What is Health At Every Size?

 Let’s chat about Health At Every Size, commonly referred to as HAES. HAES constantly trips people up, doctors, dietitians, as well as people not in the medical field. That is why I wanted to do a breakdown about what is HAES, what it is not, and why it is important.

 

HAES at its roots is a set of principles, created by ASDAH (Association for Size Diversity and Health), “to promote size-acceptance, end weight discrimination, and to lessen the cultural obsession with weight loss and thinness…promoting balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes & sizes.” 

 

Keep in mind, the first word in the HAES acronym is NOT “healthy” at every size. It is not saying that every size is necessarily healthy, it is about promoting healthy behaviors in all bodies. It is an alternative to the typical weight-centric approach taken by many health care practitioners. Far too often a diagnosis can be missed in someone in a larger body because the physician is focused on their weight. Or a patient will avoid seeking medical attention, for fear of weight stigma. Or a patient is losing weight, only to regain it, and feels it is their fault and avoids their physician out of guilt/shame/fear. 

 

This is not okay. Our first rule as health professionals is: do no harm. Weight bias and stigma are harmful. Recommending dieting to patients does not improve their health. Dieting for intentional weight loss, however, is shown to:

•   Lower metabolism (cause the body to burn fewer calories)

•   Decrease levels of leptin (which increases appetite)

•   Cause quicker digestion (AKA hungry faster)

•   Reduce energy level (why it’s so hard to stick to that new exercise routine while dieting)

•   Increase food cravings

•   Reduce the amount of total muscle (assisting with lowering your metabolism)

•   Increase fat storage enzymes & decreases fat-releasing enzymes (why each diet is less and less effective) 

•   Reduce one’s ability to notice hunger and fullness cues

•   Be the #1 predictor of future weight gain

 

Do you see why I don’t recommend dieting to anyone, ever? It does a lot more harm than good. The alternative is taking good care of ourselves regardless of our weight. 

 

 I know someone is reading this saying, well what about America’s “War on Obesity”? Isn’t fat a national health crisis?! Nope. The CDC reported in 2004 that 400,000 Americans die each year from being overweight or obese. When these numbers were questioned and reexamined they reduced their estimate 15-fold. But don’t worry they had already gotten the funding they were after to fight this “war on obesity”, before updating their estimates (insert major eye roll here). 

 

This stuff is effed up, for lack of a better term. Politics and money are so interwoven within health, that it is confusing for me, a Registered Dietitian, let alone someone without a background in health. 

 

Want a couple more truth bombs? 

•   “Overweight” people statistically outlive “normal” weight people. (But really “over” what weight?)

•   Obesity levels have leveled off since 1999. Why isn’t this in the headlines? 

•   Obese people with hypertension will live significantly longer than thinner people with hypertension. 

•   The incidences of heart diseases have dropped dramatically at the same time obesity rates have risen. 

 

For the person thinking, okay, well if fat isn’t the monster we have made it out to be, why are we heavier than our ancestors? “The generational increase in weight, like the generational increase in height, results from the complex interaction between our changing environment and our genes.” (Linda Bacon, Health At Every Size, Page 258) Our weight set points have risen due to a multitude of factors. But again, our rates of obesity have actually leveled off. Also, we are living longer than ever, with diseases coming later in life. Nobody really talks about the 3 inches we have also gained in height over the years! 

 

Humor me… Can you imagine if we had a “War on Tallness”? When you think about it that way it seems pretty ridiculous, right? 

 

My bottom line: healthy behaviors are healthy for everyone regardless of size. Dieting is not a healthy behavior. Let’s stop praising weight loss like it is the most impressive thing a person can do, and start living bigger, more meaningful lives! 

All statistics are from: Bacon, L. (2010). Health at every size: The surprising truth about your weight. Dallas: BenBella Books.This is a great read especially for anyone in the health field!