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A Guide to Size Diversity 

Bodies come in all shapes and sizes, with everything from genetics to family history and environment playing a role in how we look. But sadly, in many cultures—and especially Western cultures—that same body diversity is not widely reflected in popular media or even sometimes in medical research.

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The Slippery Slope of Dieting & Clean Eating 

Can you have too much of a good thing? If you’re following a diet, including a so-called clean eating program, the answer is yes. Unfortunately, for some people, diets lead directly to eating disorders.

An eating disorder is a behavioral condition characterized by severe disturbances in eating habits accompanied by distressing thoughts involving food and/or body image. [1] People with eating disorders often categorize foods as good or bad, and they eat from these lists depending on their mood and feelings of self-worth.

What Does Health at Every Size Mean?

The health at every size (HAES) movement encourages you to accept and nourish your body, even if the scale says you’re not at a perfect weight. 

Some people think that HAES comes with explicit permission to eat anything you want, skip all workouts, and demand acceptance for your inner beauty. The truth is a little more complicated. 

A HAES plan removes the pressure to push your body into a shape and size that isn’t right for you. Instead of focusing on numbers and idealized metrics, you’ll consider how your body feels, what your body can do, and how you can feel even more comfortable inside your own skin. 

5 Core Concepts of the HAES Movement 

The Association for Size Diversity and Health is responsible for the health at every size movement. The group recognizes that HAES represents a large shift for doctors and patients alike, and as a result, the group prioritizes education.

The following principles from the association guide the HAES movement. [1] 

Weight Inclusivity

Our culture tends to revere certain body types and despise other types. We have value when we’re thin, and we lose it when we’re not.

Body inclusivity recognizes that humans come in all shapes and sizes. And every body has the potential for beauty.

Health Enhancement

All bodies deserve access to quality health care. And all people deserve to learn more about how to pay attention to 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 be exclusively focused 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. Movement is useful whether it results in weight loss or not. 

What Makes Up a Healthy Size?

The HAES movement is built on a foundation of acceptance. Your body is the right size if you can maintain it without dieting and you enjoy how you feel inside of it. 

BMI: The Old Model

For decades, patients have moved through height/weight measurements 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 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 universal ideal. [2] 

Medical professionals appreciate BMI data. Measuring a patient’s height/weight is easy, and the results can open up a conversation about health outcomes and obesity. Many doctors still use BMI today. [3] 

However, a BMI places about half of the adult population into the overweight category. [4] BMI can’t differentiate between lean body mass (like muscle) from fat body mass. A bodybuilder could seem obese on a BMI chart, even when that person is healthy. For this reason, BMI isn’t an accurate indication of a healthy or unhealthy weight.

Redefining a Healthy Size

Within the health at every size model, people focus on building a healthy lifestyle, no matter what data comes from the scale. Doctors who hope to help their patients will discuss exercise and meal plans to help their patients get healthy, even if they never lose weight or change their fat/muscle ratio. [5] 

A HAES approach might involve the following: [6]

Mindful eating: You’ll eat when you are hungry, and you’ll stop when you’re full.

Healthy foods: You’ll choose meals that nourish your body. You won’t have a good/bad list of foods, but you’ll know more about which foods give you core nutrients. 

Joyous fitness: You’ll find a physical activity you like, and you’ll engage in that fitness type often. 

If you lose weight by following this plan, that’s an added benefit, but not the goal. [7] If you feel better about your body and how it moves and functions, that’s ideal. 

Why Is HAES Required?

Doctors have used BMI charts for years, and most people know what they are and how they work. Why not keep using them? 

Researchers say there are plenty of reasons to change. 

Weight Loss Isn’t Always Sustainable

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]

Researchers say diets don’t work. Yo-yo diets cause incredible metabolic damage, and they can be dispiriting for people too. 

Rather than forcing the body into a new shape or size, enhancing health at any size seems more realistic and humane. 

Weight Comes With Stigma 

Even doctors are proven to discriminate against their patients. [8] American culture associates excess weight with laziness and impulsivity, even though much of a person’s size is caused by genetic and metabolic factors. 

Many people who measure obese aren’t responsible for their weight, but they’re made to believe the opposite is true. 

Weight Stigma Can Be Self-Inflicted

People who feel better about themselves engage in more positive and healthy behaviors and feel motivated to participate in self-care. [7] People who aren’t at an ideal size may devalue their bodies, making their overall health worse. 

Tips to Help You Accept Your Body Image

It takes time to change the way you feel about your body, especially if you’ve struggled with size image for a long time. Following a few tips may help. 

Move mindfully. Whether you’re walking, sitting, or just breathing, your body is working for you. Take time to appreciate all of the things your body can do. [9] Don’t focus on what your body looks like, but think about how it feels to live inside your skin. 

Wear comfortable clothes. Pants that are too tight or tops that are too short remind you of your body’s so-called shortcomings every time you move.
During the pandemic, when all of us stayed home, many consumers wore more comfortable clothes. [10] Keep that trend moving forward. Wear clothes that feel good on your body.

Practice compliments. When you’re tempted to think or say something negative about your body, search for a compliment instead. Think or say something nice about yourself every time you walk by a mirror. It takes practice, but you can learn how to develop a welcoming 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. [11] Don’t talk about how great a model looks in this month’s fashion magazine and don’t encourage someone else to compare their body to a model. 

Where to Find Support for Body Image Issues

Some people struggle to find anything good to think or say about their bodies and use destructive techniques, like fasting or bingeing, when they’re dissatisfied with their body image.

Know that everyone struggles. You’re not alone. And you can get help.

Friends and Family 

Reach out to your peers and talk about your feelings. Your siblings, parents, or friends may all have the same thoughts and concerns. Together, you can plan how to change your lives and support one another to embrace body positivity.

Medical Professionals

You can also talk with your doctor. Explain that you’re struggling to accept your body shape and size, and ask for help. Your doctor could help you understand just how healthy you are now, and if it’s time to enter an eating disorder treatment program, you can find one together. 

National Eating Disorders Association

The National Eating Disorders Association maintains a helpline staffed by volunteers who can connect you with support groups and treatment programs. If you don’t feel comfortable talking with your doctor or peers, consider reaching out. [12]

Resources

HAES Principles. (n.d.). Association for Size Diversity and Health. 

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.

Body Mass Index: Considerations for Practitioners. (n.d.). Centers for Disease Control and Prevention. 

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. 

Contact the Helpline. (n.d.). National Eating Disorders Association. Retrieved September 27, 2022.

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The Impact of Body Dysmorphic Disorder

Eating disorders are mental illnesses defined by abnormal dietary habits, such as eating excessively small or large amounts of food, that have the potential to cause major physical and mental problems. Most common eating disorders are anorexia, bulimia and binge eating disorder.

Diabulimia Eating Disorder

Diabulimia is intentional insulin restriction. People with diabulimia skip or shrink their insulin doses to lose weight.

Most people with diabulimia have type 1 diabetes. Some doctors call the condition type 1 diabetes with disordered eating (T1DE) or eating disorder diabetes mellitus type 1 instead. There is no official diagnostic term, as this condition is relatively new and poorly understood.

Exercise Bulimia

While some people may be concerned that they aren’t getting enough exercise, there is such a thing as too much exercise. Regular exercise can be great for physical and mental health, if it is medically appropriate and done in combination with adequate rest and nutrition, but when exercise becomes a compulsion, it can become physically and mentally harmful.