Maria Ricupero

Banishing BMI and Scales—A Fresh Approach to Managing Health for Cardiac Rehab


As a clinical dietitian in the Cardiovascular Prevention and Rehabilitation Program at Toronto’s University Health Network (UHN), Maria Ricupero relies on scientific evidence to guide her work with her patients. But often, her biggest roadblock to success in working with people living with heart disease, stroke and type-2 diabetes is quantitative metrics.

“It’s common practice to focus on weight and waist circumference to set goals for these patients, who are typically classified as overweight or obese,” Maria explained. “They usually hear their doctors tell them that they need to lose weight. But this fails to capture the psychological struggles they face and it doesn’t address effective outcomes.”

While working on her Master’s degree, Maria learned about the Health at Every Size (HAES®) movement, which is founded in the principle that “improvements in health can be achieved regardless of shape or size.” This informed her own research and her “non-weight focused approach” to health that informs the group-based and individual counselling she does as part of a care team in a six-month cardiac rehab outpatient program at UHN.

“In a given year our program sees 2200 patients, and I counsel at least half of them,” Maria said. “Most of the patients do not lose weight for a variety of factors: medications, sleep problems and basic biology. Instead of focusing on weight and “’good vs. bad foods’ that often leads to guilt and shame, I instead focus on mindfulness principles, letting go of judgement and overall health and well being.”

In fact, research does show that healthy behaviours do help to improve health despite no changes in weight

Maria illustrates this approach with a patient story. “I recall one woman in our program recently with type-2 diabetes, who would be classified as being obese. This woman, like so many of our patients, expressed how she was committed to the exercise program and made several changes to her diet, but was feeling frustrated and unmotivated to stick with the program because her efforts did not result in the weight loss she was hoping for. She was ready to give up on these healthier living practices because she felt it wasn’t helping.

“In fact, research does show that healthy behaviours do help to improve health despite no changes in weight,” Maria continued. “Sharing the evidence with this patient helped to reassure her that what she was doing was beneficial; she continued with the program. She later reported feeling less anxious about food, more positive about eating and generally healthier overall. Attrition rates are higher when weight is the focus.”

As an HAES® advocate, Maria looks to alternate research-based approaches to diet such as the Mediterranean Diet Score to guide discussions with her patients. “Tools like this can help educate and guide patients on changes they can make to their diet to lower their risk of heart disease and diabetes. An approach that encourages implementing small changes over time is scientifically proven to be most effective in achieving meaningful long-term outcomes,” she said. “Patients feel empowered when they are presented with evidence that they can then base their own decisions instead of being told what to do.

“I applaud the efforts of CFDR as they work to fund increasing amounts of evidence, and new approaches to clinical interventions, that support dietitians like me across Canada.”


© Canadian Foundation for Dietetic Research 2016.