Have you heard of Health At Every Size®? If you’ve been a reader of this blog, then it’s a concept you might know a little about. If not, it might be brand new.
As you read this post, I ask that you keep an open mind as this information is different from the conventional way we think about health.
Health At Every Size®, or HAES, as I’ll refer to it as from now on, is a weight-neutral paradigm that continues to gain momentum. What our culture currently practices for health is known as a weight-focused paradigm, meaning measures are aimed at helping individuals reduce their body mass index (BMI) to “fight the obesity epidemic”. The problem that some health professionals and social justice groups have noticed is that this practice has been largely ineffective at the least, and more importantly, is causing harm.
The weight-focused paradigm has not resulted in thinner and healthier bodies, and actually contributes to food and body preoccupation, weight cycling (cycles of weight loss and regain), poor self-esteem, eating disorders, weight stigmatization and discrimination, and distracts from more important determinants of health (Bacon L. 2011).
Based on the increasing evidence that the number on the scale is not a reliable indicator of health, HAES has emerged as a paradigm shift from weight-focused to health-focused. The intent of HAES is to support improved lifestyle behaviors for people of all sizes, and weight loss may or may not happen. In other words, weight is put on the back burner.
The HAES framework has been studied quite a bit in the past 20 years or so. If you’re a bit nerdy and you like to read research articles, I’ve listed some at the end of this page. But generally what has been found is that by using an approach that promotes healthy behaviors without pursing weight loss, health markers such as cholesterol, blood sugars, blood pressure, stress levels and self-esteem and body satisfaction can all be improved. More importantly, they all stay improved. Weight-focused interventions may show improvements in these areas as well, but it’s mainly in the short-term. By one year weight regain has begun and shortly thereafter those health markers that improved start to worsen again. HAES interventions work in the long-term and don’t come with potential harmful side-effects like those I listed two paragraphs earlier.
So what does HAES focus on? The HAES framework consists of five principles:
1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. 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.
3. 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.
4. 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.
5. 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.
As you can see, HAES promotes healthy behaviors and attitudes to enhance well-being regardless of size. It is built on compassion, inclusion and human rights. And since it’s evidenced-based, it’s a practice I can really get behind!
Now, I understand if you’re skeptical after reading this.
I mean, it is vastly different from how our society has approached health for the last, I don’t know, what seems like forever! But even if you’re not a research nerd like me, just look around you. How many people have successfully lost weight and kept it off for a lifetime, without developing a tumultuous relationship with food and their body? How many thinner-bodied people do you know who suffer from chronic illness, and larger-bodied people who live long and healthy lives? How many times have you yourself or someone you know felt worse about themselves because of bullying, inability to comfortably take up space in the world, or workplace discrimination based on their weight?
What we’re doing now in healthcare and in our culture is just not working. Why not try something different?
Resources to check out:
Health at Every Size book by Linda Bacon, 2008
Body Respect book by Linda Bacon and Lucy Aphamor, 2014
Research articles:
Bacon L, et al., (2005). Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters. Journal of the American Dietetic Association, pp.929-936
Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10, 9. doi:10.1186/1475-2891-10-9
Bacon L, Keim N, Van Loan M, Derricote M, Gale B, et al. (2002). Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. International Journal of Obesity & Related Metabolic Disorders, 26(6), 854-865.
Ciliska, D. (1998). Evaluation of two nondieting interventions for obese women. Western Journal of Nursing Research, 20(1), 119-135.
Goodrick G, Carlos Poston II W, Kimball K, Reeves R, & Foreyt J. (1998). Nondieting versus dieting treatment for overweight binge-eating women. Journal of Consulting & Clinical Psychology, 66(2), 363-368.
Miller WC, Wallace JP, Eggert KE, Lindeman AK (1993). Cardiovascular risk reduction in a self-taught, self-administered weight loss program called the nondiet diet. Med Exerc Nutr Health, 2, 218-223.
Provencher V, Begin C, Tremblay A, Mongeau L, Corneau L, et al. (2009). Health-at-every-size and eating behaviors: 1-year follow-up results of a size acceptance intervention. Journal of the American Dietetic Association, 109(11), 1854-1861.
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