Health at Every Size® seems pretty straightforward to me, but then I forget that it took me at least two months of sitting in a nutrition class taught by Dr. Linda Bacon herself for me to really and truly understand and accept HAES®. So I do try to cut some slack to others who are completely new to the concept, especially when they are coming from a weight loss mentality. But having only so much slack to give, I have witnessed some pretty egregious attempts at weight loss folks trying to co-opt the non-diet message of HAES® for weight loss purposes and I need to say something about it. Because that is NOT okay.
I’ll give you some examples of what I’m talking about in a minute, but first, to review, this is what HAES® is:
- Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
- Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
- Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
- Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
- Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
What all this boils down to is the pursuit of health without a focus on weight as the outcome. And what that means is, you don’t use HAES® to aid in weight loss. Why? Because this has never been shown to be a reliable, significant outcome of HAES®, and because once you start focusing on weight, you’re going to develop a messed up relationship to food, exercise and other self-care behaviors.
Here’s an example of how that messed-upness can happen: Say you’ve made some positive changes in your eating habits, like you’re no longer over-eating past the point of fullness by letting your internal hunger and satiety cues guide your eating, and you’ve managed to increase your vegetable servings per day while still enjoying your overall diet. You happen to notice that you lost a few pounds (maybe because you’re still having a hard time giving up the scale). You think, “Wow, I like that!” but after another week of improved eating habits, your weight doesn’t change. You’ve become weight-focused again though, so you think that maybe if you just start eating a little less than what satisfies you, and you double your vegetables (and eat them without butter), you could lose a few more pounds. Except that after a few weeks of this new weight-focused behavior change, you’ve lost sight of your satiety point and are overeating more frequently because the extra vegetables don’t really satisfy you for very long and they weren’t want you wanted to eat. Basically, you’ve put yourself back on a diet, and you are really no longer in charge of your eating, you’re just trying to control it. On top of that, your weight might not even be doing what you want it to, and especially not long-term.
Yeah, Glenys, we got it, you’re saying, HAES® is not about losing weight (although we know that can happen as a side effect; as can weight gain), it’s about good health habits and self-care independent of weight.
I know you, dear readers, are totally getting it. But lately I’ve run into some situations where folks clearly aren’t getting it.
The first time I saw this in action was last year. Some psychologists at my workplace wanted to start a weight loss program for the particular patient population we work with. Our workplace already has a weight loss program (with which I am not involved), so I suggested a weight-neutral HAES® approach instead and explained how that worked and why it might be beneficial. A big meeting was held with the weight loss program folks and the people from my unit, and at one point, a well-meaning person said, “We can combine the principles of HAES® into the weight loss program.”
My ears pricked up. “Uh, no we can’t.” Eloquent under pressure as always, I am!
“Sure we can!” said everyone but me. And that is when I had to explain — because obviously, they weren’t getting it — that weight loss and HAES® did not hang out in the same circles for a reason They might not have gotten it even after my spiel, but at least I stopped HAES® from being corrupted (this time!) and maybe even planted some seeds for later germination (kudos to the psychologists, though, they were all over this. They are all about body positivity).
In another instance of mass HAES® confusion, a friend of mine told me recently how HAES® was being used in the pre- and post- treatment of bariatric surgery patients to help them not focus on the scale and develop a better body image. My head nearly fell off when I heard this. This is a surgery that is done primarily to induce weight loss in people (some health professionals will tell you there are other medical reasons, and there are, but ask the surgical candidate how she’d feel about having the surgery and not losing weight) . Telling them to then not diet and not focus on weight loss is completely counterproductive to the goals of that surgery. Maybe these health professionals don’t really understand that there’s no reliable way (as shown by all the scientific evidence on this) to not diet and also to lose significant weight (and keep it off) at the same time.
And in the end, if weight loss is not achieved or maintained, that surgery is probably considered a failure (oh wait, that’s right, the weight loss intervention is never considered a failure; it’s the person who is the failure); and I’m guessing that the person who had the perfectly healthy organs amputated or rearranged in the name of weight loss will be pretty disappointed, too. For that reason, the use of HAES® as part of bariatric surgery treatment is not only a corruption of its non-diet, non-weight focused principles, it’s also unfair to the surgery recipient. The Association for Size Diversity and Health registered the term HAES® to protect it against corruption and co-opting by the weight loss industry, and now we can see why.
I know HAES® is new and strange and controversial (despite being completely evidence-based) to most people, and those working in weight loss are going to be especially resistant because their livelihood depends on their ability to sell weight loss. Even those who don’t diet start out skeptical because we’re so used to being spoon-fed the usual dreck about how long-term weight loss is possible and how weight=health etc. etc. blah blah blah.
But if you’re only going to get one thing out of learning about HAES®, let it be this: HAES® is not used for weight loss. Weight loss does not figure into the philosophy of HAES. Those twains? Never shall they meet.
Nobody has to accept HAES®. Nobody is obligated to follow any particular health philosophy or plan if they don’t want to. It’s here if you want it, and it’s pretty much free. But just know that if you are looking for weight loss, and you also want to practice Health at Every Size®, you might not be getting it.