What is health at every size?

History of Health at Every Size

The ideas behind HAES have existed for some time, with roots in the civil rights movement, though it wasn’t called Health at Every Size until the late 1990s.¹

The philosophies are a direct response to the “weight-centric” model currently used by many doctors and medical centers. Sometimes called "obesity treatment," these views emphasize the importance of someone's body weight or place on the body mass index (BMI) without acknowledging other contributions to their overall health.

This can result in weight bias and stigma, even among medical professionals, and can lead to prescriptions to lose weight, which are generally unsuccessful and can contribute to the development of disordered eating behaviors or full-blown eating disorders.^5,6

The rise of ready-to-wear fashion, the development of at-home scales, and a reliably adequate supply of food in most developed countries have also contributed to higher scrutiny placed on body weight, shape, and size throughout the 20th and 21st centuries.⁷ 

The HAES movement hopes to undo the long-held assumption that body weight is a direct representation of someone's overall health. It also hopes to help people in larger bodies overcome health stigma and be heard by physicians who may otherwise write off their concerns as symptoms of their size.

The HAES approach

Health at Every Size not only challenges the widespread weight discrimination embedded in the medical world, but it also challenges many cultural and scientific assumptions about weight-related stereotypes.

Acknowledging lived experience

With the HAES approach, a person’s lived experience is acknowledged and honored, positioning them as an expert on their own body. This can help empower them during visits to the doctor, particularly people in larger bodies, who often face biased thoughts that they are "lazy" or undeserving of care due to their size. In addition, their concerns are often dismissed due to their weight.⁵

This approach can also help prevent someone from feeling like a failure if they cannot achieve the weight loss goals prescribed by their provider. The traditional weight-centric model can make people feel like something is wrong with them or that they won’t be able to live a healthy life at their size and weight if they fail to reach a certain number on the scale.³

Encouraging self-care

HAES also positions self-care as a major measure of health and a potent path for health enhancement. This includes participating in life-enhancing movement—physical activity that is enjoyable for that person. Joyful movement and physical activity can come in many forms, from dancing and yoga to gardening to simply playing with your children. If it's enjoyable and not specifically viewed as a means of intentional weight loss, it's likely a form of joyful movement.

Engaging in intuitive, pleasurable eating is another way to improve health. Intuitive eating involves learning to listen to your body’s cues of satiety, fullness, and hunger instead of eating according to external expectations or rules, such as eating at specified mealtimes or engaging in strict portion control regardless of hunger.³

Challenging traditional weight-related assumptions

Under the weight-centric model, people of higher weight seeking care for various symptoms or conditions often come away with a prescription to lose weight, regardless of their overall health. This practice is harmful, stigmatizing, and neglectful, as patients living in larger bodies often don’t get the healthcare they need.

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

• Being overweight poses a severe risk of health complications, such as cardiovascular disease and even 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 if 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, and weight loss is not viewed as a viable health intervention.³

HAES principles

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, including those that are out of the person’s individual control. Instead of defining health improvement as the eradication of disease, HAES views health from a holistic, comprehensive perspective.¹

HAES recognizes 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 there is one "healthy weight" for everyone and that striving to achieve it 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. Healthy behaviors are not just an individual concern. Using a social justice framework, HAES strives to fight inequity and 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. At Within Health, we understand that health is not a factor of weight nor a representation of health.

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 to tailor treatment to meet their needs. Weight loss is never a treatment goal, no matter what weight or size a person is. 

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

Our goal is to repair patients’ relationships with food and movement by promoting enjoyable movement through experiential therapies, teaching and practicing mindful eating, fostering community, 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.