The name Health at Every Size®, also known as HAES®, seems to throw a lot of people off. Many people falsely believe this is an argument that all people in all bodies are healthy which is a hard concept to wrap one’s head around when we are constantly bombarded with messages about lowering weight in order to improve one’s health. HAES® is not a claim that all people in all bodies are healthy, rather, it is a way to approach all bodies equally, regardless of size.
Take knee or hip pain, for example. An individual in a larger body may simply be told to lose weight and pain will go away whereas an individual in a smaller body may receive advice to purchase new sneakers, try a gait analysis, massage sore muscles, stretch, and try physical therapy. This approach can be incredibly frustrating and disheartening, which may ultimately lead individuals to disconnect from much needed care. Not to mention, it’s incredibly inequitable and leaves a significant portion of the population shifting to try dangerous diets, 95% of which don’t work in the long term, and may lead to further health complications including malnutrition and eating disorders.
Health at Every Size® is a dynamic framework based on five principles that offers an alternative to the more weight-centric approach of medical care. The HAES® paradigm appreciates that health is greater than just an absence of physical or mental illness, limitations or diseases, as well as rejects the usage of weight, body size or body mass index (BMI) as indicators of health status. Social determinants of health, the “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes”, and forms of societal oppression such as weight stigma, racism, sexism, and ableism are also facets.
As it turns out, BMI was never intended to be used as a diagnostic tool, which is precisely why the HAES® rejects its use. BMI was intended to be used as a screening tool. If someone’s BMI fell into a certain category, that individual may then be screened for medical conditions which are correlated with that BMI category. For example, if one’s BMI falls in the underweight category, their provider may then want to investigate for things such as malnutrition, malabsorption, or food insecurity. Likewise, if one’s BMI fell into the obese category their provider may then investigate for high blood pressure, high cholesterol, and consumption of sugar-sweetened beverages. The struggle is that we often make the assumption that high BMI = unhealthy, and treat that person accordingly prior to having more information. HAES® wants to change this and ensure assumptions are not being made based on inadequate information.
The HAES® Principles were originally developed in 2003 by the Association for Size Diversity and Health (ASDAH), and were most recently revised in 2013 to better advance health equity, ameliorate access to quality healthcare irregardless of size, and support ending weight stigma. It is a constantly evolving framework; according to the ASDAH website, “the current principles do not adequately support those most impacted by medical fatphobia nor do they reflect ongoing reflection and community discussion. ASDAH Leadership plans to revise the HAES® Principles during the 2022-23 board year”.
So what are the Health At Every Size® Principles?
- Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
- Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
- Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
- Eating for Well-Being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
- 5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
Summary of the literature supporting a HAES® approach:
- People with a BMI in the overweight category have the lowest mortality rates, and those in the normal weight and obese weight categories have the same mortality risk.
- Weight loss through dieting is not sustainable over time for a high majority of higher-weight individuals and is linked to harmful health outcomes.
- 95-98% of those with intentional weight loss through dieting will regain the weight, most within one year and almost all within five years; one third to two thirds will regain more weight than was initially lost.
- Dieting is the number one risk factor for the development of an eating disorder (ED).
- Weight cycling has been shown to increase mortality risk, as well as the risk of high blood pressure, diabetes, high cholesterol, heart disease, gallbladder disease, and osteoporosis more so than the risks of living in a larger body overall.
- A conventional weight-centered health paradigm contributes to: weight discrimination and fat phobia, reduced health and well-being, and poorer quality of life.
- A HAES®-centered health paradigm helps to support: body acceptance, Intuitive Eating, and clinically relevant improvements in physiological measures.
HAES® provides a structure for all to pursue health in ways that are personal and valuable based on a litany of evidence-based research. A HAES® approach helps to create healthier relationships to food and physical activity, more respectful and inclusive care, and can improve health status regardless of body size. Interested in learning more about how to apply the five principles into your own life by working with a HAES® aligned practitioner? Visit our website to get started!
So how do we incorporate HAES® principles at Pearls of Nutrition?
We do not use your weight as the primary marker of health. Unless medically necessary and agreed upon by both the provider and patient, we do not monitor patient weights regularly.
We don’t support weight loss as a primary goal in the work we do with patients. Elevated weight is a symptom of a problem, not the problem itself. The reason a higher BMI and medical conditions like diabetes and high blood pressure are correlated is because they can have common origins- unbalanced diet, eating outside of normal hunger/fullness cues, inadequate physical activity, poor sleep patterns, high stress, other medical conditions, etc. If we only focused on weight it may lead us to encourage restricted eating and/or dieting patterns (despite this not being an effective method of weight loss), and leave our patients feeling defeated and frustrated- just like dieting makes them feel. Alternatively, we help patients to improve the quality of their eating, develop trust in their bodies by listening to hunger and fullness cues, and regulate patterns of eating.
We encourage flexibility in eating. We recognize you don’t need to eat perfectly in order to have good health and wellbeing. The reasons to eat vary greatly ranging from nutritional quality, taste, comfort, convenience, etc. We help you find a balance between meeting your nutritional needs and understanding how your nutrition fits into your real life, schedule, and food preferences.
Let us know in the comments, how can HAES® principles support your care?!
- O’Hara and Taylor. What’s wrong with the war on obesity. A narrative review of the weight-centered health paradigm and development of the 3C framework to build critical competency for a paradigm shift. Sage Open. April-June 2018: 1-28.
- Tylka et al. The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity. July 2014. 1-18.
- Bacon and Aphramour. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal. 2011. 10 (9): 2-13.