Health at Every Size Approach

What is HAES® and why is it a better approach to weight and health?

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I’ve been a Registered Dietitian for over 15 years now, and I can tell you one thing: diets don’t work. I mean, yeah, maybe in the short term, but what usually happens afterwards? Exactly: back to square one or worse, as we’re about to see. That’s why, for a while now, I’ve been really interested in the HAES approach for overall health. It just fits in with what I’ve intuitively known for quite awhile now and why I prefer a non-diet approach to nutrition: diets cause more harm than good, and weight is not a predictor of health. If you’re interested in ditching the diet and learning about what is HAES and how it can benefit your health, keep on reading!

What is the Health at Every Size movement?
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What is the HAES® approach?

HAES® stands for Health At Every Size®, and is promoted by the Association for Size Diversity and Health. The primary purpose of HAES is to support improved health behaviors for people of all sizes without focusing on weight loss. Meaning, it takes a weight neutral approach to health, which is very different from the diet-centric culture we live in right now. It also addresses weight bias and stigma in people living in larger bodies, as well as the focus on individual responsibility in body weight and size.

HAES is becoming the standard practice in the eating disorders field and within civil rights groups, such as:

  • The Academy for Eating Disorders
  • Binge Eating Disorder Association
  • Eating Disorder Coalition
  • International Association for Eating Disorder Professionals
  • National Eating Disorder Association
  • National Association to Advance Fat Acceptance
  • Council on Size and Weight Discrimination
  • Association for Size Diversity and Health

HAES originates from the concern that focusing on weight as a means for better health “is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences…”, such as

  • Contributing to food and body preoccupation
  • Repeated cycles of weight loss and regain (aka, weight cycling)
  • Distraction from other personal health goals and better health determinants
  • Low self-esteem
  • Eating disorders
  • Other health risks
  • Weight stigmatization and discrimination

Therefore, attention is being focused on the ethical implications of recommending a treatment (weight loss) that may be ineffective or damaging. We’re going to see the health risks related to intentional weight loss later on.

What are the HAES® principles?

The Association for Size Diversity and Health states that “Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual”.  The HAES model is based on the following principles:

  1. Weight Inclusivity: Accepting and respecting the fact that bodies come in all shapes and sizes. It also means rejecting idealized and “specific” weights or body shapes.
  2. Health Enhancement: Considering the individual as a whole when providing health services, such as taking into account their individual physical, emotional, spiritual, social and economic needs. This also means supporting health policies that improve and equalize access to information and services.
  3. Respectful Care: Understanding that weight stigma is influenced by age, race, gender, sexual orientation, socio-economic status, and supports environments that address these inequities. This principle also helps health care providers acknowledge our own biases, and work to end weight discrimination, weight stigma, and weight bias.
  4. Eating for Well-being: This principle calls for promoting “flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure…”, instead of externally regulated eating plan focused on weight control (read: diets).
  5. Life-Enhancing Movement: Instead of structured physical activities, this principle is about supporting physical activities “that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose”. Choose is the key word here. What good is it to practice physical activity if it’s something that we don’t enjoy or that doesn’t make us feel good, right?

Can you really be healthy at any weight?

Thus, HAES promotes anyone, regardless of size, shape or weight, can lead health promoting lifestyles. But can you really be healthy at any weight? Let’s check it out.

It’s commonly assumed and promoted that by losing weight, you will improve your health, manage or avoid certain diseases and just be generally happy and healthy all over. But what if this wasn’t necessarily true? What if all that we’ve been taught about weight loss and diets and being at a “healthy” weight was largely based on incomplete evidence, herd mentality and “a private weight loss industry estimated at $58.6 billion annually in the United States” ? (I mean, seriously, Keto diet snack bars are making a killing as we speak!)

However, most long term research on weight loss practices ends up with “participants regaining on average 30% to 40% of their lost weight within 1 year, and longer-term follow-up (2–5 years) showing a gradual return to baseline weight levels or above”. #dietsdontwork

Yet, the HAES approach targets something different: promoting behaviors that support health instead of intentional weight loss.

In fact, randomized controlled clinical trials indicate that a HAES approach is associated “with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus”. 

“But”, you may be wondering, “what about all that evidence that being overweight and obese is unhealthy and can lead to disease?”. That’s what we’re about to punch holes into, right now.

Why size does not equal health

Weight bias
There can be healthy and unhealthy behaviors across the entire body size spectrum. Weight alone does not determine health status.

To start off with, I highly recommend that you check out this video on size diversity to get a feel of why a weight-centric approach is based on false assumptions and can do more harm than good.

I first saw this video when taking this amazing “Introduction to the Non Diet Approach” course (which is free, BTW). And it just makes so much sense! Think about it:

Each of us have our own genetic make-up that influences our body size, weight, shape and bone structure. And we also have different nutritional and energy needs. One of the best analogies for this that I’ve heard (but can’t remember the source; I think it was either Evelyn Tribole or Elyse Resch, the Intuitive Eating pioneers) is that if you’re a size 7 in shoes , why would you try to fit into a size 5? The same goes for body weight. We need to start learning and respecting the fact that not everyone is meant to be the same size. And that’s OK!

I plan to cover this topic more in-depth later on, because the supporting evidence is astounding! But if you need evidence right now that weight doesn’t equal health, this article from the Nutrition Journal (that I’ve been frequently referencing here!) addresses, and ultimately debunks, the following assumptions that underline the conventional weight-focused approach:

  • Adiposity poses significant mortality risk
  • Adiposity poses significant morbidity risk
  • Weight loss will prolong life
  • Anyone who is determined can lose weight and keep it off through appropriate diet and exercise
  • The pursuit of weight loss is a practical and positive goal
  • The only way for overweight and obese people to improve health is to lose weight
  • Obesity-related costs place a large burden on the economy, and this can be corrected by focused attention to obesity treatment and prevention

It seems that the evidence supporting these assumptions and claims have more holes in them than Swiss cheese (I sometimes can’t help the mom jokes!). Some of the factors that make us question these long held weight and health beliefs are:

  • Health benefits associated with weight loss rarely show a dose response (people who lose either small amounts or large amounts of weight tend to get the same health benefits. ?‍♀️
  • It is not known whether, or to what extent, the health benefits can be attributed to the weight loss itself or changes in health behaviors.
  • Methodological problems, which tend to bias the studies toward showing successful weight loss maintenance.
  • Association is not causation. Obesity is associated with increased risk for many diseases, but causation is less well-established.
  • The association between weight and health risk can be better attributed to weight cycling rather than adiposity itself. 

And this is just the tip of the iceberg! Plus, there are unhealthy people across all weight ranges, and even if they are unhealthy they can still do healthy things regardless of their weight (this is black and white thinking operating, right here).

So now, let’s look a little into the ways that recommending and pursuing intentional weight loss makes the solution worse than the apparent “problem”. And, as I’ve mentioned before, one of the main culprits is weight cycling.

Weight cycling vs weight stability

Weight cycling health risks

One of the biggest health hazards to stem from a weight-centric health approach and diet culture is the emergence of weight cycling, or “yo-yo dieting”. You know, you go on a diet, lose weight, stop the diet, regain weight, start the diet again….

Weight cycling poses a dangerous health risk, and as time goes by we have more evidence that weight cycling may result in:

Plus, the mental health effects of weight cycling can be just as harmful, or even worse. Weight cycling has been associated with the following mental health risks:

  • Eating disorders
  • Anxiety
  • Depression
  • Low self esteem 
  • Body image disturbances

 In fact, mental and psychological stress can actually alter metabolism, independent of a person’s lifestyle habits. The HAES approach looks to ensure health promotion policies that “utilize strategies known to reduce, rather than increase, psychological stress”. Which brings us to our next point.

Weight stability

The HAES approach acknowledges the scientific, yet unpopular, evidence that people have little choice about what they weigh due to involuntary genetic and environmental factors . Remember the video from above? Diversity is just a normal part of life, which should be celebrated. (I mean, seriously, how boring would it be to look and be the same as everyone else?)

Lindo Bacon, researcher and author of Body Respect and Health at Every Size (both excellent books), puts it this way: “Your body likes to maintain the status quo and keep your weight relatively stable; this range of stable weight is called your ‘setpoint” ”. What this all means is that our bodies (like a thermostat if you will), like to stay within a genetically programmed weight range.

“This, in turn, leads to the catch-22: Your body wants to maintain the status quo and is stubbornly resistant to change. When you lose body fat, the very loss of fat triggers processes to reclaim it. So losing weight in and of itself is counterproductive to maintaining weight loss. We shouldn’t be too surprised that weight loss is so rarely maintained”.

Most attempts to override this regulatory mechanism are as futile as trying to control your own temperature. If you want to learn more about this mechanism, which is known as the weight set point theory, check out the following post:

So, a HAES approach to health may result in weight loss in some, weight gain in others, but weight stability for most. Our bodies are smart, and when you regularly eat to satiety, your weight will go where it needs to go (or to your “set point”). Although our bodies are constantly changing, and absolute weight maintenance cannot be guaranteed, a HAES approach tends to lead to more long term weight stability, and way less weight cycling. This in turn leads to better health outcomes and more peace between your body and food. (Which I’m totally here for!)

What does the HAES® paradigm focus on instead of weight?

Physical activity for movement and health
Promoting health supporting behaviors is at the heart of HAES. For example, joyful movement instead of structured exercise can have a better impact on overall health.

Instead of focusing on weight loss, diet culture and a narrowly defined and socially constructed body size, the HAES paradigm focuses on sustainable health promoting behaviors, respect and self acceptance. It is a paradigm focused on empowering people in terms of their health and wellbeing, regardless of shape, size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes. Let’s take a peek at some of the most important pillars of HAES.

 Body acceptance as opposed to weight loss or weight maintenance: This circles back to that shoe analogy: why try to squeeze into a shoe size that just wasn’t made for your feet, and endure the pain of walking in them? So why try to force our bodies to be something they’re not through health risking behaviors such as strict diets and uncomfortable exercise? By accepting our bodies as they are, (which is easier said than done, I know!) we start to move away from harmful behaviors and start treating ourselves much more positively. This helps break the yo-yo dieting cycle and paves the way for more, and lasting, health promoting behaviors.

Reliance on internal regulatory processes, such as hunger and satiety, as opposed to encouraging externally imposed dietary restrictions: As I said in the beginning: diets just don’t work. HAES promotes the practice of Intuitive Eating, which means honoring when your body is hungry and feeding it what it needs. Our bodies need energy and nutrients, and by feeding them adequately, this gives us the “fuel” we need to actually, you know, live! We are called on to listen internally to our own bodies, instead of externally imposed meal plans and diets, and get in touch with what their needs really are. Not what society says you can eat, not even what your nutritionist says you can eat, but what YOUR body wants and needs to eat. By learning to eat in a way that’s internally (versus externally) regulated, we can start making peace with food and developing a better relationship with it. It also helps us to start trusting ourselves with our wellbeing.

Physical activity for movement and health versus encouraging structured exercise: The body needs movement. It needs it for motility, flexibility and strength. Movement also supports physical health (such as heart health) and emotional health (all those feel-good endorphins!). But what good is physical exercise if we don’t enjoy it or if it causes us pain when we do it? That’s why HAES encourages physical activity for health and enjoyment, rather than to reach an “x” amount of weight on the scale. It underlines the health benefits physical activity can bring, but doesn’t force anyone to partake in it if they don’t want to. Feeling good about exercise is also paramount, so we are encouraged to pick those activities we like and enjoy doing. Hate jogging but love taking a relaxing walk with your friend? No problem! Only you know what feels best for you.

HAES® criticism

As a new-ish (early 2000s) health movement, HAES gets its fair share of skepticism and criticism. One of the factors that are put into question, as this article from the American Journal of Public Health points out, is that this paradigm “requires stronger empirical evidence (i.e., larger, more representative populations), not only ideological discourse, on which to frame the debate.”

Others worry that, by taking weight out of the health equation, what happens to those that are underweight due to an eating disorder, or bedridden due to a weight that affects their mobility?

And there are those that also ask: ” What’s the big deal if someone wants to lose a few pounds? Where truly is the liberation in this movement? Shouldn’t people have sovereignty over their own bodies, including wanting to lose weight? ”

HAES does not claim that everyone is at a healthy weight. What it does do is ask for respect and help people shift their focus away from changing their size to enhancing their self-care behaviors. Two very different approaches. The weight will then go where it needs to go when we’re following good self-care practices. This means that it may not necessarily go where we want it to go, but socially constructed body ideals just don’t have our best interests in mind.

As The Association for Size Diversity and Health very well explains it: “When a weight-specific lens is applied to health, the myriad contributing factors affecting an individual’s well-being are usually lost…using a HAES approach puts the focus on [the individual’s] behaviors, unique set of abilities, and available resources, and places them in the context of their life as the primary areas of concern and consideration. Each individual will have his/her own strengths and vulnerabilities, and will likely respond to stimuli in their unique way. Improving a person’s health is a process that begins by contemplating what it would take to make certain determinants of health available and accessible to different individuals, and not by pathologizing any specific weight.”

A weight inclusive approach

I believe that there is truly a need for social change related to the acceptance of individuals regardless of body shape or size. And I think the HAES movement is one of the best ways to bring about this change. Moving away from weight-based discourse makes sense, particularly in terms of health.  The emphasis on improving our relationship with food and with our bodies needs to be more important than looking like “x” celebrity or getting to “x” pounds on the scale. Will it be hard to change from a weight-centric health model to a weight inclusive one? Definitely. But will it be worth it to stop torturing ourselves over socially created body ideals? Hell yes!

So what do you think of the HAES approach? Are you more clear now on what is HAES? Do you think it’s a better alternative to a weight centered focus, or do you think otherwise? Tell me all about it, below in the comments section!

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