What the Heck is Health At Every Size?
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Imagine going to the doctor for carpal tunnel and you’re told to lose weight……
Imagine your friend also goes to the doctor for carpal tunnel and they’re recommended x-rays, bloodwork, physical therapy, etc, their weight is not discussed.
Imagine you live in a larger body (maybe you do and this story is all too familiar) and your friend lives in an average sized body. The doctor has assumed that your weight is causing the problem, while your friend has received a more comprehensive treatment plan. Research has shown that doctors use weight loss as treatment for larger bodied individuals, while providing more comprehensive treatment for average weight people.
This is a weight-centric approach to health that assumes weight is within a persons control, links higher weight with poor health habits, and believes weight loss will lead to better health.
Health At Every Size (HAES) is a weight inclusive approach to healthcare; it is a movement focused on promoting size-acceptance, ending weight discrimination and diminishing the cultural obsession with weight loss and thinness. HAES encourages people to develop lifestyle behaviors that are health promoting and that can reduce health risks, for all bodies.
HAES is based off of five principles-
Weight Inclusivity, Health Enhancement, Respectful Care, Eating for Well-Being and Life-Enhancing Movement
Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
HAES is a holistic approach that acknowledges that health cannot be determined by someone’s body size.
HAES suggests that our traditional approach to weight loss has been ineffective- how many of you have dieted for the purpose of weight loss, lost weight and then gained it back (and maybe then some) after the diet ended? Not only are the methods of dieting and restriction ineffective, they’ve also been shown to cause physical, emotional and spiritual stress.
Those feelings of failure and shame for gaining weight or feeling uncontrolled around food can actually be quite damaging. HAES advocates have discussed how these “failures” make people feel like they aren’t normal (they’ve seen this “work” for others) and feel like they cannot possibly be “healthy” unless they achieve a certain body size. Additionally, many people in larger bodies face experiences of discrimination and prejudice, resulting in behaviors that contribute to disordered eating, compulsive exercise, or total avoidance of health care in general.
Currently, people may be assumed healthy/unhealthy because of their body size or BMI, but this assumption does not take into account all the factors that can affect health. This approach refrains from the use judgment of others regarding their health status and recognizes that shame and oppression can have a huge impact on one’s health & wellness.
Why HAES?
HAES has been studied in randomized controlled clinical trials in comparison to traditional weight loss models. One study took 82 Caucasian women that met a specific BMI marker and split them into two groups, one group would be dieting and one group would be working on HAES principles.
The participants in the weight loss group, of course, lost weight and experienced some health improvements, but also saw a drop in self-esteem, not to mention more than half of the women dropped out due to difficulty maintaining the diet requirements. However, none of the health outcomes and weight loss were sustained through follow up.
The participants in the HAES group showed significant improvement in cholesterol, blood pressure and energy levels and experienced increased levels of self-esteem and body image. Did they lose weight? No, but neither did the weight loss group because they gained it all back.
So, how was the HAES group successful if they didn’t lose weight? Because they experienced improvement in areas that are actually valid markers of health. The participants in the HAES group learned that weight loss wasn’t as important as they had once thought. They learned that they could feel better about themselves, feel more attractive and experience health improvements, regardless of weight.
The thing is, our bodies actually want us to maintain fat in order survive periods of starvation, famine and, uh, diets. This is thanks to our “setpoint weight.” This is the place your body wants to be, where it feels most comfortable. This is why people often regain weight that is lost because that current weight does not feel sustainable or safe, so our body uses whatever means necessary to get back to that place by using tools like slowing down your metabolism or increasing hunger levels.
How do we know what this setpoint is?
Our setpoint is the weight we maintain when we listen to our bodies hunger and fullness cues, when we don’t fixate on weight or food, the weight that we naturally settle into when we aren’t dieting and living a more fulfilling and meaningful life.
At the end of the day, science has shown that weight and size is not a valid indicator of one’s health. It has also taught us that weight discrimination, weight stigma and weight cycling can actually be very detrimental. People can engage in healthy and unhealthy behaviors at any size. Regardless of body size or behaviors, people are deserving of respect, proper health care and treatment that is not based off of judgment, old science, assumptions, or bias.
We could all benefit from a little bit more compassion and acceptance towards others, and ourselves. If HAES is one way to accomplish those things, then count me in.
Want to learn more?
HAES- Minded Professionals
What to find a HAES aligned professional? There are acupuncturists, therapists, doctors, dietitians and nutritionists, attorneys pledged to the HAES. See if there’s on near you here
