Why Health At Every Size®?
The shift from the traditional mindset.
We live in a society where people living in larger bodies are stigmatised; often being labelled as “lazy”, “lacking willpower” and being told to lose weight. In traditional models of health care, weight loss is endorsed for adults classified as overweight or obese by BMI under the premise that this is necessary to improve their health. Health at Every Size® (HAES®) rejects a focus on weight or BMI and is an approach to health care which supports the enhancement of physical and mental health for people of all sizes without any goal of changing weight. HAES® is based on 5 key principles; weight inclusivity, health enhancement, respectful care, eating for well-being and life-enhancing movement. You can read more about these principles here.
So, what are the main reasons for using a HAES® approach?
1. Weight-based approaches don’t work
HAES® does not aim to deny the science that those living in larger bodies have increased risk of certain health conditions. Instead it argues that higher body weight should be treated as an unmodifiable risk factor just like ethnicity or family history would be. This is due to a strong body of evidence that shows that intentional weight loss is not possible for the vast majority of people (1). While short-term weight loss is possible, long-term (3-5+ years) intentional weight loss is just not achievable for most. Furthermore, attempting to lose weight is shown to contribute to body dissatisfaction, disordered eating and eating disorders (2). Combine this with the fact that yo-yo dieting and weight cycling increase our risk of death and chronic diseases (3) and it makes absolute sense to take the focus away from losing weight. This doesn’t mean that weight loss may not happen naturally when adequate nutrition and movement which is constructive and right for the individual is in place; it just isn’t the GOAL.
2. Focusing on weight causes harm
When people feel better about themselves, they are more likely to want to take care of themselves by engaging in healthy behaviours. Promoting weight loss has the opposite effect by perpetuating weight stigma. Weight stigma, also known as weight bias or weight-based discrimination, is discrimination or stereotyping based on a person’s weight. Weight stigma leads to deep feelings of shame which make people less likely to engage in healthy behaviours (4). Weight stigma can increase body dissatisfaction, a leading risk factor in the development of eating disorders and the best-known environmental contributor to the development of eating disorders. The sociocultural idealisation of thinness for means of being in a healthier state has made a dominant stance in our society, and is very likely contributing to far greater health issues than we realise.
3. Healthy behaviours improve health, regardless of changes in weight
Another argument for a weight neutral approach is that assessment of health using BMI does not account for other lifestyle factors such as dietary quality, physical activity and smoking and alcohol intake, which are actually stronger determinants of death and disease than BMI (5,6).
A crucial issue with putting a focus on weight loss is that a person can actively engage in healthy behaviours like changing their diet and exercising, and still not lose weight. If the goal is weight loss then this person is likely to get disheartened by their lack of “results”, lose motivation and “throw in the towel”. However, if the focus is on improving health and the person realises that the behaviour changes they are making are having a positive effect on their health regardless of what their weight does, they are more likely to sustain these healthy behaviours. This is especially relevant if people are restricting food or engaging in exercise they do not actually enjoy. Humans must eat to survive, but eating is also a huge source of pleasure in life and a key part of social connection, contributing to holistic health rather than one piece of the puzzle.
The infographic below was produced from a study that took out weight bias and focused on health behaviours demonstrating if any individual regardless of their weight were to focus on these four behaviours, their risk of dying was the same.
Although this blog reviews why weight isn’t a barrier to being healthy, like originally thought, we understand the drive to be thin is unrelenting for a lot of people. Please know your body image concerns are acknowledged as we know working on that aspect is REALLY hard work.
Our dietitians at River Oak Health use a HAES approach to provide a safe space for all bodies to access safe and effective healthcare and to discuss body image concerns, however big or small.
References:
1) National Health and Medical Research Council (NHMRC), 2013, Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia, p161 https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n57_obesity_guidelines_140630.pdf
2) Polivy, Janet, and Todd Heatherton. "Spiral Model of Dieting and Disordered Eating." (2015).
3) Karahalios A, English DR, Simpson J, 2016, Change in body size and mortality: a systematic review and meta-analysis. Int J Epidemiol.
4) Puhl, R. M., & Heuer, C. A, 2010, Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028.
5) Matheson E, King D and C Everett. "Healthy lifestyle habits and mortality in overweight and obese individuals." The Journal of the American Board of Family Medicine 25.1 (2012): 9-15.
6) Queensland Government, 2016 Chief Health Officer Report, p75 https://www.health.qld.gov.au/research-reports/reports/public-health/choreport/2016/full#8
Credits:
Created with an image by Sergey Shmidt - "California blooming like crazy after months of non-stop rains. Even deserts are covered with juicy bright flowers. The photo was made on Diamond Valley Lake a few days ago."