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Towards Size Acceptance: The Health at Every Size (HAES) movement

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By Natalie Leibowitz

Health at Every Size (or HAES) is a movement that has been growing among health-care professionals and the general community. It is an approach to health-promotion that encourages size-acceptance as an alternative to the use of the traditional weight-centered approach. HAES was born out of research suggesting that measures of body weight do not accurately reflect a person’s health status, and that our cultural obsession with thinness and weight loss is actually doing more harm than good.

The HAES approach aims to shift the focus away from weight and onto health. It encourages nourishing lifestyle habits, including intuitive eating, joyful movement, stress management, and building supportive communities. HAES promotes a non-dieting approach to wellness. This means that numbers and measurements are no longer the focus. Measuring your weight, food portions, calorie content, time exercising; obsessing over these numbers is not a helpful tool in achieving wellness.

As an alternative to measurements, the non-diet approach promotes conscious and intuitive eating. This involves training individuals to listen to their hunger and satiety cues when deciding when and how much to eat. Intuitive eating is based on the idea that external cues in the environment, such as social pressures or dieting, lead to eating problems and resulting poor health. Research has shown that young children, in the absence of external cues, are able to regulate their own food intake and meet their nutritional needs for growth. This demonstrates the body’s innate ability to respond to internal cues to meet its needs. The intuitive eating approach also discourages classifying foods as “good” or “bad”, and instead supports the idea that all foods are acceptable when eaten in a balanced manner. In keeping with this non-restrictive approach to the improvement of health, HAES encourages physical activity for enjoyment rather than for the purpose of losing weight.

The ideal of thinness leads individuals to believe that being thin will grant them health, happiness, and acceptance. We have been taught to believe that weight loss is the key to prevention and treatment of illness. In reality, there are a variety of factors that play a larger role in the development of chronic illness than weight. Yes, people who are classified as “overweight” are more likely, for example, to develop diabetes. However, this has little to do with weight and much more to do with social determinants of health such as poverty and weight-based discrimination. Instead of viewing poor health as an individual issue, HAES looks at it as a wider social and cultural issue. Thus, it takes away the blame and shame that often comes with the typical weight-focused approach.

Behaviour change has been found to be much more helpful in improving health than weight loss alone. This has been backed by several studies that have found that health markers such as blood pressure and cholesterol levels are strongly related to lifestyle behaviours (balanced eating, moderate physical activity), regardless of a person’s weight. The weight loss itself only plays a small role.

Size discrimination is an example of an important, but rarely discussed, social factor that impacts population health. It occurs in countless settings, including in health care, the workplace, education systems, and when accessing a variety of services in the community. Health care professionals may unintentionally associate obesity with non-compliance and dishonesty. It is also very common for overweight patients to avoid regular check-ups with their doctor for fear they will be told that they need to lose weight. This can result in less frequent health screenings and worsening health status. Within the workplace, size discrimination may occur through the view that overweight employees are lazy and less competent. This can impact an individual’s ability to find and maintain employment. Within a school setting, children and adolescents may face bullying by peers or staff based on their size, potentially having long-term impacts on their well-being. Unlike the traditional approach to health care, HAES acknowledges and addresses the impact of weight stigma and discrimination on an individual’s state of health.

Medical professionals have been taught that the solution to many ailments is weight loss. They have been practicing for years with this notion. Thus understandably, many health professionals are demonstrating resistance towards the HAES approach. The common argument made against HAES is the belief that it promotes weight gain and obesity. The idea that it is okay to eat fast food or “junk food” as long as it’s eaten in moderation is quite uncommon for many. In addition, there has been a strong push among public health professionals for improved education of the public on reading nutrition labels. With this is mind, it may seem counter-intuitive to recommend that people refrain from consulting nutrition labels when deciding which foods to eat. This idea of intuitive eating and listening to your body is a fairly new approach, which will take time for health practitioners to begin incorporating into their practice. The hope is that with more research on the benefits of HAES and more exposure of health professionals to the size acceptance model, medical and other health practitioners will begin to favour size acceptance over the traditional model.

The lesson for family, friends, and health professionals who are supporting an individual’s journey to health, is to focus on the person’s behaviour rather than on their body size. Dr. Linda Bacon, a Registered Dietitian and HAES specialist, suggested an approach that may be taken in conversation with a friend or family member when they express concerns about their body size. Her suggested approach includes the following steps:

  • Identify their concern
  • Empathize with them
  • Point to the opportunity for improvement of health
  • Dispel common weight-related myths such as the idea that thin = happy
  • Offer a solution that conforms to a size acceptance model

People who follow the HAES approach find that they have reclaimed the ability to enjoy food again. They are also more accepting of their own and others’ body size, as they understand that health comes in every size.

For more information on HAES, including finding HAES-friendly healthcare professionals in your area, you can visit haescommunity.org or sizediversityandhealth.org.

References

  1. Association for Size Diversity and Health. The Health at Every Size Approach Principles. https://www.sizediversityandhealth.org/content.asp?id=152
  2. Find Your Voice for Body Acceptance. Dr. Linda Bacon. Presentation at NEDIC’s 2015 Body Image and Self-Esteem Conference. April 2015.
  3. Health at Every Size: Lecture by Dr. Linda Bacon. https://www.youtube.com/watch?v=Cgx6I15nIdI
  4. Size Acceptance. HAES Curriculum. http://haescurriculum.com/. August 2013.

Natalie Leibowitz holds a Bachelor of Science degree in Nutrition, and is currently completing her Bachelor of Social Work. She is a mental health advocate and is passionate about promoting size acceptance. She is the Summer Outreach Coordinator and a volunteer at Riverwalk Eating Disorders and Wellness Centres.

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