How We Approach the Topic of Weight Loss as a Health At Every Size Aligned Practice.
One of the most popular search terms regarding acupuncture is “Can acupuncture help with weight loss?” We’re not sure when or how this idea, or shall we say, rumor, started, but I’d like to take a few moments to dispel some myths, give you some real, evidence-based information about how acupuncture might be a part of your weight loss journey, and why I don’t treat patients for ‘weight loss’ in my clinic.
TW: eating disorders and dieting.
Myth: All I Need to Do is Get Acupuncture, and the Weight Will Come Off
By far, one of the most common questions we’re asked as acupuncturists is: Can acupuncture help me lose weight? My response is always the same: not really, but it’s complicated. For many people, when we see a product or treatment advertising weight loss support, our brains automatically go: Yes! Weight loss with no effort! The magic pill! The truth is, there is no magic pill when it comes to weight loss, including Ozempic or even surgery - there is always some form of effort that you will need to put in to have those treatments work in your favor. Some small sample and animal studies claim acupuncture improves lipid metabolism and augments hunger and fullness hormones like leptin and ghrelin. But, in reality, acupuncture doesn’t reduce appetite, it doesn’t increase metabolism, and it doesn’t magically turn fat into muscle in a way that’s so powerful you don’t have to put in any effort.
While it might give you a slight edge, you still need to stick to a caloric deficit, eat healthy foods, get the right amount of protein, and exercise when possible. What acupuncture does very well is that it offers some benefits that would support intentional weight loss in a roundabout way. Think of it like this: acupuncture can help you stick to your plan better; thus, it may help with weight loss.
Truth: Acupuncture Can Address Underlying Hinderences to Weight Loss
The multi-systemic effects of acupuncture make it an excellent treatment for many issues. Intentional weight loss and dieting cause a significant amount of stress on the body and mind, and acupuncture is a treatment that can help us mitigate this stress. While we have those small studies that suggest acupuncture can help improve metabolism and reduce appetite, the greatest benefit is how it helps us with all the other areas of our health and mental health, which can mitigate the side effects of dieting.
Simply put, if you’re not sleeping well, digesting well, managing stress well, or have any issues with hormones, weight loss will be a more uphill battle than it already is. Acupuncture and the coaching you’ll often receive from your acupuncturist can help with all of these multisystemic issues that halt weight loss. So, if you want to lose weight intentionally, acupuncture can be a fantastic addition to your plan. It can help you feel better while dieting and might make your diet more impactful.
That said, acupuncture is not going to mitigate the side effects of a diet or exercise regime that is too extreme or rigid. Shooting for 1200 calories a day, hours of exercise, or developing disordered behaviors and thought patterns around food should be something your acupuncturist should notice and help you move away from. These behaviors can cause lasting adverse effects on the body and mind. Check out the Ancel Keys Starvation Study for more information on how this affects you.
Myth: Dieting is Healthy for Everyone
My Anti-Diet and Health at Every Size Approach to Healing
I’ve been a chronic dieter for nearly my entire life, put on Weight Watchers at the age of 10. My weight, body image, and self-esteem have wildly fluctuated over the years thanks to this disordered relationship I’ve had with food and fitness. Amid the 2020 pandemic, I completed a Certified Nutritionist training through the National Academy of Metabolic Science. This program focused on ‘flexible dieting,’ and I felt it had the most balanced approach to intentional weight loss I’d ever encountered. No foods are off limits; protein and maintaining muscle mass were the ultimate goals, and it wasn’t some get-thin-quick scheme. They were adamant about shifting the focus from weight loss to fat loss (which I think every fad diet completely overlooks) and had a heavy dose of food and nutrition science to support the program, which my acupuncture nutrition course sorely lacked.
As I dove into this training and material, I also came across Intuitive Eating and Health at Every Size concepts, and when I read the book Secrets from the Eating Lab by Traci Mann, PhD it changed everything. I could no longer prescribe weight loss plans to clients and maintain my integrity because I learned just how harmful and problematic intentional dieting can be.
The Health at Every Size (HAES) paradigm is a weight-neutral approach to health and wellness that focuses on promoting healthy behaviors rather than aiming for a specific weight or body size. It emphasizes:
Body respect and acceptance: Encouraging self-care and appreciation of one's body at any size, rejecting the notion that weight defines health or worth.
Health-promoting behaviors: Prioritizing behaviors such as balanced eating, physical activity, stress management, and sleep for overall well-being rather than weight loss as the primary goal.
Weight inclusivity: Recognizing that people can be healthy at various sizes, challenging the assumption that higher weight always correlates with poor health.
Critical view of diet culture: Rejecting restrictive diets and weight-centric health care which can lead to weight stigma, disordered eating, and poor mental health.
HAES advocates for equitable and compassionate health care regardless of body size and promotes mental, physical, and emotional well-being, which is the type of care I implement in my practice.
Truth: Diets Fail 95% of the Time and Increase Stress Responses
The stigma surrounding obesity is strong and pervasive, giving rise to a multi-billion dollar industry preying on ‘get thin quick’ schemes, drugs, supplements, and crash diets or cleanses. Up to 95% of people who lose weight will regain it within a year, often with an added 5-10% of weight on top of it. (4) Simply put, if your doctor prescribed a treatment that had a 5% success rate and a 95% failure rate, where you would likely wind up worse off than when you started, Would you take that treatment? My guess is probably not, or maybe if it were a last resort. This is the reality of intentional dieting and weight loss - there are no long-term successful options. Yo-yo dieting and weight cycling are something that occurs in chronic dieters and it’s something that has a profoundly negative impact on our health. Over time, we experience more inflammation, loss of telomere length (i.e., accelerated aging), cardiac issues, and mental health issues.
If the means we use to attain a result are unsustainable, the results will be unsustainable.
The act of dieting and restricting caloric intake contributes to a cascade of effects in the body, upregulating the hormone ghrelin, which increases hunger, and also increasing cortisol levels, which promotes the body to hold on to fat and also contributes to decreased telomere length and integrity (5). Since telomeres are an essential component of the aging process, this tells us that dieting might make us age more quickly, and if diets fail, we regain weight.
Weight loss that’s too fast triggers our body to break down muscle tissue instead of fat, so extreme diets that promote quick weight loss may succeed in decreasing weight, but that number isn’t just fat; it’s often mostly water and lean muscle mass. Extreme and fast weight loss can lead to smooth muscle breakdown like heart tissue, increasing susceptibility to infections, increased blood pressure and decreased bone density. (6) Restrictive dieting will almost certainly cause the experience of shame in a dieter, which is shown to contribute to eating disorders or disordered eating tendencies and poor mental health outcomes in general (7).
Myth: Being Overweight Causes Health Problems
The evidence is overwhelming to the contrary; extra weight does not cause health problems, but it is correlated with health problems (8). Obesity is correlated with some poor health outcomes, but there is no research to support that it causes said health outcomes. More accurately, our weight distribution on our body affects our health more than our total weight. Studies point to excess abdominal and visceral fat as an indicator of decreased health outcomes, not total weight, pointing to ‘normal’ BMI persons with excess visceral fat as the most susceptible to poor health outcomes, not overweight people in general. (8)
Another interesting fact is that the same issues that are correlated with obesity are the same list of issues that are correlated with experiencing weight stigma. Weight stigma is the act of being discriminated against based on weight and body shape or size, and it’s one of the most common types of discrimination people experience. So the question remains: is weight the culprit? Or is it the mental turmoil, trauma, shame, and stigmatization that happens because of weight that causes health problems? We’re still learning.
Truth: You Can Become Healthier without Intentionally Losing Weight
While we can’t change our health outcomes, we often have the ability to change at least some lifestyle factors and choices. When a patient comes to my clinic with the intention of weight loss, we shift away from intentional dieting to shifting lifestyle factors. It’s not the number on the scale that matters so much as what we are doing day in and day out.
Exercise has been shown to have beneficial effects on our health metrics, and compared to dieting alone, people who exercised had improved changes in health metrics. In contrast, dieters lost weight but had no changes in their health metrics. (9). Eating whole foods, getting adequate nutrition, vegetables, and fruits, getting good sleep, improving digestion, processing stress and emotions in healthy ways, and moving our bodies are all proven ways to improve our health. And most importantly, these are processes that we do have control over.
We can choose to exercise or eat a salad, and we don’t get to choose the number on the scale. Since the number on the scale isn’t an actual indicator of health, our focus needs to turn to these other choices to improve our health.
Myth: It’s Either ALL Diet or NO Diet, There’s No In Between
I strive to meet my patients wherever they are - if dieting is something you’ve been used to or have a long history with or strong belief systems about, the idea of rejecting it all outright might be off-putting. For other patients who have battled weight stigma, the idea of dieting or intentional weight loss can be extremely off-putting, but finding a care provider who will work with you without focusing on weight can be a tall order. This is where finding a HAES-aligned practitioner can be a welcome relief.
If Intentional Weight Loss is Still a Top Goal
Many clients and patients might want to try extremely restrictive diet plans like Optavia, carnivore, keto, or others as a means to lose weight quickly. We know these diets are prone to failure and not just failure but putting people in worse positions than where they began. My goal with working with you is to help you find a doable and sane plan for slow fat loss while moving toward intuitive eating strategies with a goal to let go of dieting altogether (eventually).
We work together to find a balanced way forward. This usually includes a shift in focus toward additions vs. restrictions, being mindful of when binges are triggered by dieting, and occasionally setting more realistic macro goals to move away from severe dieting and restrictions. My goal is to help you move toward health and well-being in a safe and achievable way and move away from diet-culture-based and weight-centric models that cause more harm than good.
A Health At Every Size Approach to Acupuncture & Healing
This is my favorite way to work with clients and patients in person with acupuncture or online hypnotherapy sessions. A health at every size approach to acupuncture and healing is profoundly healing and helpful for every client regardless of weight or history. When you’ve been told for years your knee pain will resolve only with weight loss, finally meeting a practitioner who will offer you treatment that doesn’t even mention weight loss but includes rehabilitation exercises, acupuncture, and coaching around lifestyle modifications that may help your quality of life, pain levels, and move toward knee rehabilitation is likely the care you’ve been waiting for.
Another aspect of my practice is to help coach my patients on speaking with their other healthcare providers to get the care they deserve and find providers who work with them rather than dismissing them.
I realize that my balancing act between a rigid HAES approach and dieting is not the norm. Most HAES or intuitive eating practitioners fall exclusively into that paradigm and leave no room for anyone who isn’t already on board with those systems. I don’t think this is necessarily the healthiest approach because it’s leaving out a large group of people who are likely interested in leaving diet culture behind but just don’t have the information to do so yet. I will never prescribe weight loss as a treatment modality in my practice - it’s clear that it isn’t a sustainable or effective approach to the vast majority of health concerns, so rest assured that the topic will never come up in my treatment rooms.
However, if you’re already committed to weight loss, maybe eying how to let that desire go, or curious but not entirely on board with an anti-diet approach to your healing - I am happy to work with you to find a sane, sustainable solution to get you where you want to go. I would much rather take the approach of mitigating harm by coaching away from extreme diets than abandon a client because they won’t adhere to my HAES approach.
Simply put, there is a path forward for everyone in my practice, and I want to ensure it is the safest path you can take.
How We Can Help
In our practice, we pride ourselves on making care available and shame-free. We never prescribe weight loss or restrictive diets to our patients for any reason - as you've read above, they're usually more harmful than beneficial. Our Oakland acupuncture office offers in-person acupuncture, hypnotherapy, and our signature combined treatment, hypno-puncture. We also offer health and lifestyle coaching and intuitive eating support via online telehealth sessions. Click the link below to book a session or a free discovery call to start today!
References:
Han, J., Guo, X., Meng, X. J., Zhang, J., Yamaguchi, R., Motoo, Y., & Yamada, S. (2020). Acupuncture improved lipid metabolism by regulating intestinal absorption in mice. World journal of gastroenterology, 26(34), 5118–5129. https://doi.org/10.3748/wjg.v26.i34.5118
Wikipedia contributors. (2024, April 27). Minnesota Starvation Experiment. Wikipedia. https://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment
Mann, T., PhD. (n.d.). Secrets from the Eating Lab: The science of weight loss, the myth of willpower, and why you should never diet again Paperback.
Statistics on Weight Discrimination: A Waste of Talent, The Council on Size and Weight Discrimination, Retrieved July 18, 2011
Amy Kiefer et al., “Dietary Restraint and Telomere Length in Pre and Post Menopausal Women,” Psychosomatic Medicine 70, no 8 (October 1 2008): 845-49, doi:10.1097/PSY.0b013e318187d05e
‘Why Zebras Don’t Get Ulcers’, Robert Sapolsky
Eric Stice, “Risk and Maintenance Factors of Eating Pathology: A Meta Analytic Review,” Psychological Bulletin 128 no 5 (September 2002): 825-48
Coutinho et al., “Central Obesity and Survival in Subject with Coronary Artery Disease”
Perri Wiklund et al., “Metabolic Response to 6 Week Aerobic Exercise Training and Dieting in Previously Sedentary Overweight and Obese Pre-Menopausal Women: A Randomised Trial,” Journal of Sport and Health Science (June 2014), doi:10.1016/j.jshs.2014.03.013
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