Thinking about your weight?
What you might be getting wrong about the Health at Every Size approach
Many Americans are worried about the effect that eating too much and exercising too little during quarantine is having on their weight. That makes it a good time to take a look at the Health at Every Size (HAES) movement. Its goal is to define health in a more inclusive way — by eliminating weight stigma, respecting size diversity and improving access to health care for everyone, an especially helpful approach during the pandemic.
Pushback against HAES can be heated, however, especially online and on social media. And it’s a radical departure from the typical view of health, which hinges on “acceptable” body weights and lifestyle choices. But I believe some of this scorn stems from misunderstanding what HAES means. Here are three myths about HAES.
MYTH: HAES asserts that everyone is healthy at every size.
HAES advocates don’t claim that everyone is healthy no matter what their size. Rather, they reject the use of weight, body mass index or body size as proxies for health and call for health policies and personal practices that support health and well-being without requiring a change in body size or shape. For example, HAES supports eating for well-being based on hunger, satiety, nutritional needs and pleasure — not weight control. And it supports the right to enjoyable physical activity for people of all sizes, abilities and interests, if they choose to participate.
“HAES is a useful acronym, but it should really be ‘health for all sizes,’” said California-based psychologist Deb Burgard, one of the founders of the HAES model. “It’s saying that people deserve an environment and culture that supports their health, regardless of their size.”
One of the roots of this myth is a narrow definition of what health means and what contributes to health. “There are many ways to measure health; weight is just a marker of size,” said Lindo Bacon, a professor and researcher at the University of California at Davis and author of the book “Health at Every Size.” “If you care about health, why not look at direct markers of whatever health attribute you are interested in? Why go at it indirectly?” For example, someone’s size can’t tell us if they are developing Type 2 diabetes, but their blood sugar levels can.
“The HAES model was really born in this crucible that fat people are getting horrible care, medically,” Burgard said.
She said health care providers — including medicine and public health — need to figure out how to support people’s health regardless of their weight, rather than labeling some body weights as a sickness called obesity.
Bacon noted that health is a privilege to which people don’t have equal access, and research is finding that the health issues attributed to being fat can be exacerbated by stigma and discrimination.
“Too often, the stigma fat people face is veiled as ‘concern for health,’” Bacon said. HAES also considers social determinants of health, including education and income levels, neighborhood environment, discrimination, and access to health care and healthy food. “If you experience life as a member of a less fortunate group, your health is not going to be as good,” Burgard said.
MYTH: HAES is anti-weight loss. Another criticism is that HAES-aligned health care providers oppose weight loss and deny it can have a direct impact on health.
“HAES isn’t anti-weight loss but anti-prescribing weight loss as an intervention,” said Pennsylvaniabased registered dietitian Haley Goodrich, founder of Inspired Nutrition. “Instead, as HAES providers, we shift the focus to health-promoting behaviors that improve symptoms and quality of life without focusing on weight.” For example, incorporating enjoyable physical activity and improving nutrition without dieting.
The HAES model does acknowledge that in some cases weight may affect health but advocates for offering someone in a fat body the same evidencebased treatment as someone in a thin body. For example, being prescribed physical therapy instead of just weight loss for knee pain. When someone is instructed to lose weight as a primary treatment and they can’t, or they later regain the weight, their condition may continue to worsen. Isn’t it better, then, to focus on behaviors — weight is not a behavior — that most of us have actual control over?
Burgard said weight loss dieting is not a benign process. “If health care providers were really to give informed consent to people who want to begin dieting, they would have to say, ‘Weight loss is a temporary situation. You’re going to get closer to thin privilege, and then you are going to lose it and you’re going to know that you’ve lost it.’ Or they develop an eating disorder,” Burgard said.
MYTH: HAES promotes obesity. The HAES model is often accused of promoting or even glorifying obesity, as some — typically women — with fat bodies who express feeling positive about or even accepting of their bodies.
“Do people really think someone is going to look at a positive portrayal of a fat person and say, ‘That looks way cool. I want to be fat!’” Bacon said.
“The assumption of course is that weight defines health, that fat people are unhealthy, that health is a moral virtue and fatness is therefore offensive,” Bacon added. “Since the belief system also contains the idea that health is under individual control, the fat person is a failure.”
Goodrich said people differ widely in terms of body size, shape and appearance, yet we’ve been conditioned to believe that dieting is the only option for improving health and living a full, happy life.
She said instead of worrying about glorifying certain body sizes, we should be worried about how unfairly people in larger bodies are often depicted in the media.
“In our culture, the belief is that if you’re not against fat people, you’re not going to put the brakes on everyone being fat. It’s as if stigma is going to stop people from getting fat,” Burgard said. “Does the HAES model try to make a legitimate place for fat people in the world? Yes.”