Health At Every Size: Actually Possible or Too Good to Be True?
Are you curious to learn more about the Health at Every Size (HAES) approach? Did you ever come across the phrase, and wonder if it’s meant literally? What is this approach all about anyway?
This article will give you all the information you need to become acquainted with HAES. You’ll learn:
- What is HAES all about?
- Scientific evidence for HAES
- “Okay, but…”s, or some common objections and controversies surrounding HAES
- How to talk to your medical provider about HAES
Prepare yourself to hear some crazy stats and studies!
Are you ready? Let’s dive right in.
What is Health at Every Size (HAES)?
Health at Every Size is a lifestyle that encourages peace with one’s own body, inclusivity and respect for others, and the pursuit of joy in life. (Sounds pretty good, no?) It believes that “health” does not have one objective definition that applies across the board. Instead, health is a way of life that is based upon the decisions you make each day. Health is when those decisions are aimed towards body respect, joy and enthusiasm for movement, and respect for life. It’s just about taking care of your body in the way that feels best to YOU.
The 5 core principles of HAES are:
- Weight inclusivity- respect the fact that there are many different body types. None are worse or better than others.
- Health enhancement- fight society’s fatphobic stereotypes that lead to oppression in the workforce, in medical treatment, and in educational institutions. Not to mention the social isolation that fat people face, and the fact that venues such as restaurants, airplanes, and waiting rooms were clearly NOT designed to be inclusive of fat people.
- Eating for well-being- eating is not about dieting, limiting, or trying to control yourself. Instead, it’s about paying attention to your body and asking yourself questions like: “what does my body feel like it needs right now?” or “how does this food make me feel?” And then you have to really and truly listen to what your body and mind answer to those questions.
- Respectful care- acknowledge our own biases about weight. And fight the weight stigma that exists in the medical field, which prevents many fat individuals from receiving the health care they need.
(You might find it hard to believe that a doctor won’t provide care to a patient just because they’re fat, but it’s true. Studies have found that 15% of doctors refuse to accept patients over a certain weight. When fat patients show up at a doctor’s office, they’re more likely to be offered lifestyle advice such as to eat better or exercise more in order to lose weight. Doctors are less likely to recommend preventive care screenings, like mammograms or other cancer screenings. Some even refuse to provide treatments such as knee and hip replacements.)
5. Life-enhancing movement- exercise is not about workouts that burn the most calories. Instead, it’s about physical activity that you enjoy and look forward to, just because it makes you feel “good.” And you can get creative! You might not enjoy pedaling for an hour on a stationary bike while staring at a wall, but maybe hiking brings you peace and joy. (Anyways, admit it: if you enjoy your workout regimen, you’re much more likely to actually keep to it!)
Is There Scientific Evidence for Health at Every Size?
You bet! Check out this list of studies that show some mind-blowing findings.
- A 2022 study showed that after undergoing an HAES approach treatment, all the subjects improved their cholesterol level, risk of heart disease, and other important health measures. They also had healthier attitudes towards eating and body image, and overall quality of life. This was true for almost all the people in the study, regardless of whether they lost weight during the study or not. Clearly, these important health factors are not necessarily related to how much you weigh!
- A 2016 study found that fat women who were treated with the HAES approach weighed the same amount after two years as women who were treated with a typical weight loss program. The difference between the two groups? Actually, the HAES women were more active, had lower cholesterol, and healthier blood pressure than the weight loss group.
- A fascinating 2005 study compared HAES to a classic dieting approach. Though the dieters lost weight at first, they gained it all back by the end of the study. They also did not improve in any of the areas that the researchers measured, such as blood pressure and body image. They didn’t even maintain any of the positive behavior changes they had made during the study. Meanwhile, the subjects who underwent a HAES approach stayed the same weight. But they had healthier blood pressure and body image, and maintained the behavior changes they had made. So according to this, HAES is more effective than dieting in the long run.
- A 2002 study also found HAES to be more effective than dieting at getting people to stick with their healthy attitudes and behaviors. Now this study has the kicker: a LOT more people (41%) in the diet group dropped out before the study was over, compared to the HAES group (8%). A health plan that you can actually stick to– now that’s something valuable!
“Okay, but…” Some Common Objections to Health at Every Size:
Like with every new idea that becomes a movement, there are some common objections to the concepts of HAES. (Ignaz Semmelweis was scorned by his medical colleagues in 1847 when he suggested that medical students wash their hands between dissecting cadavers in the morgue and examining patients in the hospital. Only years after his death were his ideas accepted by the medical world, and hand-washing became standard practice.)
Some common objections to HAES:
- “But weight DOES impact health! Aren’t obese people more likely to die, and to suffer from heart and other diseases?
Actually, in 2004, the CDC counted fewer yearly deaths among overweight people than regular-weight people. (In fact, more underweight people die each year.) And while it is true that obesity often comes together with certain diseases, it doesn’t mean that obesity causes these diseases! Linda Bacon, founder of the HAES approach, likes to give the example of the correlation between bald men and heart attacks. Bald men are statistically more likely to have heart attacks according to studies– but baldness doesn’t cause heart attacks! It’s more likely that there’s something else behind both of these issues. (Possibly testosterone in this case.)
So here, too, it’s likely that something else is causing both the overweight and the diseases. Possibly lifestyle choices? It’s hard to say for sure. But as you saw in the studies above, eating well, moving around energetically, and feeling positively about yourself and life in general, reduce the risk of heart diseases without affecting weight.
In fact, there’s loads of research that shows that it’s actually weight cycling, not being overweight, that causes poor health. Weight cycling means going up and down in weight. It is usually the result of repeated attempts to diet. Multiple studies show that the risk of dying from heart disease is a lot higher among people who lost weight, than among those whose weight stayed stable. (Kind of terrifying, if you ask me.) So the diet culture that surrounds us and encourages us to lose weight in the name of health, is actually harming our health!
- But what about dieting? Isn’t it helpful in making me lose weight?
I hate to say it, but science seems to be out against dieting these days. An impressive collection of studies point again and again to the fact that diets simply don’t work. Even when people actually stick with them! (Even diet culture is starting to recognize that, and instead of calling their programs “diets,” they disguise them by advertising for “wellness plans” and such.)
Although dieting can cause you to lose weight in the short run, it pretty much never succeeds in the long run. Our bodies have ways of maintaining themselves, and more often than not, the weight comes back months or years down the line.
In two shocking studies of teenagers, one in 1999 and one in 2003, kids who dieted actually gained MORE weight throughout a three-year study, than kids who didn’t diet. Yikes.
Another study in 1999 showed the same to be true for adults who dieted– that attempting to lose weight actually leads to weight gain.
So, to answer the original question: no, dieting ISN’T helpful in getting you to lose weight. Whatever the reason may be that you want to lose weight, you might be better off working to change your habits and choices, such as how you eat and how you move. This will help you feel better, address whatever medical concerns you may have, and has nothing to do with your weight.
Fine, You Convinced Me! But How Do I Convince My Doctor?
First of all, know your rights. As a patient, you have the right to the best medical treatment for your condition no matter how much you weigh.
Know that you have the right to refuse to be weighed at your doctor’s office. If you think about it, it’s kind of this automatic part of a doctor’s checkup when you go to visit a doctor. But how often is it directly related to the matter at hand? You can insist on your right not to step on that scale, and to say that you prefer to hear their medical opinion outside the context of your weight. (If knowing how much you weigh is medically necessary, like if the doctor needs to know how much medication to prescribe, you can stand on the scale with your back to the numbers. Just ask the doctor not to tell you how much you weigh.) Most of the time, your weight has nothing to do with the medical reason for your visit. It’s just that universal focus on weight that assumes weight gives us the full picture of a person’s health– when it actually doesn’t at all.
Also, learn to recognize weight bias. If doctors constantly come at you with recommendations to lose weight, no matter what medical complaint you are coming in with, it might be time to take a step back and think twice about visiting this doctor.
Finally, if you’re unhappy with your doctor’s attitude towards weight, you may want to consider finding a different doctor. There are, thankfully, many providers who ascribe to the HAES approach. Find a Health at Every Size provider using the directory on asdah.org. You can also look for a Health at Every Size doctor in the various HAES-focused social media groups, and of course by turning to good ol’ Google.
When you call a doctor’s office, ask them about it! You can ask them straight up: “Is Dr. So-and-So an HAES-aligned doctor?” As the patient, you absolutely have the right to ask questions and screen your medical providers for yourself.
So, there you go. You’ve officially been introduced to HAES. Of course, there’s way more to talk about! Please leave your comments below! Ask any questions you have, bring up any subjects you’d like to see addressed, or even start an argument! If we want HAES ideas to spread, we need to keep talking about them. So let’s keep it going and change our world, bit by bit!
Resources
https://www.frontiersin.org/articles/10.3389/fnut.2022.598920/full
https://academic.oup.com/ajcn/article/70/6/965/4729081
https://www.nature.com/articles/0802012
https://www.sciencedirect.com/science/article/abs/pii/S0002822305003226
https://education.nationalgeographic.org/resource/health-every-size
https://asdah.org/health-at-every-size-haes-approach/
https://pubmed.ncbi.nlm.nih.gov/27289009/
https://psycnet.apa.org/buy/1999-01811-015
https://www.excel-medical.com/obese-patients-receive-worse-care-its-time-to-address-this-issue/