity current resources are disparate and do not specifically address obesity Support the development of a publicly available evidence-based and comprehensive health promotion resource that integrates healthy eating active living and addresses other factors which contribute to obesity

Develop peer programming that supports families including the promotion and supporting of breast feeding (eg Community Mothersrsquo Programme parenting with food)

Promote baby-friendly health care settings

Advocate for and use weight-neutral language in health promotion public health and clinical practiceclxxxiii


Encourage more public health staff to join the Canadian Obesity Network to facilitate access to and exchange of current information evidence and best practices to inform planning and programming that relates to the prevention of overweight and obesity and the promotion of healthy weights in Northern BC

Advocate for and support weight bias training clxxxiv

Implement Health At Every Size in professional practice (eg adopt guidelines)

Collaborate with other health organizations to develop resources that can be used in all regions of the province

100 Conclusion Northern Health is adopting a position on the prevention of overweight and obesity and promoting healthy weights as a modifiable risk factor to improve the quality of life of Northerners The regional messages are consistent with provincial and national messages strategies and initiatives This paper presents evidence-based strategies that have been implemented and proven to support a health-focused approach to weight and obesity in other places These strategies support the comprehensive framework presented by the Ottawa Charter for Health Promotion and support Northern Healthrsquos position

110 Other Resources

Promoting Healthy Weights

British Columbia Healthy Families BC (2012) Being me promoting positive body image Retrieved from httpwwwactionschoolsbccaImagesBeing20Me-WEBpdf

British Columbia Ministry of Health (2010) Growth Chart Training Package

Dietitians of Canada (2012) WHO Growth Chart Training Program

Freedhoff Y amp Sharma A M (2010) Best Weight A practical guide to office-based obesity management Edmonton Alberta Canadian Obesity Network

Provincial Health Services Authority (2012) Promoting Healthy Weights

Promoting Healthy Eating

Northern Health (2012) Position on healthy eating Retrieved from httpwwwnorthernhealthcaAboutUsPositionStatementsAddressingRiskFactorsaspx

Satter E (2008) Eating management to prevent and treat child overweight Retrieved from httpwwwellynsattercomresourceschildoverweightpositionpdf

Satter E (2008) Secrets of feeding a healthy family How to eat how to raise good eaters how to cook Madison WI Kelcy Press

Satter E (2005) Your childrsquos weight Helping without harming Madison WI Kelcy Press

Promoting Physical Activity

Northern Health (2012) Position on sedentary behaviour and physical inactivity Retrieved from httpwwwnorthernhealthcaAboutUsPositionStatementsAddressingRiskFactorsaspx

Canadian Society for Exercise Physiology (2011) Canadian physical activity guidelines and sedentary behaviour guidelines Retrieved from httpwwwcsepcaenglishviewaspx=804

Overweight amp Obesity Work Underway in Canada

British Columbia Select Standing Committee on Health (2006) A strategy for combating childhood obesity and physical inactivity in British Columbia Retrieved from


httpwwwlegbccacmt38thparlsession-2healthreportsRpt-Health-38-2-29Nov2006indexhtm

Canadian Obesity Network (2011) Canadian Summit on Weight Bias and Discrimination Summit Report Retrieved from httpwwwobesitynetworkcafilesWeight_Bias_Summit_Reportpdf

Government of Canada (2010) Curbing childhood obesity A federal provincial and territorial framework for action to promote healthy weights Retrieved from httpwwwphac-aspcgccahp-pshl-mvsframework-cadrepdfccofw-engpdf

Public Health Agency of Canada (2011) Our health our future A national dialogue on healthy weights Retrieved from httpourhealthourfuturegccawp-contentuploads201203OHOFreportS30cpdf

Sharma A (2011 September 8) Albertarsquos obesity initiative Not just diet and exercise Retrieved from httpwwwdrsharmacaalbertas-obesity-initiative-not-just-diet-and-exercisehtml

Overweight amp Obesity Initiatives in Other Places

Reid E M (2008 Spring) Genes load the gun the environment pulls the trigger Obesity among children and adolescents in US Schools Forum on Public Policy ndash Working Papers 1-28 Retrieved from httpforumonpublicpolicycomarchivespring08reidpdf

US Department of Health and Human Services National Institutes of Health (2011) Strategic Plan for NIH Obesity Research A report of the NIH obesity research task force Retrieved from httpwwwobesityresearchnihgovaboutStrategicPlanforNIH_Obesity_Research_Full-Report_2011pdf

Other Helpful Resources

Canadian clinical practice guidelines on the management and prevention of obesity in adults and children Canadian Medical Association Journal 176(8) 1-13 Retrieved from httpwwwcmajcacontent1768S1fullpdf+html

Canadian Obesity Network (2012) 5 Arsquos of Obesity Management Retrieved from httpwwwobesitynetworkcapageaspxpage=2895ampapp=182ampcat1=457amptp=12amplk=noampmenu=37

Evans M (2011) 23 and frac12 hours What is the single best thing we can do for our health YouTube Video Retrieved from httpwwwyoutubecomwatchv=aUaInS6HIGoamplist=PL7C0D460B0AB85735ampindex=1ampfeature=plcp

Lau D C W Douketis J D Morrison K M Hramiak I M amp Sharma A AM (2007) 2006

National Obesity Observatory (2010) National Obesity Observatory website Retrieved from httpwwwnooorguk

National Obesity Observatory (2011 April) Brief interventions for weight management Retrieved from httpwwwnooorgukuploadsdocvid_10702_BIV2pdf

National Institute for Health Clinical Excellence (NICE) (2012) NICE obesity guidance Retrieved from httpwwwideagovukidkcorepagedopageId=5843587

National Institute for Health Clinical Excellence (NICE) (2012) Public health guidance Retrieved from httpguidanceniceorgukPHGWave2053ConsultationLatest

Ontario Medical Association (2005) Obesity prevention Retrieved from httpswwwomaorgHealthPromotionObesityPagesdefaultaspx

Sharma AM (2010) M M M amp M A mnemonic for assessing obesity Obesity Review 11(11) 808-809 doi 101111j1467-789X201000766x


UK Government Office for Science Government Foresight Programme (2007) Tackling Obesities Future Choices ndash Obesity System Atlas Retrieved from httpwwwbisgovukassetsforesightdocsobesity11pdf

US Department of Health Services National Heart Lung and Blood Institute in collaboration with Diabetes and Cancer Institutes (2012) Educational campaign We can Retrieved from httpwwwnhlbinihgovhealthpublicheartobesitywecanindexhtm

i US Department of Health and Human Services (2008) Weight Cycling (NIH Publication No 01-3901) Retrieved from

httpwinniddknihgovpublicationsPDFswtcycling2bwpdf ii Public Health Agency of Canada amp Canadian Institute for Health Information (2011) Obesity in Canada A joint report from the Public Health

Agency of Canada and the Canadian Institute for Health Information Retrieved from httpwwwhealthyenvironmentforkidscaresourcesobesity-in-canada-joint-report

iii Orpana H M Berthelot J-M Kaplan M S Feeny D H McFarland B amp Ross N A (2010) BMI and mortality Results from a national longitudinal study of Canadian adults Obesity Journal Online publication doi101038oby2009191 Retrieved from httpxayimgcomkqgroups919691156873634nameoby2009191apdf

iv World Health Organization (1986) Ottawa charter for health promotion Retrieved from httpwwwphac-aspcgccaph-spdocscharter-chartrepdfcharterpdf

v Shah A H amp Bilal R (2009) Body composition its significance and models for assessment Pakistan Journal of Nutrition 8(2) 198-202 Retrieved from httpscialertnetqredirectphpdoi=pjn2009198202amplinkid=pdf

vi World Health Organization (2012) Obesity and overweight Retrieved from httpwwwwhointmediacentrefactsheetsfs311enindexhtml vii Statistics Canada (2011) Health profile October 2011 Definitions sources and symbols Retrieved from httpwww12statcangccahealth-

sante82-228detailsdownload-telechargerall_geosfinalFootnotes_2011_10_25pdf viii Health Canada (2003) Canadian guidelines for body weight classification in adults Ottawa Minister of Public Works and Government Services

Canada Retrieved from httpwwwhc-scgccafn-analt_formatshpfb-dgpsapdfnutritionweight_book-livres_des_poids-engpdf ix Butryn M L Juarascio A amp Lowe M R (2010) The relation of weight suppression and BMI to bulimic symptoms Abstract retrieved from httponlinelibrarywileycomdoi101002eat20881abstract x Bacon L amp Aphramor L (2011) Weight science Evaluating the evidence for a paradigm shift Nutrition Journal 10(9) 1-13 Retrieved from

httpwwwnutritionjcomcontentpdf1475-2891-10-9pdf xi Shea J L Randell E W amp Sun G (2011) The prevalence of metabolically healthy obese subjects defined by BMI and dual-energy a-ray

absorptiometry Obesity 19(3) 624ndash630 Retrieved from httpwwwnaturecomobyjournalv19n3fulloby2010174ahtml

xii Wildman R P Muntner P Reynolds K McGinn A P Rajpathak S Wylie-Rosett J amp Sowers M-F R (2008) The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering Prevalence and correlates of 2 phenotypes among the US population Archives of Internal Medicine 168(15) 1617-1624 Retrieved from httparchintejamanetworkcomarticleaspxarticleid=770362

xiii Reese M A T B (2008 January) Underweight A heavy concern Todayrsquos Dietitian 10 (1) 56 Retrieved from httpwwwtodaysdietitiancomnewarchivestdjan2008pg56shtml

xiv Troiano R P Frongillo E A Jr Sorbal J amp Levetsky D A (1996) The relationship between body weight and mortality A quantitative analysis of combined information from existing studies International Journal of Obesity and Related Metabolic Disorders Journal of the International Association for the Study of Obesity 20(1) 63-75 Retrieved from httpukpmcacukabstractMED8788324reload=0

xv Reese M A T B (2008 January) Underweight A heavy concern Todayrsquos Dietitian 10 (1) 56 Retrieved from httpwwwtodaysdietitiancomnewarchivestdjan2008pg56shtml xvi US Department of Agriculture amp United States Department of Health and Human Services (2010) Dietary Guidelines for Americans Retrieved

from httphealthgovdietaryguidelinesdga2010DietaryGuidelines2010pdf xvii Health Canada (2006) It‟s your health Obesity Retrieved from httpwwwhc-scgccahl-vsalt_formatspacrb-dgapcrpdfiyh-vsvlife-vieobes-

engpdf xviii British Columbia Provincial Health Services Authority amp British Columbia Mental Health amp Addiction Services (2010) Disordered eating and

Obesity Working together to promote the health of British Columbians Retrieved from httpbitlydisordered_eating_and_obesity_briefing_document

xix Wiklund P Toss F Weinehall L Hallmans G Franks P W Nordstrom A amp Nordstrom P (2008 November) Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women Journal Clinical Endocrinology Metabolism 93(11) 4360ndash4366 Retrieved from httpjcemendojournalsorgcontent93114360fullpdf

xx Geer E B amp Shen W (2009) Gender differences in insulin resistance body composition and energy balance Gender Medicine 6(1) 60ndash75 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC2908522pdfnihms212631pdf

xxi Mayo Clinic Staff (nd) Belly fat in men Why weight loss matters Retrieved from httpwwwmayocliniccomhealthbelly-fatMC00054 xxii Geer E B amp Shen W (2009) Gender differences in insulin resistance body composition and energy balance Gender Medicine 6(1) 60ndash75

Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC2908522pdfnihms212631pdf xxiii World Health Organization (2012) Obesity and overweight Retrieved from httpwwwwhointmediacentrefactsheetsfs311enindexhtml


xxiv Berg F Buechner J amp Partham E (2003 Jan-Feb) Guidelines for childhood obesity prevention programs Promoting healthy weight in

children Journal of nutrition education and behavior 35(1) 1-4 xxv Bacon L amp Aphramor L (2011) Weight science Evaluating the evidence for a paradigm shift Nutrition Journal 10(9) 1-13 Retrieved from

httpwwwnutritionjcomcontentpdf1475-2891-10-9pdf xxvi O‟Hara L amp Gregg J (2010) Don‟t diet Adverse effects of the weight centered health program In F De Meeser S Zibadi amp R R Watson

(Eds) Modern dietary fat intakes in disease promotion (pp 431-442) Abstract retrieved from httpwwwspringerlinkcomcontentv87512x0176l1038

xxvii Bacon L amp Aphramor L (2011) Weight science Evaluating the evidence for a paradigm shift Nutrition Journal 10(9) 1-13 Retrieved from httpwwwnutritionjcomcontentpdf1475-2891-10-9pdf

xxviii Puhl R amp Heuer C (2010 June) Obesity stigma Important considerations for public health American Journal of Public Health 100(6) 1019-1028 Retrieved from httpajphaphapublicationsorgdoipdf102105AJPH2009159491

xxix Butryn M L Juarascio A amp Lowe M R (2010 November) The relation of weight suppression and BMI to bulimic symptoms Abstract retrieved from httponlinelibrarywileycomdoi101002eat20881abstract xxx Canadian Obesity Network (2011) Canadian summit on weight bias and discrimination Summit report January 2011 Retrieved from

httpwwwobesitynetworkcafilesWeight_Bias_Summit_Reportpdf xxxi Puhl R amp Heuer C (2010 June) Obesity stigma Important considerations for public health American Journal of Public Health 100(6) 1019-1028 Retrieved from httpajphaphapublicationsorgdoipdf102105AJPH2009159491 xxxii Canadian Obesity Network (2011) Canadian summit on weight bias and discrimination Summit report January 2011 Retrieved from

httpwwwobesitynetworkcafilesWeight_Bias_Summit_Reportpdf xxxiii Council on Size and Weight Discrimination (nd) Statistics on weight discrimination A waste of talent Retrieved from

httpwwwcswdorgdocsstatshtml xxxiv British Columbia Ministry of Health (2005) Food health and well-being in British Columbia Public Health Officer‟s Report 2005 Retrieved from

httpwwwhealthgovbccaphopdfphoannual2005pdf xxxv Bacon L amp Aphramor L (2011) Weight science Evaluating the evidence for a paradigm shift Nutrition Journal 10(9) 1-13 Retrieved from

httpwwwnutritionjcomcontentpdf1475-2891-10-9pdf xxxvi Ibid xxxvii Shields M Tremblay M S Laviolette M Craig C L Janssen I amp Gorber S C (2010 March) Fitness of Canadian adults Results from

the 2007 ndash 2009 Canadian Health Measures Survey Statistics Canada Health Reports 21(1) 1-16 Retrieved from httpwwwstatcangccapub82-003-x2010001article11064-enghtm

xxxviii Statistics Canada (2012) Health profile Canada Statistics Canada (Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228detailspagecfmLang=EampTab=1ampGeo1=PRampCode1=59ampGeo2=PRampCode2=01ampData=RateampSearchText=British20ColumbiaampSearchType=ContainsampSearchPR=01ampB1=AllampCustom=ampGeoLevel=PRampGeoCode=59

xxxix Statistics Canada (2012) Health profile British Columbia Statistics Canada (Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228detailspagecfmLang=EampTab=1ampGeo1=PRampCode1=59ampGeo2=PRampCode2=01ampData=RateampSearchText=British20ColumbiaampSearchType=ContainsampSearchPR=01ampB1=AllampCustom=ampGeoLevel=PRampGeoCode=59

xl Statistics Canada (2012) Health profile Northwest Health Service Delivery Area 5951-H Statistics Canada (Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228indexcfmLang=E

xli Statistics Canada (2011) Statistics Canada community profile Health profile Northern Interior Health service delivery area 5952-H Retrieved from httpwww12statcangccahealth-sante82-228detailspagecfmLang=EampTab=1ampGeo1=HRampCode1=5952ampGeo2=PRampCode2=59ampData=RateampSearchText=Northern20Interior20Health20Service20Delivery20AreaampSearchType=ContainsampSearchPR=01ampB1=AllampCustom

xlii Statistics Canada (2012) Health profile Northeast Health Service Delivery Area 5953-E Statistics Canada (Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228indexcfmLang=E

xliii Statistics Canada (2012) Health profile Peer group Statistics Canada (Peer Group E Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228search-recherchelstpagecfmLang=EampGeoLevel=PEERampGeoCode=05

xliv Statistics Canada (2012) Health profile Peer group Statistics Canada (Peer Group H Catalogue No 82-228-XWE) Retrieved from httpwww12statcangccahealth-sante82-228search-recherchelstpagecfmLang=EampGeoLevel=PEERampGeoCode=05

xlv McIntyre L amp Tarasuk V (2002) Food security as a determinant of health Paper presentation for The Social Determinants of Health across the Life-Span Conference Toronto November 2002 Retrieved from httpwwwphac-aspcgccaph-spoi-arpdf08_food_epdf

xlvi Drewnowski A (2004 October) Obesity and the food environment Dietary energy density and dietary costs American Journal of Preventive Medicine 27 (3) 154-162 Retrieved from httpwwwajpmonlineorgarticleS0749-3797(04)00150-3abstract

xlvii Casey P H Simpson P M Gossett J M Bogle M L Champagne C M Connell C Harsha D McCabe-Sellers B Robbins J M Stuff J E amp Weber J (2006 November) The association of child and household food insecurity with childhood overweight status Pediatrics 118(5) 1406 -1413 Retrieved from httpwwwpediatricsdigestmobicontent1185e1406fullpdf+html

xlviii Drewnowski A (2004 October) Obesity and the food environment Dietary energy density and dietary costs American Journal of Preventive Medicine 27 (3) 154-162 Retrieved from httpwwwajpmonlineorgarticleS0749-3797(04)00150-3abstract

xlix Richards R amp Smith C (2010) Investigation of the hungerndashobesity paradigm among shelter-based homeless women living in Minnesota Journal of Hunger amp Environmental Nutrition 5(3) 339-359 Retrieved from httpwwwtandfonlinecomdoiabs101080193202482010504100


l Irwin J D Ng V K Rush T J Nguyen C amp He M (2007) Can food banks sustain nutrient requirements A case study in southwestern

Ontario Canadian Journal of Public Health 98(1) 17 ndash 20 li Tse C amp Tarasuk V (2008) Nutritional assessment of charitable meal programs serving homeless people in Toronto Public Health Nutrition

11(12) 1296ndash1305 lii Irwin J D Ng V K Rush T J Nguyen C amp He M (2007) Can food banks sustain nutrient requirements A case study in southwestern

Ontario Canadian Journal of Public Health 98(1) 17 ndash 20 liii British Columbia Recreation and Parks Association amp Heart and Stroke Foundation of BC amp Yukon (nd) Everybody active Why donrsquot people participate Retrieved from httpwwwphysicalactivitystrategycapdfsWhy_Dont_People_Participatepdf liv British Columbia Provincial Health Services Authority (PHSA) (2010) Final report Physical activity working group recommendations for obesity

reduction in BC Retrieved from httpwwwphsacaNRrdonlyres2E9592B9-C3EE-4F47-A723-4DB330553E8757544ORS_WG_PhysicalActivityFINALReportApril192010pdf

lv Public Health Agency of Canada (2012) Curbing childhood obesity A federal provincial and territorial framework for action to promote healthy weights Retrieved from httpwwwphac-aspcgccahp-pshl-mvsframework-cadrepdfccofw-engpdf

lvi ODea J (2005) Prevention of child obesity bdquoFirst do no harm‟ Health Education Research Theory amp Practice 20 (2) 259ndash265 Retrieved from httpheroxfordjournalsorgcontent202259fullpdf+html

lvii Ibid lviii British Columbia Provincial Health Services Authority amp British Columbia Mental Health amp Addiction Services (2010) Disordered eating and

obesity Working together to promote the health of British Columbians Retrieved from httpbitlydisordered_eating_and_obesity_briefing_document

lix Ikeda J Crawford P B amp Woodward-Lopez G (2006) BMI screening in schools Helpful or harmful Health Education Research 21(6) 761-769 Retrieved from httpheroxfordjournalsorgcontent216761full lx Sharma A (2011) Inactivity does not explain Canadarsquos obesity epidemic Retrieved from httpwwwdrsharmacainactivity-does-not-explain-

canadas-obesity-epidemichtml lxi Nihiser A J Lee S M Wechsler H McKenna M Odom E Reinold C Thompson D amp Grummer-Strawn L (2009) BMI measurement in

schools Pediatrics 124(S1) 89-98 lxii American Heart Association amp American Stroke Association (nd) Policy position statement on body mass index (BMI) surveillance and

assessment in schools Retrieved from httpwwwheartorgidcgroupsheart-publicwcmadvdocumentsdownloadableucm_428412pdf

lxiii Ikeda J Crawford P B amp Woodward-Lopez G (2006) BMI screening in schools Helpful or harmful Health Education Research 21(6) 761-769 Retrieved from httpheroxfordjournalsorgcontent216761full

lxiv Nihiser A J Lee S M Wechsler H McKenna M Odom E Reinold C Thompson D amp Grummer-Strawn L (2009) BMI measurement in schools Pediatrics 124(S1) 89-97 Retrieved from httppediatricsaappublicationsorgcontent124Supplement_1S89fullpdf+html

lxv Ibid lxvi Ikeda J Crawford P B amp Woodward-Lopez G (2006) BMI screening in schools Helpful or harmful Health Education Research 21(6) 761-769 Retrieved from httpheroxfordjournalsorgcontent216761full lxvii Satter E (2007) Feeding dynamics of child overweight definition prevention and intervention In W O‟Donahue B A Moore amp B Scott

Pediatric and adolescent obesity treatment A comprehensive handbook (pp 291-318) New York Taylor and Francis lxviii Ibid lxix Statistics Canada (2011) Statistics Canada community profiles Health profile Northern Interior Health service delivery area 5952-H Retrieved

from httpwww12statcangccahealth-sante82-228detailspagecfmLang=EampTab=1ampGeo1=HRampCode1=5952ampGeo2=PRampCode2=59ampData=RateampSearchText=Northern20Interior20Health20Service20Delivery20AreaampSearchType=ContainsampSearchPR=01ampB1=AllampCustom

lxx Tobin P (2007) The social and cultural experience of food security in the Takla Lake First Nation informing public health (Master‟s thesis) University of Northern British Columbia Prince George BC Catherine can you please confirm this is APA

lxxi Foulds H J A Bredin S S D amp Warburton D E R (2011) National prevalence of obesity The prevalence of overweight and obesity in British Columbian Aboriginal adults Obesity 12 4-11 Retrieved from httponlinelibrarywileycomdoi101111j1467-789X201000844xpdf

lxxii Public Health Agency of Canada (2012) Risk factor atlas Retrieved from httpwwwphac-aspcgccacd-mcatlasindex-engphp lxxiii British Columbia Recreation and Parks Association amp Heart and Stroke Foundation of BC amp Yukon (nd) Everybody active Why donrsquot people participate Retrieved from httpwwwphysicalactivitystrategycapdfsWhy_Dont_People_Participatepdf lxxiv Ibid lxxv Wiklund P Toss F Weinehall L Hallmans G Franks P W Nordstrom A amp Nordstrom P (2008 November) Abdominal and gynoid fat

mass are associated with cardiovascular risk factors in men and women Journal Clinical Endocrinology Metabolism 93(11) 4360ndash4366 Retrieved from httpjcemendojournalsorgcontent93114360fullpdf

lxxvi Northern Health (2010) Where are the Men Chief medical health officerrsquos report on the health amp wellbeing of men and boys in northern BC Northern Health Chief Medical Officer Dr D Bowering Retrieved from httpwwwnorthernhealthcaPortals0Your_HealthMensHealthnorthen-health-mens-health-reportpdf

lxxvii Ibid lxxviii Ibid lxxix World Health Organization (2012) Obesity and overweight Retrieved from httpwwwwhointmediacentrefactsheetsfs311enindexhtml


lxxx US Department of Agriculture amp US Department of Health and Human Services (2010) Dietary Guidelines for Americans Retrieved from

httphealthgovdietaryguidelinesdga2010DietaryGuidelines2010pdf lxxxi Centers for Disease Control and Prevention (2010) Obesity amp genetics Retrieved from httpwwwcdcgovFeaturesObesity lxxxii Yang W Kelly T amp He J (2007) Genetic epidemiology of obesity Epidemiologic Reviews 29(1) 49-61 Retrieved from

httpepirevoxfordjournalsorgcontent29149fullpdf lxxxiii Loos R J F amp Bouchard C (2003) Obesity-is it a genetic disorder Journal of Internal Medicine 254 401ndash425 Retrieved from

httponlinelibrarywileycomdoi101046j1365-2796200301242xpdf lxxxiv O‟Rahilly S amp Farooqi I S (2006) Genetics of obesity Philosophical Transactions of the Royal Society of Biological Sciences 361 1095ndash

1105 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC1642700pdfrstb20061850pdf lxxxv Poirier P Giles T D Bray G A Hong Y Stern J S Pi-Sunyer FX amp Eckel R H (2006) Obesity and cardiovascular disease

Pathophysiology evaluation and effect of weight loss Journal of The American Heart Association Arteriosclerosis Thrombosis and Vascular Biology 26 968-976 Retrieved from httpatvbahajournalsorgcontent265968fullpdf

lxxxvi US Department of Agriculture amp US Department of Health and Human Services (2010) Dietary Guidelines for Americans Retrieved from httphealthgovdietaryguidelinesdga2010DietaryGuidelines2010pdf

lxxxvii British Columbia Provincial Health Services Authority (PHSA) (2010) Final report PHSAworking group on food recommendations for obesity reduction in BC Retrieved from httpwwwcrfacanews2010crfa_talks_nutrition_with_ontario_and_bc_ministries_reportpdf

lxxxviii UK Department for Business Innovation amp Skills Government Foresight Programme (2007) Tackling Obesities Future choices ndash obesogenic environments ndash summary of discussion workshops Retrieved from httpwwwbisgovukassetsforesightdocsobesity07pdf

lxxxix Powell P Spears K and Rebori M (2010) What is an obesogenic environment Retrieved from httpwwwunceunredupublicationsfileshn2010fs1011pdf

xc Swinburn B Eggar G amp Raza F (1999) Dissecting obesogenic environments The development and application of a framework for identifying and prioritizing environmental interventions for obesity Preventive Medicine 29(6) 563-70

xci US Department of Agriculture amp US Department of Health and Human Services (2010) Dietary Guidelines for Americans Retrieved from httphealthgovdietaryguidelinesdga2010DietaryGuidelines2010pdf

xcii British Columbia Provincial Health Services Authority (PHSA) (2010) Final report PHSAworking group on food recommendations for obesity reduction in BC Retrieved from httpwwwcrfacanews2010crfa_talks_nutrition_with_ontario_and_bc_ministries_reportpdf

xciii Ibid xciv US Department of Agriculture amp US Department of Health and Human Services (2010) Dietary Guidelines for Americans xcv US Department of Agriculture amp US Department of Health and Human Services (2010) Dietary Guidelines for Americans xcvi British Columbia Provincial Health Services Authority (PHSA) (2010) Final report PHSAworking group on food recommendations for obesity

reduction in BC Retrieved from httpwwwcrfacanews2010crfa_talks_nutrition_with_ontario_and_bc_ministries_reportpdf xcvii Grun F amp Blumberg B (2009) Mini-review The case for obesogens Molecular and Cellular Endocrinology 23(8) 1127-1134 xcviii Ibid xcix Labelle C (2010 August) Endocrine disruptors update Retrieved from httppublicationsgccaCollection-RLoPBdPBPprb0001-ehtm c Grun F amp Bluberg B (2009) Endocrine disrupters as obesogens Molecular and Cellular Endocrinology 304(1-2) 19-29 Retrieved from

httpwwwncbinlmnihgovpubmed19433244 ci Chiolero A Faeh D Paccaud F amp Cornuz J (2008 April) Consequences of smoking for body weight body fat distribution and insulin

resistance American Journal of Clinical Nutrition 87 (4) 801-809 Retrieved from httpwwwajcnorgcontent874801fullpdf+html cii Soni A C Conroy M B Mackey R H amp Kuller L H (2011 March) Ghrelin leptin adiponectin and insulin levels and concurrent and future

weight change in overweight postmenopausal women Menopause 18(3) 296-301 Retrieved from httpwwwncbinlmnihgovpubmed21449093

ciii Avena N M Rada P amp Hoebel B G (2009) Sugar and fat bingeing have notable differences in addictive-like behavior The Journal of Nutrition 139 623ndash628 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC2714381pdfnut139623pdf

civ Avena N M Rada P amp Hoebel B G (2007) Evidence for sugar addiction Behavioral and neurochemical effects of intermittent excessive sugar intake Neuroscience and Biobehavioral Reviews 32(1) 20-39 Retrieved from httpwwwncbinlmnihgovpubmed17617461

cv Yanovski S (2003) Sugar and fat Cravings and aversions American Society for Nutritional Sciences Symposium Sugar and Fat ndash From Genes to Culture (pp 835-837) Retrieved from httpjnnutritionorgcontent1333835Sfullpdf+html

cvi British Columbia Provincial Health Services Authority (PHSA) (2010) Final report PHSAworking group on food recommendations for obesity reduction in BC Retrieved from httpwwwcrfacanews2010crfa_talks_nutrition_with_ontario_and_bc_ministries_reportpdf

cvii Bacon V L amp Russell P J Addiction and the college athlete The multiple addictive behaviors questionnaire (MABQ) with college athletes Retrieved from httpwwwthesportjournalorgarticleaddiction-and-college-athlete-multiple-addictive-behaviors-questionnaire-mabq-college-athlet

cviii Willms J D (2004) Vulnerable teens A study of obesity poor mental health and risky behaviours among adolescents in Canada Summary of results from Canadian Research Institute for Social Policy University of New Brunswick Retrieved from httpwwwcihicaCIHI-ext-portalpdfinternetWILLMS_VULNERABLE_TEENS_EN cx Gagnon-Girouard M P Beacutegin C Provencher V Tremblay A Mongeau L Boivin S amp Lemieux S (2010 June) Psychological impact of a

ldquohealth-at-every-sizerdquo intervention on weight preoccupied overweightobese women Journal of Obesity


cxi McElroy S L Kotwal R Malhotra S Nelson E B Keck P E Jr amp Nemeroff C B (2004 May) Are mood disorders and obesity related A

review for the mental health professional Journal of Clinical Psychiatry 65(5) 634-651 Retrieved from httparticlepsychiatristcomdao_1-loginaspID=10000873ampRSID=39321292739327

cxii Patel S R amp Hu F B (2008) Short sleep duration and weight gain A systematic review Obesity 16 643ndash653 Retrieved from httpwwwnaturecomobyjournalv16n3pdfoby2007118apdf cxiii Higuchi S Motohashi Y Liu Y Ahra M amp Kaneko Y (2003) Effects of VDT tasks with a bright display at night on melatonin core

temperature heart rate and sleepiness Journal of Applied Physiology 94 1773-1776 cxiv Patel S R Malhotra A White D P Gottlieb D J amp Hu F B (2006) Association between reduced sleep and weight gain in women

American Journal of Epidemiology 164 (10) 947-954 Retrieved from httpajeoxfordjournalsorgcontent16410947fullpdf+html cxv Spiegel K Tasali E Penev P amp Van Cauter E Sleep curtailment in healthy young men is associated with decreased leptin levels elevated ghrelin levels and increased hunger and appetite Annals of Internal Medicine 141 846ndash850 cxvi Benedict C Brooks S J ODaly O G Almegraven M S Morell A Aringberg K Gingnell M Schultes B Hallschmid M Broman J-E Larsson

E-M amp Schioumlth H B (2012 March) Acute sleep deprivation enhances the brains response to hedonic food stimuli An fMRI study Journal of Clinical Endocrinology amp Metabolism 97(3) 443-447 Abstract retrieved from httpjcemendojournalsorgcontent973E443

cxvii Patel S R amp Hu F B (2008) Short sleep duration and weight gain A systematic review Obesity 16 643ndash653 Retrieved from httpwwwnaturecomobyjournalv16n3pdfoby2007118apdf cxviii Gill T P (1997) Key issues in the prevention of obesity British Medical Bulletin 53(2) 359-388 Retrieved from httpbmboxfordjournalsorgcontent532359fullpdf cxix Johnson D B Gestein D E Evans A E amp Woodward-Lopez G (2006) Preventing obesity A life cycle perspective Journal of the

American Dietetic Association 106(1) 97-102 cxx American Dietetic Association American Society of Nutrition Siega-Riz A M amp King J C (2009) Position of the American Dietetic

Association and American Society for Nutrition Obesity reproduction and pregnancy outcomes Journal of American Diet Association 109(5) 918-27

cxxi Health Canada (2009) Canadian gestational weight gain recommendations Retrieved from httpwwwhc-scgccafn-annutritionprenatalqa-gest-gros-qr-engphp

cxxii Mumford S L Siega-Riz A M Herring A Evenson K R (2008 October) Dietary restraint and gestational weight gain Journal of the American Dietetic Association 108(10) 1646-53 Abstract retrieved from httpwwwncbinlmnihgovpubmed18926129

cxxiii Dietitians of Canada (2012) World Health Organization growth charts adapted for Canada Retrieved from httpwwwdietitianscaSecondary-PagesPublicWHO-Growth-Chartsaspx

cxxiv World Health Organization (2009) World Health Organization child growth standards and the identification of severe acute malnutrition Retrieved from httpwwwwhointnutritionpublicationsseveremalnutrition9789241598163_engpdf

cxxv Monasta L Batty G D Cattaneo A Lutje V Ronfani L Van Lenthe F J amp Brug J (2010 October) Early-life determinants of overweight and obesity a review of systematic reviews Obesity Reviews 11(10) 695-708 Abstract retrieved from httpwwwncbinlmnihgovpubmed20331509

cxxvi Health Canada (2004) Exclusive breastfeeding duration 2004 Health Canada recommendation Retrieved from httpwwwhc-scgccafn-analt_formatshpfb-dgpsapdfnutritionexcl_bf_dur-dur_am_excl-engpdf

cxxvii Satter E (2000) Child of mine Feeding with love and good sense Boulder CO Bull Publishing cxxviii Zlotkin S H (1996) A review of the ldquoCanadian nutrition recommendations update Dietary fat and childrenrdquo Journal of Nutrition 126(4)1022 ndash

1027 cxxix Satter E (2008) Secrets of feeding a healthy family How to eat how to raise good eaters how to cook Madison WI Kelcy Press cxxx Zlotkin SH (1996) A review of the ldquoCanadian nutrition recommendations update Dietary fat and childrenrdquo The Journal of Nutrition126(4)

1022 ndash 1027 cxxxi Nihiser A J Lee S M Wechsler H McKenna M Odom E Reinold C Thompson D amp Grummer-Strawn L (2009 September) BMI

measurement in schools Pediatrics 124 (S1) 89-97 Retrieved from httppediatricsaappublicationsorgcontent124Supplement_1S89fullpdf+html

cxxxii Dietitians of Canada Canadian Pediatric Society College of Family Physicians of Canada amp Community Health Nurses of Canada (2010) Promoting optimal monitoring of child growth in Canada Using the new WHO growth charts A collaborative public policy statement Canada Retrieved from httpwwwcpscaenglishstatementsNgrowth-charts-statement-FULLpdf

cxxxiii Benedict C Brooks S J O Daly O G Almegraven M S Morell A Aringberg K Gingnell M Schultes B Hallschmid M Broman J-E Larsson E-M amp Schioumlth H B (2012 March) Acute sleep deprivation enhances the brains response to hedonic food stimuli An fMRI study Journal of Clinical Endocrinology amp Metabolism 97(3) 443-447 Abstract retrieved from httpjcemendojournalsorgcontent973E443

cxxxiv Satter E (2005) Your childrsquos weight Helping without harming Birth through adolescence Madison WI Kelcy Press cxxxv Ibid cxxxvi Sheppard F (2007) Focus on food regulation A strategy for childhood obesity prevention Dieticians of Canada Paediatric Nutrition 5(3) 1 ndash

7 cxxxvii Satter E (2000) Child of mine Feeding with love and good sense Boulder CO Bull Publishing cxxxviii Clark H R Goyder E Bissell P Blank L amp Peters J (2007 June) How do parents child-feeding behaviours influence child weight

Implications for childhood obesity policy Journal of Public Health 29(2)132-41 Abstract retrieved from httpwwwncbinlmnihgovpubmed17442696


cxxxix Birch L L McPhee L Shoba B C Steinberg L amp Krehbiel R (1987) bdquoClean up your plate‟ Effects of child feeding practices on the

conditioning of meal size Learning and Motivation 18 301-317 cxl Birch L L (1998) Psychological influences on the childhood diet The Journal of Nutrition 128 407 ndash 410 cxli Hubbs-Tait L Kennedy T S Page M C Topham G L amp Harrist A W (2008) Parental feeding practices predict authoritative

authoritarian and permissive parenting styles Journal of American Dietetic Association 108(7) 1154-1161

cxlii Ibid cxliii Golan M (2006 April) Parents as agents of change in childhood obesity ndash from research to practice International Journal of Pediatric Obesity 1(2) 66-76 Retrieved from httpaix1uottawaca~nedwardspdfGolan20200620MIP20Oct200720Searchpdf cxliv Kater K J (2005) Healthy body image Teaching kids to eat and love their bodies too (2nd ed) Seattle WA National Eating Disorders

Association cxlv Neumark-Sztainer D (2005) ldquoIrsquom like so fatrdquo Helping your teen make healthy choices about eating and exercise in a weight-obsessed world

New York NY The Guilford Press cxlvi Newmark-Sztainer D Wall M Guo J Story M Haines J amp Eisenberg M (2006) Obesity disordered eating and eating disorders in a

longitudinal study of adolescents How do dieters fare five years later Journal of the American Dietetic Association 106 559 ndash 568 cxlvii Ibid cxlviii Haines J amp Neumark-Sztainer D (2006) Prevention of eating disorders and obesity A consideration of shared risk factors Health Education Research 21(6) 770-782 Retrieved from httpheroxfordjournalsorgcontent216770fullpdf+html cxlix Hawks S R amp Gast J A (2000) The ethics of promoting weight loss Healthy Weight Journal 14 25 ndash 26 cl British Columbia Recreation and Parks Association (2007) BC healthy living allowance physical activity strategy Retrieved from

httpwwwphysicalactivitystrategycawpwp-contentuploads200806bchla_physicalactivitystrategypdf cli Levy-Milne R (2004) British Columbia nutrition survey Report on seniorsrsquo nutritional health Prepared for BC Ministry of Health Services

Vancouver BC University of British Columbia Retrieved from httpwwwhealthgovbccalibrarypublicationsyear2004seniors_reportpdf

clii Villareal D Apovian C M Kushner R amp Klein S (2005) Obesity in older adults Technical review and position statement of the American Society for Nutrition and NAASO The Obesity Society The American Journal of Clinical Nutrition 82 923ndash34 Retrieved from httpwwwnutritionorgmedianewsfact-sheets-and-position-papersObesity20in20Older20Adults20joint20position20paperpdf

cliii Paterson D H amp Warburton D E R (2010) Physical activity and functional limitations in older adults A systematic review related to Canadas physical activity guidelines International Journal of Behavioral Nutrition and Physical Activity 7(38) 1-22 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC2882898pdf1479-5868-7-38pdf

cliv Strawbridge W J Deleger S Roberts R E amp Kaplan G A (2002) Physical activity reduces the risk of subsequent depression for older adults American Journal of Epidemology 156(4) 328-34

clv Nguyen H Q Thomas Koepsell T Unuumltzer J Larson E amp LoGerfo J P (2008 August) Depression and use of a health planndashsponsored physical activity program by older adults American Journal of Preventive Medicine 35(2) 111ndash117 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC2496994pdfnihms59422pdf

clvi Lautenschlager N T Osvaldo P Almeida O P Flicker L amp Janca A (2004) Can physical activity improve the mental health of older adults Annals of General Hospital Psychiatry 3 (12) 1-5 Retrieved from httpwwwncbinlmnihgovpmcarticlesPMC449721pdf1475-2832-3-12pdf

clvii Gaesser G A Angadi S S amp Sawyer B J (2011) Exercise and diet independent of weight loss improve cardiometabolic risk profile in overweight and obese individuals The Physician and Sportsmedicine 39(2) Retrieved from httpsphyssportsmedorgdoi103810psm2011051898

clviii Anderson J W Konz E C Frederich R C amp Wood C L (2001) Long-term weight-loss maintenance A meta-analysis of US studies American Journal of Clinical Nutrition 74(5) 578-584 Retrieved from httpwwwajcnorgcontent745579fullpdf+html

clix Pagano-Therrien J amp Katz D L (2003 March) The low-down on low-carbohydrate diets The Nurse Practitioner 28(3) 5 14 Abstract retrieved from httpwwwncbinlmnihgovpubmed12800688

clx O‟Reilly C (2010) Weighing in on the health and ethical implications of British Columbiarsquos weight-centered health paradigm (Master‟s thesis defense power point) Retrieved from httpubcacademiaeduCaitlinOReillyPapers704020Weighing_in_on_the_Health_and_Ethical_Implications_of_British_Columbias_Weight-centered_Health_Paradigm_Masters_of_Public_Policy_Capstone_Defense

clxi Gaesser G A Angadi S S amp Sawyer B J (2011) Exercise and diet independent of weight loss improve cardiometabolic risk profile in overweight and obese individuals The Physician and Sportsmedicine 39(2) Retrieved from httpsphyssportsmedorgdoi103810psm2011051898

clxii National Institute for Clinical Excellence (NICE) (2006) Obesity Guidance on the prevention identification assessment and management of overweight and obesity in adults and children Clinical Guidelines Retrieved from httpwwwniceorguknicemedialive110003036530365pdf

clxiii Gaesser G A Angadi S S amp Sawyer B J (2011) Exercise and diet independent of weight loss improve cardiometabolic risk profile in overweight and obese individuals The Physician and Sportsmedicine 39(2) Retrieved from httpsphyssportsmedorgdoi103810psm2011051898

clxiv Statistics Canada (2011) Canadian community health survey Annual component (CCHS) Retrieved from httpwww23statcangcca81imdbp2SVplFunction=getSurveyampSDDS=3226amplang=enampdb=imdbampadm=8ampdis=2


clxv Barr S (2011) The obesity of epidemic Are increased intakes of sugarscarbohydrates the most probable cause The University of British

Columbia Vancouver BC clxvi Satter E (2008) Secrets of feeding a healthy family How to eat how to raise good eaters how to cook Madison Wisconsin Kelcy Press clxvii Day M (2012) Clinical management strategies for overweight obese or at risk children Paper written for Population and Public Health

Victoria BC clxviii Shivers J Wu V Vance L amp Close K (2012 April) Close concerns Stopping the gain Close Concerns Healthcare Information Firm

Retrieved from httpwwwdrsharmacaobesity-close-concerns-stopping-the-gainhtml clxix Sharma AM (2010) M M M amp M A mnemonic for assessing obesity Obesity Review 11(11) 808-809 doi 101111j1467-

789X201000766x clxx Ibid clxxi Hill J O (2006) Understanding and addressing the epidemic of obesity An energy balance perspective Endocrine Reviews 27(7) 750ndash761

Retrieved from httpedrvendojournalsorgcontent277750fullpdf+html clxxii Padwal R S Pajewski N M Allison D B amp Sharma A M (2011 October) Using the Edmonton obesity staging system to predict mortality

in a population-representative cohort of people with overweight and obesity Canadian Medical Association Journal 183(14) 1059 ndash 1066 Retrieved from httpwwwcmajcacontent18314E1059fullpdf

clxxiii Sharma A M amp Kushner R F (2009) A proposed clinical staging system for obesity International Journal of Obesity 33(3) 289-295 clxxiv Sokar-Toddl H B amp Sharma A M (2004) Obesity research in Canada Literature overview of the last 3 decades Obesity Research 12 (10)

1547ndash1553 Retrieved from httpwwwnaturecomobyjournalv12n10pdfoby2004194apdf clxxv Canadian Institutes of Health Research (2010) Bibliometric study of obesity research in Canada 1998-2007 Retrieved from httpwwwcihr-

irscgccae41601html clxxvi Buchwald H (2007) Surgical intervention for the treatment of morbid obesity and the dyslipidemias Future Lipidology 2(5) 513-525 clxxvii Lau D C W (2006) Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and

children Canadian Medical Association Journal 176 (8) 1103-1106 Synopsis for the Obesity Canada Clinical Practice Guidelines Steering Committee and Expert Panel Retrieved from 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children | Canadian Obesity Network

clxxviii Alberta Health Services (2012) Weight wise adult weights management clinic Programs and services Retrieved from httpwwwalbertahealthservicescaservicesasppid=serviceamprid=1008784

clxxix Dietitians of Canada (2011) Strengthening the Canadian health system A call to action from dietitians Submission to the Senate Committee on Social Affairs Science and Technology Retrieved from httpwwwdietitianscaDownloadable-ContentPublic2011-11-10-Senate-Committee-SAST-Health-Accord_finaspx

clxxx Willows N D Hanley A J G amp Delormier T (2012) A socio-ecological framework to understand weight-related issues in Aboriginal children in Canada Applied Physiology Nutrition and Metabolism 37 1ndash13 Retrieved from httpwwwnrcresearchpresscomdoipdf101139h11-128

clxxxi Canadian Society for Exercise Physiology (2011) Sedentary behaviour guidelines Retrieved from httpwwwparticipactioncomen-usGet-InformedSedentary-Behaviour-Guidelinesaspx

clxxxii O‟Reilly C amp Sixsmith J (2012) From theory to policy Reducing harms associated with the weight-centered health paradigm Fat Studies An Interdisciplinary Journal of Body Weight and Society 1(1) 97 ndash 113

clxxxiii O‟Reilly C (2010) Weighing in on the health and ethical implications of British Columbiarsquos weight-centered health paradigm (Master‟s thesis defense power point) Retrieved from httpubcacademiaeduCaitlinOReillyPapers704020Weighing_in_on_the_Health_and_Ethical_Implications_of_British_Columbias_Weight-centered_Health_Paradigm_Masters_of_Public_Policy_Capstone_Defense

Northern Health Position on Health Weight and Obesity June 27 2012 ndash Appendix A Page 1 of 3

Appendix A Limitations of BMI

What is BMI Body mass index (BMI) was developed to be a simple means of classifying sedentary populations with an average body compositioni BMI is widely used as it is non-invasive test requiring little skill or expensive equipment to perform According to the World Health Organization (WHO) and Health Canada guidelines health risk levels are associated with each of the following BMI categories (Table 1) Intended to be a population measure BMI has evolved in practice to a method of using an individualrsquos body weight to determine health risk As such there are some concerns with the nature and use of the BMI These concerns are summarized in this appendix

Table 1 Adult Health Risk Classification According to BMIii

BMI Category Classification Risk of Developing Health

Problems



Measuring BMI in Adults For adults (age 18 and older) BMI is calculated using a personrsquos weight and height

body weight (kg) (height [m])2

BMI is only intended to be used by those aged 18 years and over (excluding pregnant and lactating females and persons less than 3 feet [0914 metres] tall or greater than 6 feet 11 inches [2108 metres])iii

Measuring BMI in Children For children in Canada gender-specific BMI-for-age growth charts may be used to screen for risk of over and underweight in children ages 2 to 18 years (WHO Growth Charts for Canada) With increasing age BMI increases are anticipated (eg influenced by the age sex and pubertal maturation of the child)iv However the Northern Health Position on Health Weight and Obesity promotes that the focus remain on health and not weight As such we promote longitudinal growth monitoring and sustaining growth along a consistent growth curve rather than subscribe to a BMI-for-age


Assumptions in BMI BMI is a proxy measure of adiposity1 It assumes a consistent proportion of fat lean mass bone cartilage water weight and other components BMI fails to consider factors such as frame size and muscularity Consequently it may underestimate or overestimate health risks in certain adults including highly muscular adults adults who naturally have a very lean body build young adults who have not reached full growth and adults over 65 years of agev vi At the individual level BMI incorrectly assumes that lean body mass is constant at any given height so any BMI change is a change in body fat Thus it does not reflect the substantial variation in adiposity that can occur at similar BMIs For example young women of identical height weight and BMI a plusmn 20 range of lean body mass is associated with a remarkable range of fat content (total body fatbody weight) from 10 to 40vii

Is BMI Accurate in Assessing Health Recent research questions whether higher BMIs are a risk for poor health In one study large population data sets were analyzed to determine that overweight (BMI of 25 to 30) was associated with a decrease in relative risk of mortality and that obesity (a BMI of 30 to 35) was only associated with a modest increase in mortality riskviii Similarly another recent study determines that between one-third and one-half of obese people are metabolically healthy2ix The implications of using BMI to determine health risk are far-reaching particularly if BMI is not the most accurate method to assess health Referring to the US population it is estimated that 163 million normal weight people may not be healthy appear to be healthy and may be overlooked for treatment Further 554 million overweight and obese people who are healthy are identified as needing treatment As such it is estimated that nearly one-third of the population are being misidentified as a result of using BMI to measure healthx Thus considering that health can occur at a diverse range of BMIs and that weight is not behaviour it is important to remember that BMI is only one flawed tool to assess health risk Efforts would be better spent on supporting individuals and populations to develop eating competence and engage in regular and rewarding activity and accept the weight that evolvesxi

How a ldquoNormal Weightrdquo May be Misleading Some eating disorder practitioners may not consider a BMI of 185-199 as a normal or healthy weight Clients with a diagnosed eating disorder (as per the DSM-IV) may present with BMIs in this range Further others with diagnosed eating disorders (eg bulimics) could present in the normal and overweight BMI ranges

1 Adiposity is the quality or state of being fat 2 Based on measures of triglycerides high sensitivity C-reactive protein glucose high density lip-protein cholesterol insulin resistance and blood

pressure


Are there Other Ways to Measure How Body Fat Affects Health BMI does not determine the distribution of body weight in particular body fat which may be a better predictor of health Specifically abdominal obesity has been associated with increased disease risk and some suggest that waist circumference3 is a better measure of obesity and health risk than BMIxii

i World Health Organization Expert Committee on Physical Status (1995) Physical Status The use and interpretation of anthropometry (WHO

Technical Report Series No 854) Retrieved from httpwhqlibdocwhointtrsWHO_TRS_854pdf ii Health Canada (2012) Body Mass Index (BMI) Nomogram Retrieved from httpwwwhc-scgccafn-annutritionweights-poidsguide-ld-

adultbmi_chart_java-graph_imc_java-engphp iii Statistics Canada (2010) Canadian Community Health Survey (CANSIM Table No 105-0502) iv Rogol AD Clark PA Roemmich JN (2000) Growth and Pubertal Development in Children and Adolescents Effects of diet and physical

activity American Journal of Clinical Nutrition 72(2) 521S ndash 528S v Romero-Corral A Montori VM Somers Virend K Korinek J Thomas RJ hellip Lopez-Jimenez F (2006) Association of Bodyweight with

Total Mortality and with Cardiovascular Events in Coronary Artery Disease A systematic review of cohort studies The Lancet 368(9536) 666ndash78 doi101016S0140-6736(06)69251-9

vi Health Canada (2005) Canadian Guidelines for Body Weight Classification in Adults Retrieved from httpwwwhc-scgccafn-annutritionweights-poidsguide-ld-adultqa-qr-pub-engphp

vii Lesser GT (2009) Problems in Measurement of Body ldquoFatnessrdquo Journal of the American College of Cardiology 53(6) 526-527 doi101016jjacc200809059

viii Flegal KM Graubard BI Williamson DF amp Gail MH (2005) Excess Deaths Associated with the Underweight Overweight and Obesity Journal of the American Medical Association 293(15) 1861-1867

ix Shea JL Randell EW amp Sun G (2011 March) The Prevalence of Metabolically Healthy Obese Subjects Defined by BMI and Dual-Energy X-ray Absorptiometry Obesity (Silver Spring) 19(3) 624-30 doi101038oby2010174

x Bacon L amp Aphramor L (2011) Weight Science Evaluating the evidence for a paradigm shift Nutrition Journal 10(9) 1-13 Retrieved from httpwwwnutritionjcomcontent1019 doi 1011861475-2891-10-9

xi OrsquoReilly C (2011) The Importance of Promoting Health Not Weight Loss Retrieved from httpsdocsgooglecomviewera=vamppid=sitesampsrcid=ZGVmYXVsdGRvbWFpbnxvcmVpbGx5Y2FpdGxpbmp8Z3g6Nzc4ZmRmZTIxZWNjYTM2MQ

xii Janiszewski PM amp Ross R (2010) Effects of Weight Loss Among Metabolically Healthy Obese Men and Women Diabetes Care 33(9) 1957-1959 doi 102337dc10-0547

3 Waist circumference (WC) provides an indicator of abdominal fat A WC at or above 102 cm (40 in) for adult men and 88 cm (35 in) for adult

women is associated with an increased risk of developing health problems The cut-off points are approximate so a WC just below these values should also be taken seriously From ldquoCanadian Guidelines for Body Weight Classifications in Adultsrdquo by Health Canada 2005 retrieved from httpwwwhc-scgccafn-annutritionweights-poidsguide-ld-adultqa-qr-pub-engphp4

Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

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izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

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ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

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tabl

ishe

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Cau

se o

f obe

sity

O

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d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

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U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

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l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

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t I

t is

bette

r to

lose

and

rega

in th

an n

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se a

t all

Siz

e ac

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O

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heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

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A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf

Northern Health Position on Health Weighs and Obesity July 27 2012 ndash Appendix C Page 1 of 2

Appendix C Dynamics of Childhood Feeding and Activity

Within the Division of Responsibility in Feeding and the Division of Responsibility in Activity parents practice an authoritative parenting style where they provide leadership (through structure and opportunity) and allow children to develop autonomy This is grounded in trust parentsrsquo trust that children will eat move and grow as nature intended It supports children to grow and mature in eating competence and appreciation and celebration of their bodies through regular movement When parents fail to do their jobs or take on some of their childrenrsquos jobs disruptions in feeding activity and body image occur

Divisions of Responsibility in Feeding amp Activity Roles of Parents and Children

Age Parentsrsquo Jobs Childrenrsquos Jobs

Division of Responsibility in Feeding

Infancy The parent is responsible for what

The parent helps the infant to be calm and organized and feeds smoothly paying attention to information coming from the baby about timing tempo frequency and amounts

The child is responsible for how much (and everything else)

Toddlers to Adolescents

The parent is responsible for what when where

Parentsrsquo jobs Choose and prepare the food Provide regular meals and

snacks Make eating times pleasant Show children what they have

to learn about food and mealtime behavior

Not let children graze for food or beverages between meal and snack times

Let children grow up to get bodies that are right for them

The child is responsible for how much and whether

Childrenrsquos jobs Children will eat They will eat the amount they need They will learn to eat the food their

parents eat They will grow predictably They will learn to behave well at the

table

From school age through adolescence children develop independence and will begin to participate in decision making around food and eating For example the school-aged child may function within the structure created by the parent to manage hisher afterschool snacks right after school at the table no distractions (eg television video games) For more information on how to support childrens growing independence with food and eating please see wwwellynsattercom Satter E (2008) Secrets of feeding a healthy family How to eat how to raise good eaters how to cook Madison WI Kelcy Press (Chapter 6) Satter E (2005) Your childrsquos weight Helping without harming Madison WI Kelcy Press (Chapters 6 and 7)




Division of Responsibility in Activity

Infancy The parent is responsible for safe opportunities

The parent provides the infant with a variety of positions clothing sights and sounds Then the parent remains present and lets the infant experiment with moving

The child is responsible for moving


The parent is responsible for structure safety and opportunities

Parentsrsquo jobs Develop judgment about

normal commotion Provide safe places for activity

the child enjoys Find fun and rewarding family

activities Provide opportunities to

experiment with group activities such as sports

Set limits on TV but not on reading writing artwork other sedentary activities

Remove TV and computer from the childs room

Make children responsible for dealing with their own boredom

The child is responsible for how how much and whether he or she moves

Childrenrsquos jobs Children will be active Each child is more or less active

depending on constitutional endowment

Each child is more or less skilled graceful energetic or aggressive depending on constitutional endowment

Childrens physical capabilities will grow and develop

They will experiment with activities that are in concert with their growth and development

They will find activities that are right for them

Northern Health Position on Health Weight and Obesity July 27 2012 ndash Appendix D Page 1 of 1

Appendix D Comparing and Contrasting Food Management Satter Eating Competence Model (ecSatter) and Conventional Approach

Issue ecSatter Conventional Approach

Eating Attitudes Positive relaxed flexible Responsively attuned to outer and inner experiences relative to eating including relaxed expectation of hedonic rewards from eating

Unintended negative attitudes secondary to conflict between preferred and prescribed food selection Ambivalence and anxiety predispose to inconsistent eating behavior

Food Acceptance Experiential Attitudes and behavior Nutritional status maintained through intrinsic motivation to eat a variety of food including nutritious food genuine enjoyment and learned food preferences

Cognitive Nutritional status maintained through externally motivated conformity to food-selection standards Downplays oral hedonic needs

Regulation of food intake Internal Cooperates with physiological homeostatic mechanisms and maintains energy balance by attending to sensations of hunger appetite and satiety

External Encourages ignoring and overruling internal regulatory processes Calculates calorie requirement food selection patterns and portion sizes

Activity Encourages intrinsically motivated activity that enhances the salience of internal regulation cues

Prescribes activity duration to achieve health and weight management goals

Body weight Primarily determined by genetics modified by the dynamic equilibrium of lifestyle age activity and internally regulated food intake

Defines BMI between 185 and 249 as target level for all adults of all ethnic groups and all ages

Body weight intervention Addresses unstable body weight Identify and correct limitations and distortions in eating competence and activity to restore weight stability

Imposes defined food intake and prescribed activity to achieve negative energy balance and defined BMI

Eating context Prioritizes structure and meal planning Emphasizes strategic meal-planning principles in tandem with strong permission to eat adequate amounts of preferred food at predictable times

Prescribes calorie levels translates into daily amounts and types of foods distributed among food groups or applied to sample menus

Source Satter E (2007) Eating Competence Definition and Evidence for the Satter Eating Competence Model Journal of Nutrition Education and Behavior 39(5S) S142-S153 doi101016jjneb200701006

Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

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DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N

Northern Health Position on Health Weight and Obesity July 27 2012 ndash Appendix F Page 1 of 1

Appendix F Health Benefits of Adopting a Healthy Lifestyle Independent of Changes in Body Weighti

Glucose metabolism and insulin action Decreased fasting glucose fasting insulin and HbA1c Increased glucose tolerance and insulin sensitivity

Blood pressure Decreased resting systolic amp diastolic blood pressures and ambulatory blood pressure

Lipids and lipoproteins Decreased cholesterol LDL-C or oxidized LDL and triglycerides Increased HDL-C Improved lipid subfractions

Endothelial function Increased vascular dilatory function

Hemostasis Increased tissue plasminogen activator release capacity and MMP inhibitors (tissue factor pathway inhibitors) Fibrinolytic control Decreased fibrinogen plasminogen activator inhibitor-1 and MMPs Tissue factor pathway inhibitor

Inflammation Increased anti-flammatory markers Decreased proinflammatory markers

Skeletal muscle adaptations Mitochondrial enzyme increase in number and activation Increased mitochondrial fat oxidation Decreased muscle diacylglycerol content and muscle ceramide content

Postprandial metabolism Decreased lipemia and glycemia

i Gaesser GA Angadi SS amp Sawyer BJ (2011) Exercise and Diet Independent of Weight Loss Improve Cariometabolic Risk Profile in

Overweight and Obese Individuals Physician and Sportsmedicine 39(2) np doi 103810psm2011051891

2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012

HWO App A 2012 07 27pdf

HWO App D 2012 07 27pdf

HWO App E 2012 07 27pdf

HWO App F 2012 07 27pdf

HWO App G 2012 07 27pdf

HWO App J p2of2 Edmonton Obesity Stagingpdf

For further information about this position statement please contact

Christine Glennie-Visser Regional Coordinator HEAL Network Northern Health Telephone 250-565-7455 Email christineglennie-vissernorthernhealthca

Flo Sheppard Population Health Team Lead Northwest Health Services Delivery Area Northern Health Telephone 250-631-4258 Email flosheppardnorthernhealthca

Northern Health Corporate Office Suite 600 299 Victoria Street Prince George BC Canada V2L 5B8 General enquiries 1-866-565-2999 or 250-565-2649 wwwnorthernhealthca

Acknowledgements We would like to acknowledge and thank the people who have helped to compile this position statement Christine Glennie-Visser Flo Sheppard Chelan Zirul Julie Kerr Kelsey Yarmish and Dr Ronald Chapman and numerous others who also provided direction and information which assisted us to compile the document

ldquohellip Sometimes it feels like this There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man So I jump into the river put my arms around him pull him to shore and apply artificial respiration Just when he begins to breathe there is another cry for help So I jump into the river reach him pull him to shore apply artificial respiration and then just as he begins to breathe another cry for help So back in the river again reaching pulling applying breathing and then another yell Again and again without end goes the sequence You know I am so busy jumping in pulling them to shore applying artificial respiration that I have no time to see who is upstream pushing them all inrdquo

McKinlay J 1979


July 27 2012 Page 1 of 34


20 Background










Northern Health Position on Health Weight and Obesity July 27 2012 of 34










High blood pressure



Osteoporosis Stroke



Cancers

















































liv


























52 Genetics




































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

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niv

ers

ity

Gannett

Healt

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012








July 27 2012 Page 1 of 34


20 Background




















High blood pressure



Osteoporosis Stroke



Cancers

















































liv


























52 Genetics




































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012

















High blood pressure



Osteoporosis Stroke



Cancers

















































liv


























52 Genetics




































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012


















































liv


























52 Genetics




































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

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ING

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TTER

NS

EA

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G D

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ERED

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DY

OW

NER

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IMAG

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N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012




























52 Genetics




































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

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pic

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ng-b

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ATE

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N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012






































































1



2












cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012










cycle












choice































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012
































921 Home









922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

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ISSU

E

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UT

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2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012








922 Work








923 School























924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

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fm

FOO

D IS

NO

T AN

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E

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UT

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ATE

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ASSO

CIA

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N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012



















924 Leisure





































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012


































































110 Other Resources


















































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012








































































































































































































Problems












pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

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CC

UPI

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BSE

SSED

D

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RD

ERED

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ING

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TTER

NS

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G D

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ERED

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DY

OW

NER

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PR

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ED

DIS

TUR

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DY

IMAG

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OD

Y H

ATE

DIS

ASSO

CIA

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N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

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ly 2

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pressure

















Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

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ING

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TTER

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EA

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OW

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OD

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PR

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PIED

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SESS

ED

DIS

TUR

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BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012























Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

B

Page 1

of

1

Appendix

B

Com

mon A

ppro

aches

to S

ize a

nd S

hape

The f

ollow

ing c

hart

sum

mari

zes

thre

e c

om

mon a

ppro

aches

to s

ize a

nd s

hape w

hic

h r

ela

te t

o b

ody w

eig

ht

and o

besi

ty

The N

ort

hern

Healt

h

Posi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty a

ccepts

the t

rust

adapta

tion o

f healt

h a

t every

siz

e p

ara

dig

m

C

onve

ntio

nal P

arad

igm

C

ontr

ol

Size

Acc

epta

nce

Para

digm

Tr

ust A

dapt

atio

n of

Hea

lth a

t Eve

ry S

ize

Para

digm

Bod

y W

eigh

t P

rimar

ily o

ptio

nal

Prim

arily

a g

enet

ic g

iven

P

rimar

ily a

gen

etic

giv

en

Assu

mpt

ion

Abou

t Fat

ness

BM

I gt25

is s

erio

usly

unh

ealth

y an

d sh

ould

be

treat

ed

Eve

ryon

e sh

ould

hav

e B

MI lt

25 o

r at l

east

lt3

0

Fat

ness

is a

nor

mal

bod

y ty

pe

The

re a

re a

rang

e of

nor

mal

siz

es a

nd

shap

es

Fat

ness

is n

orm

al fo

r som

e pe

ople

E

xces

sive

fatn

ess

can

resu

lt fro

m e

nviro

nmen

tal

dist

ortio

ns

Def

initi

on o

f O

besi

ty

BM

I abo

ve 3

0 fo

r adu

lts (B

MI gt

25 is

ldquoo

verw

eigh

trdquo)

Chi

ldre

n A

bove

95th

per

cent

ile B

MI

Obe

sity

an

unac

cept

able

term

it

med

ical

izes

a n

orm

al c

ondi

tion

All

size

s a

nd w

eigh

ts a

re n

orm

al

Fat

ness

that

is e

xces

s fo

r the

indi

vidu

al

Adu

lt u

nsta

ble

wei

ght

Chi

ldre

n w

eigh

t acc

eler

atio

n ab

ove

a pr

evio

usly

es

tabl

ishe

d tra

ject

ory

Cau

se o

f obe

sity

O

vere

atin

g an

d un

der-

exer

cise

G

enet

ics

Met

abol

ic a

bnor

mal

ities

U

nkno

wn

Lik

ely

gene

tic p

redi

spos

ition

plu

s (m

ultip

le)

envi

ronm

enta

l dis

torti

ons

Inte

rven

tion

Eat

less

exe

rcis

e m

ore

Los

e w

eigh

t I

t is

bette

r to

lose

and

rega

in th

an n

ot to

lo

se a

t all

Siz

e ac

cept

ance

O

ptim

ize

heal

th a

t pre

sent

wei

ght

Non

-die

ting

Est

ablis

h co

mpe

tent

eat

ing

and

sus

tain

able

act

ivity

A

ccep

t wei

ght t

hat e

volv

es

Chi

ldre

n o

ptim

ize

feed

ing

from

birt

h to

sup

port

cons

iste

nt g

row

th a

t any

leve

l T

reat

men

t id

entif

y an

d re

solv

e fa

ctor

s th

at d

isru

pt

cons

iste

nt g

row

th

Out

com

e

Los

e 10

(o

r oth

er

) of b

ody

wei

ght o

r ac

hiev

e a

certa

in B

MI

Chi

ldre

n k

eep

wei

ght b

elow

95

or e

ven

85

per

cent

ile B

MI

Non

-die

ting

Phy

sica

l sel

f-est

eem

C

hild

ren

all

grow

th p

atte

rns

are

norm

al

Com

pete

nt e

atin

g e

njoy

able

act

ivity

I

mpr

oved

qua

lity

of li

fe s

tabl

e w

eigh

t C

hild

ren

grow

at a

con

sist

ent t

raje

ctor

y d

onrsquot

mak

e w

eigh

t an

issu

e

Rec

omm

enda

tion

in a

Med

ical

Se

tting

Los

e w

eigh

t to

impr

ove

med

ical

con

ditio

n O

nly

wei

ght l

oss

will

impr

ove

para

met

ers

bl

ood

chem

istri

es p

hysi

olog

ical

in

dica

tors

Acc

ept w

eigh

t as

give

n D

onrsquot

look

too

clos

ely

at p

aram

eter

s be

caus

e it

puts

pre

ssur

e on

wei

ght l

oss

A

ttend

to m

edic

al is

sues

sep

arat

ely

Res

olve

fact

ors

dest

abili

zing

wei

ght

Exp

ect i

mpr

ovem

ent i

n he

alth

par

amet

ers

seco

ndar

y to

ou

tcom

e A

ttend

to re

mai

ning

med

ical

issu

es s

epar

atel

y

Sourc

e

Satt

er

E

(2005)

Thre

e P

ara

dig

ms

in S

ize a

nd S

hape

Retr

ieved f

rom

htt

p

w

ww

ellynsa

tter

com

re

sourc

es

thre

epara

dig

ms

pdf




















table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012


























table












































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012

















































Nort

hern

Healt

h P

osi

tion o

n H

ealt

h

Weig

ht

and O

besi

ty

July

27

2012 ndash

Appendix

E

Page 1

of

1

Appendix

E

Eati

ng Iss

ues

and B

ody Im

age C

onti

nuum

This

conti

nuum

repre

sents

the r

ange o

f eati

ng b

ehavio

urs

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

Most

healt

hy p

eople

functi

on in t

he t

wo

cate

gori

es

on t

he f

ar

left

that

refl

ect

hig

h s

elf

-est

eem

and p

hysi

cal healt

h

Healt

hy B

ut

Conce

rned a

nd N

ot

An Iss

ue

How

ever

indiv

iduals

can

move

fro

m o

ne c

ate

gory

to a

noth

er

dependin

g o

n c

hanges

that

occur

in t

heir

self

-est

eem

and a

ttit

udes

tow

ard

food a

nd b

ody im

age

An

indiv

idual can b

e in o

ne c

ate

gory

for

food a

nd a

noth

er

for

body im

age

Als

o

an indiv

idual can e

xhib

it s

om

e

but

not

all

chara

cte

rist

ics

wit

hin

a c

ate

gory

I fee

l no

gu

ilt o

r sh

ame

no

mat

ter

how

mu

ch I

eat

or

wh

at

I eat

Foo

d is

an

imp

ort

ant

par

t o

f my

life

bu

t o

nly

occ

upi

es a

re

aso

nab

le p

art

of

my

tim

e

I tru

st m

y b

ody

to

tell

me

wh

at a

nd h

ow

mu

ch t

o e

at

I am

mo

der

ate

and

fle

xib

le in

go

als

for

eati

ng

wel

l

I en

joy

eati

ng f

or

ple

asu

re a

nd

bal

ance

th

at

wit

h c

once

rn f

or

a h

ealt

hy

bod

y

I try

to

fo

llow

nu

trit

ion

gu

idel

ines

an

d e

at in

a

bal

ance

d w

ay

I hav

e tr

ied

die

tin

g e

xclu

din

g ce

rtai

n f

oo

ds o

r co

un

ting

cal

ori

es t

o lo

se w

eigh

t

I th

ink

abo

ut f

ood

a lo

t an

d r

egu

larl

y w

atch

w

hat

I ea

t

I fee

l ash

amed

wh

en I

eat

mo

re t

han

oth

ers

or

mo

re t

han

wh

at I

feel

I sh

ou

ld b

e ea

tin

g

I wis

h I

cou

ld c

han

ge h

ow

mu

ch I

wan

t to

eat

an

d w

hat

I am

hu

ngry

for

I hav

e tr

ied

die

t p

ills

su

pp

lem

ents

lax

ativ

es

vom

itin

g o

r ex

tra

exer

cisi

ng

in o

rder

to

lost

or

mai

ntai

n m

y w

eigh

t

I hav

e fa

sted

or

avo

ided

eat

ing

for

lon

g p

erio

ds

of

tim

e in

ord

er t

o lo

se o

r m

ain

tain

my

wei

ght

I fee

l str

on

g w

hen

I ca

n re

stri

ct h

ow

mu

ch I

eat

Eati

ng

mo

re t

han

I w

ante

d t

o m

akes

me

feel

o

ut

of

con

tro

l

I reg

ula

rly

rest

rict

foo

d o

r ex

erci

se v

omit

use

die

t p

ills

su

pple

men

ts o

r la

xati

ves

to g

et r

id o

f th

e fo

od

o

r ca

lori

es

My

frie

nd

sfa

mily

tel

l me

they

are

con

cern

ed a

bou

t m

y w

eigh

tap

pea

ran

ce

I am

ter

rifi

ed o

f ea

tin

g fa

t

Wh

en I

let

mys

elf

eat

I h

ave

a h

ard

tim

e co

ntr

ollin

g th

e am

ou

nt

of

food

I ea

t

I am

afr

aid

to

eat

in f

ront

of

oth

ers

I fee

l go

od

ab

out

my

bo

dy a

nd

wh

at it

can

do

My

bo

dy is

bea

uti

ful t

o m

e

I bel

ieve

th

at h

ealt

hy

and

bea

utif

ul b

od

ies

com

e in

all

shap

es a

nd

siz

es

I kn

ow

th

at t

he

sign

ific

ant

oth

ers

in m

y lif

e w

ill a

lway

s fi

nd

me

attr

acti

ve

I tru

st m

y b

ody

to

fin

d t

he

wei

ght

it n

eed

s to

be

at s

o I

can

mov

e w

ith

co

nfid

ence

I bas

e m

y bo

dy

imag

e eq

ual

ly o

n s

oci

al n

orm

s an

d m

y o

wn

sel

f-co

nce

pt

I pay

att

enti

on

to

my

bo

dy

and

ap

pea

ran

ce

bec

ause

it is

impo

rtan

t b

ut it

onl

y o

ccu

pie

s a

smal

l par

t o

f my

day

I no

uri

sh m

y b

ody

so

it h

as s

tren

gth

and

en

ergy

to

ach

ieve

my

ph

ysic

al g

oal

s

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

view

ing

my

bo

dy in

th

e m

irro

r

I sp

end

a s

ign

ific

ant

amo

un

t o

f ti

me

com

par

ing

my

bo

dy t

o o

ther

s

I hav

e m

any

day

s w

hen

I fe

el f

at

Irsquod b

e m

ore

att

ract

ive

if I

was

th

inn

er m

ore

m

usc

ula

r e

tc

I do

nrsquot

see

an

yth

ing

po

siti

ve a

bo

ut m

y b

ody

sh

ape

and

size

I bel

ieve

th

at m

y bo

dy

keep

s m

e fr

om d

atin

g o

r fi

nd

ing

som

eon

e w

ho

will

tre

at m

e th

e w

ay

I wan

t

I hav

e co

nsid

ered

ch

angi

ng

or

hav

e ch

ange

d m

y b

ody

sha

pe

and

siz

e th

rou

gh s

urg

ical

m

ans

so

I ca

n a

ccep

t m

ysel

f

I hat

e m

y b

ody

and

I o

ften

iso

late

mys

elf

from

o

ther

s

I do

nrsquot

bel

ieve

oth

ers

wh

en t

hey

tel

l me

I loo

k O

K

I hat

e th

e w

ay I

loo

k in

th

e m

irro

r

Sou

rce

C

orn

ell U

niv

ers

ity

Gannett

Healt

h S

erv

ices

Nutr

itio

n a

nd H

ealt

hy E

ati

ng

(2012)

Eati

ng a

nd B

ody Im

age C

onti

nuum

Retr

ieved

fro

m

htt

p

w

ww

gannett

corn

elle

duto

pic

snutr

itio

neati

ng-b

odyim

agebodyc

fm

FOO

D IS

NO

T AN

ISSU

E

HEA

LTH

Y B

UT

CO

NC

ERN

ED

FOO

D P

REO

CC

UPI

EDO

BSE

SSED

D

ISO

RD

ERED

EAT

ING

PA

TTER

NS

EA

TIN

G D

ISO

RD

ERED

BO

DY

OW

NER

SHIP

B

OD

Y A

CC

EPTA

NC

E

BO

DY

PR

EOC

CU

PIED

OB

SESS

ED

DIS

TUR

BED

BO

DY

IMAG

E B

OD

Y H

ATE

DIS

ASSO

CIA

TIO

N













2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012



















2

Hea

lth W

eigh

t and

Obe

sity

App

endi

x G

Ju

ly 2

7 2

012







position on health, weight and obesity · northern health position on health, weight and obesity...

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