Book Review: Health at Every Size (HAES) — By Linda Bacon

This is a review of the book “Health at Every Size” (HAES) by Linda Bacon. My review is of the 2010 “revised and updated” (aka second edition) as read on the Kindle.

The basic premise of the book is that dieting does not work (not a shock) and that instead, one should focus on finding health at your current weight.

These are all good thoughts and generally aligned with other reading on nutrition and health that I have done.

I am going to skip a discussion of the nutrition, diet, and exercise-related advice in the book. (This is the first ~160 pages of the book.) For me, the material was repetitive.

I agree that as a society, we should be more accepting that health is the most important thing, not a particular weight, BMI number, etc. Or as Bacon says on page 190: “[m]y weight is not a problem. Society’s problem about weight is the problem.”

Note: I know I raise/frame several points in this summary in a negative light, I overall think this is a good, but challenging book. See my posts about my weight struggles [Immunity to change; Falling off the wagon in 2018; start publicly blogging] and resolution struggles [Sep 2019 checkin].]

Unrestrained vs. Restrained Eating + Emotional Eating

Bacon’s primary thesis about eating patterns seems to be that people fall mostly into one of two camps about how they eat:

• Unrestrained eaters (aka intuitive or healthy eating pattern) — Able to primarily respond to your body’s signals about food vs. external signals.
• Restrained eaters (aka dieters or unhealthy eating pattern) — Tend towards being more responsive to external cues/reasons to eat and have (mal)adapted to not listen to the body’s hunger/fullness signals

To those two camps, she throws in a specific sub-pattern of restrained eaters who have emotional eating patterns. Some quotes from the book capture these ideas well:

• If you feel driven to eat for emotional reasons, you don’t have an eating problem. Nope. You have a caretaking problem. You’re not taking proper care of yourself. (Page 35, emphasis added)
• [A]ttempts to control your food intake through willpower and control require that you drown out the internal signals, leaving you much more vulnerable to external signals. (Page 40)
• Restrained eaters react to emotions and external cues in a nearly totally opposite manner of unrestrained eaters. (Page 41)
• Many of us eat what’s in front of us because we’ve been taught to take our hunger cues from external cues (what’s on the plate) rather than internal cues like hunger. That’s why it becomes so important to use your internal signals to guide you, rather than relying on the amount served to you. (Page 107)
• You’ll understand why food doesn’t fix feelings and explore the links between emotion, hunger, and eating as you learn how to recognize and short-circuit those connections. Once you learn how to take better care of yourself, you will lose interest in eating when you’re not hungry. (Page 171, emphasis added)

The book also includes a 20-ish question assessment of your (un)restrained eating tendencies.

Thus the thrust of the book/HAES plan from Bacon’s perspective is to figure out how to become an unrestrained eater. To support that (and in light of the science she presented) she focuses on guidelines that can help you find healthier eating patterns. Weightloss is explicitly a non-goal.

Guidelines

These guidelines are explicitly not meant to be hard and fast rules, but rather guideposts to help you move towards healthier (unrestrained) eating.

Guideline 1: Eat Delicious Food

Linked to the research, Bacon highlights that our enjoyment of the food we eat is an essential element of satiety. The underlying premise is that you are only eating if and only if you are truly physically hungry. Bacon says, “The next time you want those French fries, go for it! Eat them attentively and notice if they satisfy you… Commit to choosing food you love.”

I struggle with this advice because it seems to rely on you being able to tell if you are physically hungry. If I knew that, I probably would already be an intuitive eater.

Guideline 2: Pay Attention When You Eat

Guideline 2 is more actionable. Bacon asks, “So from now on, aim to be fully present for your meals. Eat with awareness. Turn off the TV, put away the newspaper, put on some soft music, set a nice table, and sit down to enjoy the food — even if it’s just a peanut butter and jelly sandwich!” (page 196)

Guilty as charged, I usually am at a minimum reading while eating if not two-to-three other tasks. Will try.

Guideline 3: Satisfy Your Hunger

Bacon proposes some simple chocolate-truffle exercise to start getting in touch with your feelings. Honestly, I’m confused by her descriptions since they ring hollow to me. I have no experience that after several bites, the enjoyment of a food type diminishes. So let’s call that a swing and a miss for now.

On to something that is more generally actionable, Bacon proposes a food log based on just tracking how hungry/full you are before and after eating and the associated emotions. Logging in this way does make sense to me. The initial hunger/fullness scale is meant to be a guide.

The goal of the journal is to help identify patterns, e.g., what does hunger feel like, fullness, what degree of hunger do you feel best responding to, fullness/content?

For myself, I somewhat know I fall into the “eating without eating” pattern described on page 204. (“You might also be ‘eating without eating,’ allowing yourself to become so distracted while eating that you don’t pay attention to fullness signals. Remember what I said earlier: You must be present and taste your food. Eating in front of the television or while driving won’t allow you to be fully sensitive to your food. Nor should you be eating while participating in a stressful meeting at work or while squabbling with your family at home. Food has to satisfy you on numerous levels to fully activate your satiety sensors.”)

Guideline 4: Tackle Emotional Eating

The critical point, as noted earlier, is that this is an emotional issue related to (insufficient self)caretaking in Bacon’s view. Within this step, there are six steps:

1. Thank your appetite: Sort of a Marie Kondo-like thought here, recognize and appreciate that your eating patterns have helped you in the past.
2. Question yourself before you eat: Pause (briefly) before eating and ask what you are looking for in the food and what would it take to satisfy that need. Hard.
3. Sit quietly: Try pausing if you are reaching for food when not hungry and sit in a quiet place and experience your emotions. Name the emotion(s) you are having. (Note that, fat, good, and bad are not emotions.) Do not attempt to change the feeling, feel it, and acknowledge it. As Bacon observes on page 210, “[w]hen you experience your emotions, rather than numbing them with food, you can realize that you have a choice.”
4. Feel those emotions: Sort of an extension of (2) and (3), but focusing on experiencing the emotion, e.g., journaling, talking with friends, etc. Bacon’s point on page 211 is, “[a]n important part of the healing is being able to tolerate the discomfort, rather than distracting yourself from it with food.”
5. Take care of the most important person in your life: Here she wants you to do something for you. She provides a list of 20-ish ideas to try (crossword, walk, knit, listen to music, etc.) The point is to do something you enjoy and do it. The point is to find non-food sources of pleasure. Repeat as needed.
6. Show compassion toward yourself: Do not judge yourself or blame yourself if/when you overeat. It just creates a cycle of more overeating.

That’s more or less it. The culmination of the guidelines is Bacon’s “Live Well” pledge:

• Today, I will try to feed myself when I am hungry.
• Today, I will try to be attentive to how foods taste and make me feel.
• Today, I will try to choose foods that I like and that make me feel good.
• Today, I will try to honor my body’s signals of fullness.
• Today, I will try to find an enjoyable way to move my body.
• Today, I will try to look kindly at my body and to treat it with love and respect.

In fairness, I’m skipping over two or so other main areas:

• One on respecting yourself. Respecting oneself can be challenging. Finding a healthy body image is critical. I spotted on concrete exercise here: “…list the successes you’ve achieved throughout your life. Make sure you’re listing things you feel were successful, not things society deems successful… [now] laminate it. Once a day, sit down with the list in front of you and make a new list: successes you had today, and new things you found to like about yourself today. Even if you only add one or two items a day, this exercise will remind you of your strengths and help you support yourself as you move toward self-acceptance.”
• The other is about broadening what you eat. Honestly, for a section that Bacon cross-referenced numerous times, I was disappointed that it was pretty vague. I’m not 100% sure what concrete exercises she is proposing here to change your taste palette.

Some Negatives

Overall a few areas:

• For a book published in 2008, I am confused by the number of references to the 1990s. Similarly, Bacon’s presentation of the conventional wisdom about diet and exercise confuses me. I could be missing something here. For example, maybe there was a much earlier book edition, or perhaps the book grew out of a previous work.
• Lack of concrete examples. Compared to most “self-help” or “self-help-esque” books, I was surprised how few examples Bacon gave of people using her program successfully.
• Lastly, as the ratio/detail of the book seems off to me. The “second half” of the book is barely 100 pages. These are Bacon’s suggestions and guidelines on how to move to intuitive eating. I would have preferred some roadmapping of the HAES plan in chapter 1 or 2, more like 50 pages of nutrition science and then a lot more detail on her guidelines.

Comparison to Guyenet’s “The Hungry Brain”

So as noted, I framed several parts of this review on the negative side; I think there is a lot to like and embrace in HAES. My struggle, I suffer from what Stephan Guyenet refers to as the “deadliest combination”: “when an impulsive person with a high food reward sensitivity lives in an environment that’s bursting at the seams with highly rewarding foods.” (“The Hungry Brain” page 68))

Like Bacon, Guyenet is not advocating a particular diet approach, but rather like Bacon has a handful of guidelines (“The Hungry Brain” pages 230–235):

1. Fix your food environment
2. Manage your appetite
3. Beware of food reward
4. Make sleep a priority
5. Move your body
6. Manage stress

Like Bacon, Guyenet is quite science-based in his approach. And implicitly in his six guidelines is taking care of yourself. Bacon’s differentiator is that she talks more explicitly about reconnecting with hunger signals. My struggle is we know information alone is insufficient.

Arguably, a key differentiator is that Guyenet is still talking about losing weight and some of his items (particular 1) rely on an external locus of control.

Conclusion

Perhaps the most subtle aspect of Bacon’s book is that she does not give a flying f*ck whether you lose weight or not.

What she does care about is that:

1. You embrace your body as it is and find ways to love it
2. Find a path to an internal locus of control around food (intuitive/unrestrained eater)
3. Enjoy life

Those are reasonable goals to have. I would (still) like to see more tools from her or other in the HAES/intuitive eating camp to get there, particularly around item number two.