If there’s one thing the pandemic has taught us, even healthcare remains divided about the ever-changing field of science. Over the course of their career, medical professionals may choose to take a stance on developing research or specialize in particular frameworks. Evidence-based fields can be vulnerable to misinformation, especially when professionals disagree on questions like, “What does it mean to be healthy?” and, “Who deserves health?” This inconsistency can breed doubt in the minds of patients and clients, who understandably may be unsure of where to find accurate health information nowadays.
Nutrition science is no exception, as this young science falls victim to headline sensationalism in virtual and printed sources alike. Programs that educate dietitians prepare us for these headlines. When training to become a Registered Dietitian, we learn how to assess the validity and accuracy of research to pass truthful information onto the public. But the reality is that one person’s truth is shaped by their biases, environment, and perception of the world. Rather than following a “cookie-cutter” approach to nutrition, many dietitians (including the ones here at NPN!) have adopted an individualized model called Health at Every Size ® (HAES®). HAES® is more than a set of principles though. It is a social justice-minded, holistic alternative to modern-day healthcare, often riddled with shame and weight stigma.
It may seem like the new nutrition buzzword on the block, but the Health at Every Size movement has historic roots. The industrialization and increased convenience of the American food system forever altered notions of wellness. From the start of Weight Watchers in 1963 (Weight Watchers, 2020) to the National Institute of Health’s declaration of obesity as a disease in 1998 (Rosen, 2014), the late 20th century built the foundation for modern-day diet culture. Yet for thousands of years, fat-shaming jokes and weight stigma have been used openly as a form of discrimination. Colonial Europeans condescendingly depicted larger African bodies as “uncivilized,” (Gershon, 2019) in the earliest generalized association of body size and worth. Today, if you go on Youtube or TikTok, you will see a range of content ridiculing fat bodies as a punch line. In efforts to dismantle growing fatphobia in American culture and medicine, the Health at Every Size Approach has been trademarked by the Association for Size Diversity and Health, after Dr. Lindo Bacon’s book, “Health at Every Size: The Surprising Truth About Your Weight” was published in 2008 (Bruno, 2017).
This approach is the evidenced-based manifestation of the common saying: “We could all eat and exercise the exact same way, yet look completely different.”
The HAES Approach shifts the focus from our physical bodies, and considers factors such as genetics, health access, and negative body attitudes. Similar to body sizes in colonial times, certain lifestyle behaviors receive a morally righteous or morally lesser connotation. This sense of “healthism” (ASDAH, 2021) and labeling of behaviors only contributes to the internalization of these attitudes. Health At Every Size helps providers discover a patient’s true motivations that can create permanent change. According to ASDAH.org, pillars of HAES include, “Weight Inclusivity, Health Enhancement, Respectful Care, Eating for Well-being, and Life-Enhancing Movement.” (ASDAH, 2021). By emphasizing lifestyle changes and overall health outcomes (i.e., laboratory values), medical professionals can reclaim “wellness” from the weight loss tyrants preoccupied with thinness. Key interventions used within a Health at Every Size practice for nutrition include knowledge of intuitive eating, identifying sustainable habits, flexible movement, and referral to mental health services when deemed appropriate. Acknowledging barriers to receiving empathetic care remains an integral part of any medical approach, especially when considering the Social Determinants of Health (more on that here: https://health.gov/healthypeople/objectives-and-data/social-determinants-health).
Critics of the Health at Every Size approach argue the relevance of the fat acceptance movement in the face of an “obesity epidemic.” The truth of the matter is, making someone feel any lesser for existing in their own skin, in addition to being unkind, will never serve as motivation for positive change. Discrimination can only contribute to poorer health outcomes, such as disordered attitudes towards one body and food (Penney & Kirk, 2015). This is well documented in the research and is something we see with clients all the time. Weight-based discrimination in the health field can lead to providers ignoring client complaints, gatekeeping treatments, and misdiagnosing by focusing on weight loss rather than getting to the root of the issue. In addition, folks who have experienced weight based discrimination at the doctor's office might start to avoid of healthcare altogether. Who would want to go to the doctor if you know a weight loss lecture awaits?
Advocates of the HAES approach promote individualized attitudes and behaviors to explore one’s personal definition of health with the resources at their disposal. As the pillars promise, Health at Every Size doesn’t equate to healthy at every size, which remains a common misconception. HAES® displays that your body fat percentage does not equate to moral or physical superiority, and behavior change can happen at any size if so desired.
So, if you’re considering making a sustainable lifestyle change in the near future, consider reasonings that have nothing to do with your weight or physical appearance. More consistent sleep schedule for better brainpower? More upper arm workouts so you can reach your mobility goals? Trying a new food while traveling? Or maybe even, more outdoor walks for your cholesterol levels?
Whatever it is that makes you tick, do it for you and only you. There's so much noise out there about food and body size, especially in TikTok and YouTube comment sections… promise me you will stay out of those! Ultimately what matters most is what matters to you. Hopefully I have provided some insight into why we adopt the HAES® framework at New Paths Nutrition. We'd love to work with you using this approach if you are interested.
For more information on the HAES movement, visit ASDAH.org.
References
ASDAH. (2021, May 2). The health at every size® (HAES®) approach. ASDAH. https://asdah.org/health-at-every-size-haes-approach/
Bruno, B.A. (2013). History of the Health At Every Size® Movement, Part 1. ASDAH. https://asdah.org/history-of-the-health-at-every-size-movement-part-1/
Bruno, B.A. (2017). History of the Health At Every Size® Movement, Part 7. ASDAH. https://asdah.org/history-of-the-health-at-every-size-movement-part-7/
Gershon, L. (2019, August 30). How colonialism shaped body shaming. JSTOR Daily. https://daily.jstor.org/how-colonialism-shaped-body-shaming/
Penney, T. L., & Kirk, S. F. (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–e42. https://doi.org/10.2105/AJPH.2015.302552
Rosen H. (2014). Is Obesity A Disease or A Behavior Abnormality? Did the AMA Get It Right?. Missouri medicine, 111(2), 104–108.
Weight Watchers. (2020, October 14). Evolution & history of WW Program. WW NZ. https://www.weightwatchers.com/nz/wellbeing/evolution-of-ww#:~:text=As%20word%20spread%20and%20attendee,York%2C%20attracted%20over%20400%20attendees.
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