Health at Every Size is Not Up for Debate
With the rise in popularity and mainstream media coverage of Intuitive Eating in the past year, the Health at Every Size (HAES) approach has caused much controversy. HAES, at its core, is a social justice movement for every body, ethnicity, race and gender. To quote the Association of Size Diversity and Health, “It is a movement working to promote size-acceptance, to end weight discrimination and to lessen the cultural obsession with weight loss and thinness". The HAES approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.”
Similar to Intuitive Eating, the HAES approach shifts from a weight-focused to a health-focused paradigm, which challenges some of the key assumptions of traditional approaches to weight management. Intuitive Eating and HAES aligned messages have dated back to the 1970’s, so why are we just now hearing about them?
Two words: Diet culture. By definition, diet culture is a system of beliefs that:
Worships thinness and equates it to health and morality.
Promotes weight loss as a means of gaining a higher status.
Demonizes certain ways of eating while elevating others, which means you’re obsessed about food and eating, ashamed of making certain food choices and distracted from your pleasure, your purpose and your power.
Oppresses people who don’t match up with its supposed picture of health.
Not to mention, diet culture is a 72-billion-dollar industry. All of these things listed above are the standard for health that our society pushes. Which brings me back to why HAES has caused much controversy. A question that is often asked when HAES is discussed is, “It’s ‘health’ at every size but not ‘healthy’ at every size, right?”
Let’s look at the research, which illustrates why this quote is inaccurate:
1. Long-term sustainability of weight loss interventions shows on average 30% to 40% of lost weight is regained within 1 year, and longer-term follow-up (2–5 years) show a gradual return to baseline weight levels or above. Overall, diets don’t work and traditional weight loss interventions fail.
2. Those residing in a larger body that have been diagnosed as “obese” have experienced the devastating effects of bias and stigma while seeking weight management support.
First thing’s first, “healthy” does not have a “look” or size. The research stated above has led to the prevalent assumption of whether a weight-focused approach to obesity management is either appropriate or effective. At the core, this research advocates that one's weight does not equal their health. As more and more research has come to light in the 2000’s, we have seen great strides to reframe this narrative and provide unconditional support for clients recovering from the harmful effects of diet culture, weight stigma, and "fatphobia."
HAES proposes that practitioners and all health professionals encourage body acceptance, support intuitive eating, and support active embodiment. HAES also suggests that not only are traditional approaches ineffective, but dieting and restriction also cause physical, emotional and spiritual distress.
It is important to understand that removing the focus on weight does not mean it is ignoring health risks and medical problems. When someone resides in a larger body and has medical problems, HAES suggests that health professionals offer the same approaches that they would for a thin person presenting with similar problems. In the case of a thin person with essential hypertension, for example, conventional wisdom suggests dietary changes, increases in aerobic physical activity, and stress management followed by medication if necessary. Yet a heavy person presenting with the same diagnosis is told to lose weight, regardless of all that is known about the person's dietary and exercise habits and stress levels and/or management. This is fatphobia and it's not okay. Every body, gender and race deserve the same quality of healthcare; healthcare that is unbiased and without shame or judgment.
By putting weight loss on the back burner and not promoting it as a primary goal, we can help to prevent future generations of children, women, and men from developing disordered eating, loathing their bodies, engaging in risky weight-loss strategies and dying to be thin.
For more resources on the HAES approach, you can visit the Association for Size, Diversity, and Health. In addition, Lindo Bacon has written an incredible book: Health at Every Size that offers valuable insight for anyone looking to improve their relationship with food and their body. It is also a wonderful resource for any health professional wanting to incorporate these principles into their practice.
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Written by: Anna Crum, Wellness Workdays Dietetic Intern