By AMANDA BOYER, MS, RDN, CD, NASM-CPT
Health is so much more than how much a person weighs or their BMI.
To further understand this approach to health, Health At Every Size® (HAES®), written by Linda Bacon, explores this growing paradigm shift among health professionals who see health as much more than what a person weighs or where they fall in terms of a BMI category. Some may even view these numbers as arbitrary and likely have minimal influence on overall health.
Part of the foundation of HAES® is that all persons, of any size, have the right to pursue health for themselves if they choose and that this health pursuit does not mean they have to lose weight to achieve their version of it. Instead, HAES shifts the focus to weight neutral health outcomes that are more individualized than a pre-set number that takes little else into consideration.
The science behind HAES continues to grow (2), but an important piece of the research presented is set point theory. Set point theory says that weight, much like pH levels, body temperature, or height has a pre-determined range that is unique to each individual and influenced by things beyond their control, such as genetics and environment. The human body works very hard to keep the weight within this set point range. When weight is suppressed below this point, the body often responds as it would to starvation (bodies do not know the difference between starvation and a restrictive diet) and in an act of protection and survival, the set point rises. Therefore, when the restrictive diet or excessive exercise is stopped, weight goes back up and often exceeds the previous weight to restore to the new set point (and be better prepared for the next starvation/diet). Following, the next diet begins and with time, set point becomes much higher and weight loss efforts become more difficult as the body is more prone to keep the weight on as a protective measure and the war against the body presses on. The weight cycling (repeated bouts of weight loss and weight gain), increased risk of eating disorder, disordered eating, negative body image and self-acceptance, weight stigma and discrimination all lead to poor health outcomes that are often overlooked in the weight-centered model that supports the war on obesity. (1,2)
The Association for Size Diversity and Health (ASDAH), a non-profit dedicated to the research and promotion of HAES, founded in 2003, outlines five principles:
- Weight Inclusivity
- Health Enhancement
- Respectful Care
- Eating for Well-being
- Life-Enhancing Movement
The first principle, weight inclusivity, suggests we can recognize how diverse bodies are and move away from setting an “ideal” weight or the belief that there are wrong weights or body types. Instead of pathologizing weight and body shapes, they recommend focusing on aspects of health and health determinants that we can access and have the ability to modify given adequate resources, such as behaviors and certain abilities.
The second principle is health enhancement, which is individualized for each person given their desire to improve or not to improve their well-being. However, with health enhancement the idea is that everyone should have equal access to information, resources, services, and practices that could improve their well-being on any level of health. It should be noted that this is not always the case and different barriers must be taken into consideration for each person.
The third principle is respectful care, which is about turning inward and identifying our own biases, questioning our judgements, and working to put a stop on weight stigma, discrimination, and bias. Keep in mind there are both internal and external factors that influence weight stigma. Some of these factors include race, sexual orientation, and economic status.
The fourth principle is eating for well-being. This principle supports and promotes an intuitive eating model versus external cues, such as diets, for weight management.
The fifth and final principle is life-enhancing movement, which encourages movement that can be modified for a variety of people of all ability and sizes in a way that is interesting and enjoyable.(3)
Criticisms of HAES include that it is “pro-obesity” or “anti-weight loss.” It is neither of these things. As mentioned above, it strives to be weight neutral does not classify weight as a pro or con. Health At Every Size is not anti-weight loss, rather, it is non-diet and against the restrictive and rigid guidelines used to pursue weight loss. If the supported health behaviors result in weight loss, so be it. Weight loss is just not guaranteed or emphasized using this paradigm. (1,4)
Research shows that health behaviors alone, without the focus on or dependence on weight loss, directly improves health. Stay tuned for what to focus on if not weight coming soon. (2,5)