Understanding Health at Every Size (HAES)

First, what is HAES? 

  1. Focuses on HEALTH instead of WEIGHT
  2. Relies on hunger and fullness cues from the body to guide eating (internal), not counting calories (external)
  3. Promotes being active because it feels good and has many health benefits
  4. Is weight neutral by taking focus off of weight, and that weight and body shape/size is another component of diversity

I understand Health At Every Size can be a difficult paradigm to accept living in our fat phobic society. The name alone is met with a lot of assumptions, judgements, and misunderstandings.  What people often don’t understand of HAES is that everyone- regardless of their body size- deserves respectful medical care in efforts to achieve their health.  They deserve to have the same testing and treatments afforded to those with the same conditions in smaller body sizes.  

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What is an example of HAES?

My brain works best in examples so here is one… if you go to the doctor complaining of knee pain the doctor may consider prescribing physical therapy, cortisone shots, surgery etc.  If you are complaining of knee pain in a larger body you will most likely get prescribed weight loss and exercise.  Possibly without any inquiries about the nutritional content of your eating or the movement you currently do.  Not to mention that due to weight stigma and terrible past experiences going to the doctor delayed you from seeking treatment.

You may have waited months to years to decades to get intervention on said knee.  What was once something manageable with lesser interventions may be significantly more deteriorated. However, without the threat of being stigmatized by the doctor or dismissed with arbitrary weight loss recommendations, you could have gotten what you needed and deserved . You could be well on your way to healing. 

Now is as good a time as any to call out my own thin privilege.  I have never had to consider pros and cons of visiting a doctor’s office due to how I would be treated.  I have also never had to plan ahead as to how I might comfortably sit in public spaces, have access to clothing that fits me, or have my body be ridiculed by complete strangers. I do my best to educate myself on this topic to listen and learn from the experiences of my clients and to advocate in any way possible., but I still do not have the lived experience of going about my day in a world that is conditioned to place hate on my body.  Our culture angers me and saddens me and I am here for the fight for Health at Every Size. 

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For a second let’s simplify HAES to the weight neutral approach it is. What is the difference between a weight neutral approach (HAES) and the traditional medical model of a weight focused approach?.  Let’s look at the facts: 

Weight Neutral Approach 

  • Improves cholesterol (maintained after 2 year follow up)
  • Improves blood pressure (maintained after 2 year follow up)
  • Improves mood, self esteem, body image, and depression (maintained after 2 year follow up)

Limitations of weight-focused approach (weight loss)

  • Weight loss showed improvements in labs and psychological tests but all these values returned to normal at the 2 year follow up.
  • Drop out rate of 41%
  • Increase in weight stigma leading to increased need to cope, potentially involving maladaptive eating behaviors 
  • Effects of weight cycling  (weight loss and regain) increased cardiovascular risk of heart attack and stroke with higher mortality

 

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So, what are some HAES myths?

 

Myth 1: HAES means you are healthy at any weight

    1. What HAES is saying is that being in a larger body does not disqualify you from also being healthy.  Being thin is not a requirement for good health.  Back to examples for my brain! 
      • The patient going in for their annual check up and the doctor educating them on diabetes or high cholesterol despite having no indicators of high blood sugars or high cholesterol.  This happens a lot where the patient is judged based on their body and not on the actual measures of their health ie: lab values, nutrition quality, movement, stress, sleep etc.  
      • How about the person that gets a great review at their annual check up because they fall in the normal BMI category but they live on fast food and a diet without any veggies? 
      • What about the person that lost a ⅓ of their weight in the last year and is  getting congratulated despite the fact that they are dealing with a very serious eating disorder that has led to the weight loss along with digestive issues, increased anxiety and loss of their menstrual cycle?  

The assumptions with weight need to stop!  This is not an accurate measure of health or healthy behaviors. 

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Myth 2: If you support HAES, do not speak of weight loss!

This is such a tough one.  I have clients that are ready to embrace HAES and have been down the weight loss focused dieting trap for years and years and they feel guilty bringing up their desire to lose weight. I have so much compassion for those who want to lose weight or who are pursuing weight loss. Why wouldn’t they be focused on weight loss living in the culture we do?  I would imagine it has been years to decades of their life where family members, medical providers, and/ or social influences have placed blame on their weight for everything.  Promises from diet culture that weight loss will improve mental health, physical health, relationships, job opportunities, etc.

It takes a freaking warrior to stand up against the society we are in.  That is why the thoughts of wanting to lose weight is something I am always willing to hear about and understand better.  At the same time I cannot recommend weight loss in good conscience as I believe it to be doing harm.  Even if I didn’t consider it unethical, there is also no researched method of weight loss that can be sustained for the majority of people beyond 2-5 years.  Even those that do sustain it, at what cost? Most often these 2-5% of people are stuck in a cycle of obsession and isolation around food that may even be considered disordered by some criteria.  I certainly do not want that to be the case for my clients.  I wanted them to live a full life that includes food in a positive way along with the connection it brings.

Therefore if health is something you are searching for, you can get there without changing the shape and size of your body. Some medical professionals will argue that studies show us a correlation between body size and certain diseases. Yes, but correlation does not mean causation. We also know that weight stigma and weight cycling have a huge negative impact and a strong positive relationship to diseases that are often blamed on body size. Aka the more cycling/stigma, the more of an increase in disease/disease risk. So how do we know the weight stigma/cycling isn’t actually to blame? 

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Myth 3: You don’t need to worry about nutrition and exercise

It is interesting that when there is a weight focus what is considered healthy and nutritious goes out the window.  Unfortunately, for the most part advice to lose weight is “by any means necessary” with flat out advice from health care professionals to “cut out white foods”, “cut carbs”, or “try keto”. What all of these equate to is essentially cutting out an entire food group.  One of the hallmark signs of disordered eating! Mostly at this time that is carbohydrates- the preferred energy source for our brains! How is that healthy?

Similarly, healthy foods are suddenly banned due to the caloric content- avocados, olive oil, nuts, peanut butter.  What is interesting is when we listen to and trust our bodies we will find that they crave a variety of foods, not just the highly palatable foods like pizza or cupcakes but fresh foods and even veggies.  The trouble is with a layer of diet mentality over top of foods distinguishing them as “good” or “bad” we can’t access these not judgemental cues around food.  Diet mentality has also interfered with exercise as a way to alter the body as opposed to doing something that connects you to your body, honors your body and makes us feel well. To me moving your body in a way that enhances your life is the goal- not to do it to make yourself smaller, feel guilty that it is never enough, or suffer through when denying your body the sustenance it needs to fuel the exercise itself.  

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Myth 4: But what if someone “needs to lose weight” to be healthy? I mean after all, weight loss is the best way to be healthy?

Losing weight is not a behavior.  We are not able to simply choose the weight our body wants to be, but rather our body will tend to stay in our “set point” which is usually a range of 10-20 pounds- that is when we are eating mostly in accordance with our hunger cues, not acting on disordered eating behaviors and moving our bodies. Our focus in nutrition appointments is to create and nurture these healthy behaviors such as listening to our bodies internal hunger and fullness cues and eating in a way that provides us energy, improves our mood, and enhances our lives.  Yes the weight can change (up or down) as a side effect of changing behaviors, or it can stay the same. 

I can understand not knowing what will happen to your weight being a terrifying thought.  But I can say when you are well on your way to mending your relationship with food and your body it will not matter as much.  It still might be a lingering thought but it will not consume you the way it once did. What is interesting is all that what we think will improve if only we were to shrink our body size usually doesn’t improve.  Our lives are still the same, our problems are still the same.  Some even have had this experience first hand where life wasn’t better and may have even been worse at a smaller size.

Maybe we think we had more confidence- but did we?  Did that make going to the beach easier or did we still find a way to say it wasn’t enough?  Did it make us more confident at work, or were we still ruminating about how our bodies looked? 

Perhaps the stigma of weight changed and that would certainly be a breath of fresh air but I would imagine the fear of maintaining weight loss or the tactics used to achieve it would detract from it. By changing the behaviors around food we can achieve better health (lets not forget that genetics and other factors like socio economic status play a role in health as well).  That means we can improve things like blood pressure, blood glucose and cholesterol without seeing a change in weight.  Again remember, even if weight did affect our health we do not have the studies that show us weight loss is sustainable. People gain weight back. So even IF weight loss made people healthier, it’s not going to last. 

NOT BECAUSE YOU FAILED, but because of biology and our bodies’ extremely smart mechanisms of preservation.

I know it is counter cultural to not be actively dieting and trying to lose weight. It takes support and has to be the right time when you are ready to do something different and even radical to improve your health and wellbeing. Instead of focusing on decreasing weight, ask yourself how you can shift the focus to improving your relationship with food and body. This means nourishing the body, eating when hungry, enjoying foods, eating a variety of foods including the foods you crave, moving the body for fun, getting enough sleep, being compassionate toward yourself and others, respecting boundaries…

What else would you add to this list?

 

 

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