Health at Every Size (HAES) is an alternative approach to health that offers a holistic, weight-inclusive model of health and removes the focus from weight as a measure of health. HAES acknowledges health encompasses and is influenced by many factors.
The Association for Size Diversity and Health (ASDAH) introduced the Health at Every Size movement. The group recognizes that HAES represents a paradigm shift for both doctors and patients, and its mission includes prioritizing education to disprove our society’s misconceptions about weight and health.Being at a higher weight is “unhealthy” is one misconception that’s widely believed in our society, for example. But this is simply not true. People can be “healthy” or “unhealthy” at all weights, shapes, and sizes.1 The Health at Every Size principles provide a framework for redefining what constitutes and affects health.
Health at Every Size Principles
The following principles guide the HAES movement.2
Weight Inclusivity
Our culture tends to revere and idealize certain body types and criticize, pathologize, and even despise other types. We have value when we’re thin, and we do not when we’re not. This is fatphobia and weight stigma in action.3
Body inclusivity recognizes that humans come in all shapes and sizes. Everybody deserves acceptance and respect, regardless of weight, shape, or size.
Health Enhancement
All bodies deserve access to quality health care, and all people deserve to learn more about managing their physical, economic, social, spiritual, and emotional health needs.
Respectful Care
No one should encounter stigma or bias when they need medical care. Everyone at any weight deserves to learn more about how to live a fulfilling life. And all people deserve a team that supports them.
Nourishment
Meal plans should combat hunger, help you feel full, and give you pleasure. They shouldn’t focus on helping you gain or lose weight.
Focused Movement
People of all sizes and abilities should have the opportunity to engage in physical activity if they choose to do so. These movements should make them feel better about their bodies and their capabilities. Life-enhancing movement is helpful whether it results in weight loss or not.
BMI: An Inaccurate, Arbitrary and Stigmatizing Measure of Health Model
For decades, patients have had height/weight measurements taken at the beginning of medical appointments. Their scores were recorded as a body mass index (BMI), sorting people into categories of “underweight” to “obese.”
Ancel Keys was instrumental in developing the BMI scale, and he started his research with arbitrary measurements from life insurance companies. Originally, the data was used to help people understand how they compared to others. In time, it became a measurement of how close people came to a weight ideal.4
While many doctors still use BMI today, it is inaccurate and stigmatizing to measure a person’s level of health by their weight.5
BMI places about half of the adult population in the “overweight” category.5 And BMI should not be used to gauge a person’s health for many reasons. For one, it can’t differentiate between lean body mass (like muscle) from fat body mass. A bodybuilder would qualify as obese on a BMI chart, even when that person is healthy.
Redefining Health by Not Using Weight or Size
Within the Health at Every Size model, people focus on building a healthy lifestyle, regardless of weight or size. Doctors should never recommend that their patients lose weight or change their fat/muscle ratio because the effects of losing weight are far more harmful to health than weight itself.6
A HAES approach might involve the following:7
- Mindful eating: You’ll eat when you are hungry and stop when you’re full.
- A variety of foods: You’ll listen to your body’s cues and choose foods you’re hungry for that nourish your body. You won’t label foods as good or bad and eat various foods without eliminating certain foods, food groups, or ingredients.
- Joyous fitness: You’ll find a physical activity you like and engage in that movement when you feel your body needs to move.
While you may lose weight, that’s not the goal.8 Feeling good about and in your body is. Additionally, “healthy habits” don’t focus on weight control but on intuitive eating.
Why HAES?
There are many reasons to change how we view health and take weight out of the equation with the HAES approach.
Weight Loss Isn’t Sustainable
Research repeatedly finds that diets don’t work. People regain up to 40% of the weight they lost within one year, and within 2-5 years, they return to their original weight.5 Weight cycling or yo-yo-ing, as a result of going on diets, causes incredible metabolic damage.
Rather than forcing the body into a new shape or size, enhancing health at any size is more realistic and humane.
Weight Comes With Stigma
Even doctors are proven to discriminate against their patients.9 American culture associates excess weight with laziness and impulsivity, even though a person’s size is determined by genetic and metabolic factors. This is an example of weight stigma, and it is more harmful to health than weight itself
Weight Stigma Can Be Self-Inflicted
People who feel better about themselves engage in more positive and beneficial behaviors and feel motivated to participate in self-care.9 People who aren’t at what our culture considers an ideal size may devalue and feel bad about their bodies, which can worsen their overall health.
Tips to Help You Accept Yourself Exactly as You Are
It takes time to change the way you feel about your body, especially if you’ve struggled with poor body image for a long time. Following a few tips may help you accept yourself exactly as you are today and feel better about yourself.
- Move mindfully: Whether walking, sitting, or breathing, your body is working for you. Take time to appreciate all the things your body can do.10 Don’t focus on your body’s appearance, but think about how it feels to live inside your skin.
- Wear comfortable clothes: Clothes that are too tight or not quite the right fit are simply uncomfortable and don’t feel good. When you wear more comfortable clothes, you will feel more comfortable.11
- Practice compliments: When you’re tempted to think or say something negative about your body, try a compliment instead. Think or say something nice about yourself whenever you walk by a mirror. It takes practice, but you can learn how to develop a more accepting form of self-talk. Over time, you’ll notice a change in how you think about your body.
- Limit body-focused discussions: Researchers say people feel worse about their bodies when they engage in media discussions.12 Don’t talk about how great a model looks in this month’s fashion magazine; don’t encourage someone else to compare their body to a model. Try not to talk about your or anyone else’s appearance or weight status at all.
Where to Find Support for Body Image Issues
Many people struggle with their body image. It’s hard not to be in a culture that values certain body weights, sizes, and shapes over others. Having a negative body image can lead to developing disordered eating patterns.
If you don’t have a supportive family member or friend you can talk to openly about your struggles, talking to a mental health professional can help.
Resources
- Bacon L, & Aphramor L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition Journal; 10:9.
- HAES Principles. (n.d.). Association for Size Diversity and Health.
- Puhl RM, & Heuer CA. (2009). The stigma of obesity: a review and update. Obesity (Silver Spring, Md.); 17(5):941–964.
- Blackburn H, Jacobs Jr D. (2014). Commentary: Origins and evolution of body mass index (BMI): continuing saga. International Journal of Epidemiology; 43(3):665–669.
- Nuttall FQ. (2015). Body Mass Index: Obesity, BMI, and Health. Nutrition Today; 50(3):117-128.
- Penney TL, Kirk SF. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American Journal of Public Health; 105(5):e38-42.
- Health at Every Size. (n.d.). National Geographic. Retrieved September 27, 2022.
- Nicholson Z. (2018). Understanding the ‘Health at Every Size’ Paradigm. The Royal Australian College of General Practitioners. Retrieved September 27, 2022.
- Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity (Silver Spring); 21(10):2146-52.
- 10 Steps to Positive Body Image. (n.d.). National Eating Disorders Association. Retrieved September 27, 2022.
- Salfino C. (2020). How Consumers Are Trying to Stay Positive and Comfortable Right Now. Sourcing Journal. Retrieved September 27, 2022.
- Shen J, Chen J, Tang X, Bao S. (2022). The Effects of Media and Peers on Negative Body Image Among Chinese College Students: A Chained Indirect Influence Model of Appearance Comparison and Internalization of the Thin Ideal. Journal of Eating Disorders; 10(49).