What is health at every size?

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Health at Every Size (HAES) is an alternative approach to healthcare that proposes a weight-inclusive model which takes the focus off body weight as a gauge of health, and refocuses on actual metabolic indicators as measures of health.

Most doctors in the U.S. treat patients using a “weight-centric” model, in which they view weight as one of the most important indicators of health. Under this model, higher-weight patients seeking care for various symptoms or conditions may come away with a prescription to lose weight. This practice is harmful, stigmatizing, and neglectful, as patients living in larger bodies often don’t get the healthcare they need, because doctors often don’t take their complaints seriously.

The evidence-based health recommendations of HAES help teach acceptance of one’s body size and shape, while learning to eat intuitively and joyfully, and enjoying movement from a patient perspective. (1)

Last updated on 
May 27, 2022
In this article

The HAES approach

Health at Every Size challenges the widespread weight stigma and bias that guides healthcare in the United States. It is a public health approach that deprioritizes weight as a key influence on health outcomes, instead respecting and celebrating body diversity. (2)

HAES challenges cultural and scientific assumptions about weight-related stereotypes and centers a person’s lived experience, positioning them as an expert on their own body. HAES asserts that typical weight-centered approaches are not only ineffective, but that prescriptive caloric restriction and dieting can cause significant distress.

Many people living in larger bodies who are instructed to lose a specific amount of weight may feel like failures if they are unable to achieve the provider’s goals, or after they do lose the weight but gain it back, which is likely to happen. They may feel like something is wrong with them or that they won’t be able to live a healthy life at their size and weight. (3) It is this feeling of failure and weight shaming from the provider that feeds into feeling more shame. This, then often leads to psychological distress and disordered eating, which often results in the outcome their provider informed them was the problem to begin with–being in a higher weight body. (4)

Another integral component of HAES is self-care. This involves doing things that are enjoyable and fun to that person, and engaging in movement and physical activity that’s enjoyable to that person and not viewed as a dreaded means to lose weight or negate calories consumed. 

Engaging in intuitive, pleasurable eating is another. Intuitive eating involves learning to listen to your body’s cues of satiety, fullness, and hunger, as opposed to eating according to external expectations or rules, like specific mealtimes, or only eating certain foods at certain events, or portion sizes on food packaging. (3)

HAES challenges traditional weight-related assumptions

Some of the harmful weight-related assumptions that HAES challenges include: (2)

  • Being overweight poses a severe risk of disease and death
  • Obesity-related costs are responsible for the financial burden on the health and economic system and weight-loss treatment and obesity prevention can fix this
  • The only way for people living in larger bodies to improve their health is to lose weight
  • Weight loss is a positive and pragmatic goal
  • Anyone can lose weight and keep it off as long as they set their mind to it and are committed to exercising and eating a healthy diet
  • Weight loss will increase life expectancy

Within the HAES approach, the success of any health-related interventions is not measured by body composition, weight, or size. (3) And weight loss is not a viable health intervention for anything to begin with, as resulting health outcomes are often negative and more harmful to health.

Principles of HAES

Health at Every Size recognizes and affirms that health exists on a continuum that varies from person to person, may change over time, and depends on many factors, some of which are out of the person’s individual control. Instead of defining health as the absence of disease, HAES views health from a holistic, comprehensive perspective. (1)

Also, HAES views health as an ongoing process or resource accessible to all people and not as a goal to achieve. This public health approach rejects the stigmatizing and damaging notion that striving for health is a moral pursuit or obligation. As such, health status does not determine a person’s worth and should never be used to judge or discriminate against anyone. (1)

Lastly, HAES recognizes and celebrates the healing power of community and connecting with others. And it uses a social justice framework, which means that it fights inequity and aims to achieve freedom from oppression for everyone. (1)

Inclusive eating disorder care for people living in larger bodies

One of the biggest treatment barriers for people living in larger bodies is navigating fatphobic treatment providers, programs, and healthcare settings.

Within Health offers an inclusive virtual treatment program for clients of all identities and experiences. Our treatment modalities are all accessible within the Within Health app, and our treatment team approaches recovery from a compassionate, patient-centered perspective. We acknowledge BMI and weight are not gauges of health or eating disorder recovery.

Instead, we meet patients where they are. We acknowledge that eating disorders vary from person to person, and that treatment plans must reflect these differences. We get to know our patients, their history, and their challenges, in order to tailor treatment to meet their needs. No matter what weight or size a person is, weight loss is never a treatment goal. 

Our goal is to repair patient relationships with food and movement by promoting enjoyable movement through experiential therapies, teaching and practicing mindful eating, fostering community and encouraging new relationships, and providing nutrition and meal support. Our virtual program offers a safe and inclusive space for all for lasting eating disorder recovery.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. The health at every size (HAES) principles. ASDAH. (2022, April 22). Retrieved May 25, 2022, from https://asdah.org/health-at-every-size-haes-approach/ 
  2. Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health, 105(5), e38–e42. https://doi.org/10.2105/AJPH.2015.302552
  3. Health at Every Size. (2022). Retrieved May 25, 2022, from https://haescommunity.com/
  4. Puhl RM, Lessard LM, Himmelstein MS, Foster GD (2021) The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PLoS ONE 16(6): e0251566. https://doi.org/10.1371/journal.pone.0251566

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