Setting the Stage for Health At Every Size (HAES)

Recently I’ve noticed that whenever I tell someone that I support a HAES approach, I am met with a blank face OR someone who nods and then goes on talking about weight loss strategies. So I thought I’d start a little series here on the blog to explain more about the HAES philosophy.

 

The HAES approach is truly a radical divergence from traditional views around health. So if you’re new to this space, buckle up and stay open!

 

This approach takes a weight-neutral approach to health and recognizes:

  • The size of a person actually has little effect on their health 

  • All individuals, regardless of their size (and for that matter gender, race, ability, ethnicity, sexual orientation, etc.) deserve to receive appropriate, respectable, evidence-based medical care.

 

Too often a large person will go to the doctor for an ailment and be told they could solve this ailment purely by losing weight. Now, if that same ailment is experienced by a thin body, the doctor will prescribe evidenced-based medicine. Just this past week I was referred to speak with a young man with hypertension who happened to have an Obese BMI (BMI discussion to come). Instead of discussing nutrition therapies to help with HTN, the doctor asked me to discuss weight loss strategies. You bet your bottom dollar that had this person been within the normal BMI range, I’d have been asked to discuss the Low Sodium/DASH (Dietary Approaches to Stop Hypertension) diet.

 

It’s a VERY common misconception that being fat is unhealthy. This myth is considered doctrine in virtually our entire medical system, the public health arena, wellness industry, and media. Our fat-phobia creates and perpetuates unhealthy relationships with food/body, poor self-esteem, eating disorders, and a subsequent reliance on the weight loss/beauty industry.

 

The stigma a fat person faces could easily account for the health issues associated with being fat rather than the weight itself. Did you know that weight discrimination is now more common than race discrimination in our country? It’s seen a 66% rise in prevalence over the past decade.

 

Research demonstrates that weight stigma does not actually lead to people losing weight or improving their health. Rather, this stigma leads to greater risk of depression, poor body image, low self-esteem, higher stress, disordered eating patterns, and less physical activity.

 

Side note: While the word “fat” may sound like an insult because of the way our society has conditioned us to think. I want to clarify that I always use the word, “fat” in an empowered way. If hearing the word makes you feel uncomfortable – you’re in good company and I invite you to consider taking a minute and thinking about why it makes you feel this way.

 

We know that the current body of weight loss research indicates that no diet is successful long term in maintaining weight loss for the vast majority (I’m talking 95%) of individuals. So it’s unethical to prescribe weight loss because we know it likely won’t last. AND – research does not support the misconception that losing weight will help or reverse comorbid diseases. Even diabetes researchers are recognizing that weight loss only helps with blood sugar control for a limited time period (and likely has nothing to do with the weight loss at all).

 

Have you heard of the Body Mass Index (BMI)? I’ll go deeper into the history of BMI, but for now – just know that it was created for statistical purposes as an easier way to classify populations. It was NEVER created to assess health. And yet, we continue to use it to assess individual’s health and health risks, which is incredibly problematic.

 

 

So now that we know BMI has been helpful for researchers to classify people into groups, let’s take a gander at their findings. A large majority of research draws associations between higher body weights and worse health outcomes. Correlation is not causation. There are SO many other reasons that someone who is in a bigger body could be experiencing health issues. Something we all need to hold in mind whenever we’re reviewing the literature is the inherent biases that researchers maintain. They are human just like the rest of us, and they have also been conditioned by our fatphobic society to believe that fat means bad and unhealthy.

 

 Remember Maslow’s Hierarchy of Needs. See Health? It’s on the second step on the way towards self-actualization. With our society’s thin=healthy line of thinking, we’d be excluding a huge population from moving forward – how unfair and untrue is that?! I know plenty of larger individuals who have moved beyond that rung.

 

And yet, someone who is fat may in fact lack self-esteem or sexual intimacy. What’s the doctor prescribe? Weight loss via food restriction. So then we’re back at the bottom of the ladder where our body is trying so hard to keep homeostasis with inadequate food supplies. What an exhausting process that keeps people STUCK.

 

The process of dieting leaves little time to form strong bonds with others, makes it difficult to maintain self-confidence, or find the energy to be creative. Being consumed by thoughts of food and body is not a very abundant place to be.

 

The response to the weight-centric paradigm is HAES.

 

“It supports people of all sizes in addressing health directly by adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.”

– Linda Bacon

The Association for Size Diversity and Health (ASDAH) lays out the principles of HAES as follows:

•   Accepting and respecting the diversity of body shapes and sizes

•   Recognizing that health and well-being are multi-dimensional and that they 
 include physical, social, spiritual, occupational, emotional, and intellectual aspects

•   Promoting all aspects of health and well-being for people of all sizes

•   Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure

•   Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss

Unlike our current system, this framework truly supports an individual’s health journey. If you'd like to learn more, I encourage you to peruse the ASDAH website.

 

Pursuing health isn't a moral imperative, but it's imperative that this message gets out because our current system is oppressive and harmful.

 

 

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