The Health At Every Size Approach

A Social Justice Movement

You may have noticed that I am a huge proponent of the Health At Every Size® (HAES®) approach, and almost every social media post I create has hashtag haes and/or HealthAtEverySize. Health At Every Size is often misunderstood and misrepresented. So…

What is Health At Every Size?

In short, Health at Every Size is a social justice movement. It promotes respect and dignity for all bodies, and supports the idea that health-promoting behaviors (among many other social and ecological factors), not trying to lose weight, promotes health. It exclaims that size, weight, and BMI do NOT accurately represent health.

The Health At Every Size approach was developed by, and a registered trademark of, the Association for Size Diversity and Health (ASDAH), which describes HAES as an approach that “honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.” ASDAH identifies five main principles of HAES.

1. Weight Inclusivity

Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

-ASDAH

Natural, inherent weight diversity exists. We understand that some people are taller, and some people are shorter. Some people have blonde hair, and others have brown hair. Some people have darker complexions, and others have lighter complexions. Likewise, some bodies are bigger while others are smaller.

Natural, inherent weight diversity exists.

Thus, a person’s weight is not a result of their behaviors. For example, a smaller person may not exercise or eat nutrient dense food, and, at the same time, a larger person can be very fit and eat a healthy variety of nutrient-dense foods.

Reject our culture’s idealization of thinness, and recognize the inherent value and dignity of all bodies. Challenge society’s biases that assume fat people are lazy. Stop using pathologizing terms like “overweight” and “obese” to describe people with larger bodies.

Reject our culture’s idealization of thinness, and recognize the inherent value and dignity of all bodies.

Your body has a natural, biological set-point weight range, and your body will do everything that it can to remain in that range at homeostasis. If your set-point range naturally falls into the “overweight” BMI category, the fallacy of the term becomes clear. You are not “over” your healthy weight and size. “Obese” is a particularly medicalizing and pathologizing term. It is derived from the term “obesus,” which translates to “that has eaten itself fat.” Again, it fails to recognize size diversity, as well as the social and environmental, not behavioral, factors that can affect weight.

BMI, which categorizes people as “underweight,” “normal,” “overweight,” or “obese” was not intended to be an indicator of personal health. It was meant to see population-level statistics. In fact, people in the “overweight” category, on average, live longer than anybody else. People who are considered “normal” and “obese” can expect similar life expectancies to one another.

Fat activists are reclaiming the term fat as a neutral descriptor to describe larger bodies. It is much less pathologizing than “overweight” or obese.”

Fat activists are reclaiming the term fat as a neutral descriptor.

2. 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.”

-ASDAH

When we consider how to enhance health, we need to look at it holistically and considering people’s physical, economic, social, spiritual, mental, and emotional well-being. We cannot simply focus on physical health.

Choosing to eat nutrient-dense foods and move your body joyfully may result in some health enhancements. However, focusing on restrictive eating and exercise may ultimately lead you away from holistic well being. For example, if you are struggling to afford a place to live, it is important not to elevate the importance of buying locally-grown, organic, fresh produce. If your friends are going out for pizza or celebrating a birthday with a birthday cake, it is important to join them and enhance those connections.

Becoming fixated on physical health can lead to severe mental health conditions, such as orthorexia (the unhealthy obsession with eating healthily) or eating disorders — the deadliest mental illness. Working out at a gym with stigmatizing, anti-fat posters and attitudes will likely reduce your emotional wellness.

3. 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.

-ASDAH

In the United States today, fat people are discriminated against in almost all aspects of life. Weight discrimination, stigma, and bias (not fat itself) are likely the causes of diseases that are typically attributed to “obesity.”

If we really want to promote health, we need to challenge our personal and cultural biases. We need to fight the idea that people need to change their body’s size or shape to increase health. We need to recognize the harm we cause by our tradition of trying (and failing) to shame fat people into smaller bodies.

Weight discrimination, stigma, and bias (not fat itself) are likely the causes of diseases that are typically attributed to “obesity.”

There is no doubt that people in larger bodies are a marginalized group in our society. Many of these fat people have intersectional identities that include other marginalized characteristics. For example, a superfat, queer woman of color is likely going to face greater discrimination (and thus greater chance of poor health outcomes) than her small-fat, straight, cis-gender, male counterpart, regardless of their personal behaviors.

Importantly, people in bigger bodies face discrimination in the workplace. For example, our stereotypes about fat people being lazy or disgusting often prevent well-qualified, intelligent people from being hired for some jobs. When larger people are hired, they often earn less money than thinner people, and they are less likely to receive promotions. These types of sizeist discrimination cause both emotional and economic stress for that individual (and their family).

Another place that fat people face discrimination, which severely impacts their health, is in the healthcare system itself. Healthcare professionals are not immune to the biases held by the general public. For example, many healthcare providers assume that their larger patients are noncompliant and believe they are repulsive. Often times, when a person in a larger body goes to the doctor for a certain health concern, the doctor prescribes weight loss (even if there is a different treatment that they would provide to their thinner patients). Some patients in larger bodies dread going to the doctor and facing judgment and blame so much that they avoid going in for preventative screenings altogether. This obviously increases the chances that health problems will go undiagnosed until they are severe and harder to treat. Often times, larger people are even required to pay more for health insurance.

Consider also the way our public facilities are designed only to accommodate thin, able-bodied people. People in larger bodies often find that a facility only has weak, narrow chairs with armrests or that they have to pay more money than a straight-sized person to travel on an airplane. Bathroom stalls may be too small. Hallways and isles may be too narrow. It is not fair. All of these discriminatory experiences negatively impact health. At both individual and societal levels, we need to advocate more strongly for the HAES approach.

4. 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.

-ASDAH

As you have been told by the media and health care professionals, eating “healthily” is a health-promoting behavior. This means that honoring our bodies’ hunger and satiety cues (most of the time), eating a wide variety of food, being flexible with eating, and eating for pleasure is healthy.

Eating in a rigid or restrictive way intended to help you lose weight is not healthy. It does not allow you to be attuned to your body’s needs. For example, some days you may crave a particular food because you are low on a nutrient it provides. Also, some days we just need more food than other days. The rigidity also does not allow for flexibility and can prevent you from participating in social events and other activities that are important for your well-being, especially if these events involve food and do not have foods that are allowable on your pre-determined eating plan.

Eat for well-being, not weight loss. Our bodies were designed to give us important cues to help us meet our nutritional, social, and emotional hunger; we need to listen.

Eat for well-being, not weight loss.

As a society, we need to do a better job of making a variety of nutritious and fun foods accessible to all people, regardless of body size, location, or socioeconomic status. We need to create affordable, geographically-close, stigma-free places for people to buy or receive food.

Note: Dietician-supported, externally-guided eating is helpful for many people in the early stages of recovery from a restrictive eating disorder.

5. 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.

-ASDAH

As I am sure that you know, physical activity is another important health behavior for most people. (Note: It is NOT healthy for people with restrictive eating disorders or exercise compulsions.) Our bodies were designed to move, and we often feel better when we do move them.

Going to the gym and habitually completing intense, regimented exercise workouts is unnecessary for promoting health, and it is often very harmful. It does not allow you to be attuned with your body’s needs. For example, some days your body really does need more rest or time to heal. The rigidity also does not allow for flexibility and can prevent you from participating in non-exercise-related social activities that are important for your well-being.

If you do choose to participate in movement, find something joyful. For me, this is hiking in the mountains or going for walks with my dog. For others, it may be dancing in their kitchen while they are preparing dinner or playing on their school’s basketball team. Exercise for well-being, not weight loss.

As a society, we need to do a better job of making joyful movement accessible. We need to create places for physical activity that are designed for all bodies, including large bodies and disabled bodies. Further, these places need to be affordable, safe, and stigma-free places for people to enjoy movement.

As a society, we need to do a better job of making joyful movement accessible.

Learn More

To find out more about HAES, check out ASDAH’s website. They have many resources for learning more about body-liberation and the HAES approach.

Another great HAES-informed resource is the book, Health At Every Size, by Linda Bacon, PhD.

Linda Bacon is a leading researcher on the topic. To learn more about the evidence-based research that supports HAES, check out some of the peer-reviewed journal articles describing her research, such as “Weight Science: Evaluating the Evidence for a Paradigm Shift,” which she co-authored with Lucy Aphramor, PhD, RD.

Support ASDAH

Please consider donating to ASDAH (a volunteer-run, non-profit organization) so it can continue to expand the influence of the Health At Every Size movement and the quality of life for all those who are affected by weight discrimination, bias, or stigma (which, in this society, really is most of us).

Important Notes

Health At Every Size does NOT mean that any person can be healthy in any size body. A person at any size can choose to partake in health-enhancing behaviors if they want, and destigmatizing larger bodies is health-promoting on its own. However, people categorized in the “underweight” BMI category will likely suffer health consequences due to the behaviors required to sustain such a low weight; most people’s set-point range does not fall into this category.

Editorial content in this blog has not been authored by, or represent the views or opinions of ASDAH or the ASDAH Board of Directors.

“Health At Every Size” and “HAES” are registered trademarks of the Association for Size Diversity and Health.