Health at Every Size
Health at Every Size, or HAES, is a registered trademark owned and promoted by the Association for Size Diversity and Health. The HAES message notes that while the “war on obesity” has been going on for years now, rates of chronic and deadly diseases that are commonly associated with weight are still high for Americans. It argues that fighting obesity head-on is not what is going to help individuals live longer, healthier lives. HAES describes itself as a movement that, “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.”
So, what does this entail?
There are five principles of Health at Every Size:
- Weight inclusivity
- To change health is to change behaviors, not size, shape, weight, or BMI.
- Fighting weight discrimination in all settings, especially healthcare.
- Health enhancement
- Well-being is multi-dimensional and includes physical, social, spiritual, occupational, emotional, and intellectual health.
- Respectful care
- Accepting, respecting, and appreciating diversity in body shapes, sizes, types.
- Eating for well-being
- Mindfulness, compassion, and understanding in eating that focuses on a balance of individual nutrition needs, hunger/satiety cues, and pleasure.
- Life-enhancing movement
- Promoting physical activity that is focused on the individual and what they enjoy, not what will help lose weight.
The size acceptance movement started in the 1960s as a backlash to beauty standards that idealized slim bodies and stated that the measure of slimness is not optimal or achievable for all individuals. In 1967, an article titled “More People Should Be Fat” was published in a major magazine. In this article, Lew Louderback pointed out the advantages to being overweight, discrimination happening against fat people, and negative consequences of dieting and a diet culture. He elaborates on the idea that dieting below natural body weight and forcing weight changes are dangerous and can cause physical harm, emotional damage, and weight loss that is only temporary. In 1969, Bill Fabrey, inspired by Louderback, founded the National Association to Aid Fat Americans, which later became the National Association to Advance Fat Acceptance. This nonprofit organization was the start of the size acceptance movement, and it’s dedication to improving quality of life for overweight and obese individuals has since gained attention as they strive to be heard in public health, research, advocacy, and member support.
What do the professionals think?
Registered dietitians (RDs) are credentialed and certified experts in nutrition who are often faced with individuals looking for specific foods or diets to help gain or lose weight. While dietitians want to help everyone reach their health goals, the main focus of nutrition and dietetics must remain on overall health and well-being. We understand now more than ever that individuals should not diet for weight loss, but should instead adopt small, sustainable changes to promote overall health. There is an understanding that promoting health through positive behavior changes (such as exercising regularly, eating a diet high in fruits and vegetables, not smoking) will result in the best possible outcomes for all who partake.
However, not all RDs support the HAES movement. Opponents of the HAES movement draw attention to the fact that having a BMI in the obese range is in fact associated with a number of chronic illnesses, including heart disease, stroke, diabetes mellitus, and some cancers. This leads some healthcare providers to see this movement as a way to glorify an unhealthy life, or accept risk factors that are in fact within one’s power to eliminate. While this may not be the intention of HAES, healthy lifestyle habits should always be promoted. Proponents of HAES argue that a patient-centered counseling technique involves putting the diverse individual’s opinions, needs, and abilities first in order to promote change. After all, a single objective number such as BMI may not be a good measure of someone’s habits and the progress they are making.
Some recommendations that are evidence-based which promote healthy behaviors include: 150 minutes a week of moderate-vigorous intensity exercise, eating a diet high in fruits and vegetables, having a healthy relationship with food, having lab values within normal limits, being free of chronic lifestyle diseases, and maintaining other aspects of health such as mental health and social relationships.
Size and diversity acceptance and respect are of the utmost importance in the HAES movement. This concept of size and diversity lays the groundwork for other principles explored within the phrase. To practice HAES, we must keep in mind acceptance and respect of others while we acknowledge and appreciate that health is not a “one size fits all” and is multi-dimensional.
To leave some scenarios for thought, consider the following: Who would you consider “healthier”? An individual with a normal BMI who regularly binge drinks, smokes cigarettes, and eats McDonald’s twice a day, or an individual with an overweight BMI who exercises 4 times a week and cooks healthy meals at home? An individual with an underweight BMI who tracks every calorie, restricts their diet, and exercises for 2 hours every day to lose weight, or an individual with an obese BMI who is happy in their skin and eats food in moderation when they want?
Written by Caitlin Branson and Alec Pienta, Georgia State University Graduate Nutrition Students