A Nutritional Therapist Asks: What Should We Be Gaining? Why the future of health isn’t measured by what we lose.

words by Alexandra Cortina

“The curious paradox is that when I accept myself just as I am, then I can change.” Carl Rogers

As a nutritional therapist, I see clients with a wide range of health concerns, from digestive disorders and hormonal imbalances to autoimmune conditions, fatigue and mental wellbeing. Yet one of the most common conversations still begins in exactly the same way; “I need to lose weight.”

It is an understandable place to start. For decades we have been taught that health is about subtraction. Lose weight. Cut calories. Eliminate sugar. Success has been measured by what disappears: kilograms, centimetres and clothing sizes. Many women still carry the belief that becoming healthier means becoming smaller. But over the years I have found myself wondering whether we have been asking the wrong question. What if, instead of asking what we need to lose, we began asking what we should be gaining?

The Carl Rogers quote above is more than 60 years ago and yet feels remarkably relevant. Sustainable behaviour change rarely begins with self criticism. Research in behavioural psychology, including Self Determination Theory, suggests that lasting change is more likely when it is driven by autonomy and purpose than by guilt or shame. The way we frame our health goals influences how we pursue them.

Training as a psychotherapist has changed the way I think about nutrition. Nutrition tells us what supports health. Psychology helps us understand why we struggle to do the very things we already know are good for us. That is where the two disciplines become inseparable. As I was writing this article, I realised that I have not always thought this way. I remember my late twenties and much of my thirties being defined by the number on the scales. Like many women, I believed that maintaining a particular weight was one of the most important measures of my health. I exercised consistently, but if I am honest, it was often with the goal of staying slim rather than building a stronger body for the future.

Then life gradually became fuller. Like many women, I found myself balancing work, family and the demands of everyday life, often putting everyone else’s needs before my own. Looking back, I realise I was maintaining my weight rather than intentionally building the muscle, metabolic health and resilience that I now understand are fundamental to healthy ageing.

Today, in my fifties, I no longer judge my health through the lens of the scales. I think about preserving muscle, protecting my metabolism, supporting a diverse gut microbiome and building the resilience to continue doing the work I love for years to come.

If there is one lesson I could share with younger women, it is this: start building sooner than you think you need to. Our bodies take us through menstruation, pregnancy for many women, motherhood, perimenopause and menopause. Every stage asks something different of us, yet every stage also offers an opportunity to invest in our future health. The habits we build in our twenties, thirties and forties become the foundation on which we age.

One of the clearest examples of this is muscle. We often associate muscle with appearance or athletic performance. In reality, skeletal muscle is one of the body’s most important metabolic organs. It is responsible for most insulin mediated glucose uptake after meals, helping regulate blood sugar and maintain insulin sensitivity. It also releases signalling molecules known as myokines that influence metabolic health. In many ways, the muscle we build today becomes the metabolic reserve that supports us later in life.

This matters because muscle naturally declines with age. The European Working Group on Sarcopenia estimates that adults begin losing around 3 to 8 per cent of muscle mass per decade from approximately the age of thirty if it is not maintained through resistance exercise, with the rate accelerating later in life. This is about far more than looking toned. By building muscle today, we are building the metabolism we will rely on tomorrow while also protecting mobility, independence and long term health.

The same principle extends beyond muscle. Rather than constantly thinking about what we should remove from our diets, perhaps we should ask what we can build. A more diverse gut microbiome, supported by eating a wider variety of plant foods, contributes not only to better digestion but also to immune function, metabolic health and the gut brain axis. In the same way, nourishing our bodies helps us build stronger bones, more stable energy, better sleep and the physiological resilience that allows us to navigate the inevitable stresses of life. Increasingly, nutrition is not simply about preventing disease. It is about creating the conditions in which we can thrive.

If we are intentionally building all of these foundations, we are also building capacity: the capacity to think clearly, recover from illness, cope with stress, move confidently, remain independent and continue participating fully in the lives we want to live. It is this capacity that ultimately gives us agency, one of my favourite words. To me, agency is the quiet confidence that our choices matter and that, through the small decisions we make every day, we are actively shaping our future health. Health is not something that simply happens to us. It is something we build.

The future of health is not measured by what you remove from your life. It is measured by what you intentionally build into it.