In this article I am going to give an overview of Health at Every Size, or HAES, and the background behind the philosophy.
What is HAES? HAES is an approach to health that focuses on self-care behaviors, not the pursuit of weight loss. It celebrates size diversity and honoring our differences, body attunement, autonomy, and taking care of ourselves from a more compassionate and joyful approach. It challenges the more prevalent approach to health that focuses on weight loss as a primary treatment for health issues and conditions–there is no proven way to lose weight and keep it off long term for the majority of people. HAES does not deny the challenges of living in our culture in a larger body, but recognizes the reality that we all come in different shapes and sizes. Rather than seeking to change bodies to fit the cultural “norm,” HAES challenges this “norm” by promoting cultural change and acceptance of all bodies.
Over the past year, I learned more about the HAES philosophy and it turned my world upside down. It changed the way I approach my own health and the way I practice.
Weight is very complex. You cannot make judgments regarding someone’s health behaviors based on their weight, and you cannot predict someone’s weight based on their health behaviors. Therefore, you cannot treat weight as a behavior. You cannot assume someone in a larger body is unhealthy. You cannot assume someone in a smaller body is healthy.
We are often blamed for our weight, or blamed for regaining weight, when research shows us intentional weight loss is not sustainable for most. Our bodies naturally seek to protect us from starvation, and it responds in a similar way when pursuing weight loss. Restriction only works short term. Restriction is not sustainable. Our body’s natural protection mechanism kicks in and keeps us from remaining in a state of “starvation,” no matter how much “willpower” you have. You are not to blame for your weight.
Strong evidence shows, in those intentionally trying to lose weight, weight loss reaches its max within 6-12 months; most weight is regained within 2 years; and the majority of people return to their initial weight within 5 years. Research also shows that weight cycling results in gaining more weight than initially lost for more than half of those studied. (If this seems discouraging, let it encourage you to jump off the roller coaster and just focus on feeling good and taking care of yourself.)
Most research studying the effects of weight loss on health markers monitor participants short term, usually no more than 1 year. Since weight loss peaks in the first year, we really do not know what happens in the long term, when weight regain occurs for the majority of people. There are strong studies supporting that, independent of body size, positive self-care behaviors can decrease health risks. (More about this in a bit)
Internalized weight stigma has been shown to negatively affect health outcomes. You can feel the effects of weight stigma when given unsolicited weight loss advice from a health care provider, when treated differently because of body size–being told to lose weight instead of receiving the same treatment as someone in a smaller body with the same issue, and having treatment withheld until weight is lost. (For example, surgery to relieve orthopedic issues/pain, fertility treatments, etc.) When weight is upheld as the ultimate marker of health, it can feel shaming to stand on a scale in front of others and then be evaluated based on this number. These feelings can keep you from seeking out medical care when you really need it, especially with issues requiring early detection for best outcomes. Weight stigma can also cause feelings of loneliness and isolation which have been shown to negatively affect health outcomes.
In addition to the physical effects of weight cycling, we have to think about the mental effects as well. I speak about this in more detail in my original post on the subject, but constantly pursuing an “ideal” our bodies naturally resist leads to constant feelings of shame and failure, blaming ourselves when we cannot “keep the weight off.” You may put off the dream in your heart until you “lose the weight.” You may avoid intimacy because you don’t feel worthy of love in the body you are in, so you put off love until you “lose the weight.” Don’t wait for your life to start. Give your body what it needs—fuel, nourishment, care, and love. Our culture, not our bodies, is what needs to be “fixed.”
Research does strongly support that self-care behaviors/habits can possibly improve health markers, regardless of body size. Being more self-compassionate and flexible in our approach to self-care also creates more sustainable change, which positively affects our well-being. When weight loss is glorified and praised, it perpetuates weight bias. This can create a “weight loss at any cost” mentality, often resulting in behaviors that do not promote self-care and well-being in order to lose weight, or maintain lost weight–disordered eating, restricting nutrients, overexercising, etc. Pursuing weight loss may cause you to isolate yourself more from others–avoiding family gatherings and eating out with friends in order to avoid losing “control” or straying from your diet plan. Why not just focus on self-care—joyful movement to keep our muscles strong if we so choose, eating in a more satisfying and nourishing way, decreasing the stress around eating—and resist the voices that tell you your body is wrong.
The extent of the influence weight has on health is up for debate, but we do know intentional weight loss is not effective for the majority of people and may cause more harm than good.
In conclusion, HAES is an approach to health that takes the current science and lack thereof into consideration. HAES accepts the reality that we all come in different shapes and sizes. HAES means not promoting intentional weight loss as a cure or treatment to promote mental and physical well-being. We know intentional weight loss is not sustainable for most people and can cause more harm than good. We know self-care behaviors can positively affect health markers. We know approaching self-care in a more compassionate and flexible way leads to sustained change and improved well-being.
As I mentioned, HAES does not deny the challenges faced living in a thin-obsessed culture, but offers an alternative approach to health and body acceptance–resisting the negative messages instead of feeling pressure to change your body.
Since I’ve established HAES is more about focusing on self-care, not weight, you can read more practical tips for physical and mental well-being here. Take away whatever nuggets you need to help you love on your body and give it what it needs.
If you are interested in finding practitioners who work from the HAES model, you can use the directories found in the following links and search for practitioners in your area. If there are no HAES practitioners in your area, keep in mind there may be many professionals in the directory that offer virtual care:
https://www.sizediversityandhealth.org/content.asp?id=32
https://haescommunity.com/search/
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