Why Health At Every Size Matters

Some people are familiar with "Health At Every Size" or HAES® (pronounced "haze"), and yet some have never heard the term. So what is HAES® and why does it matter?

HAES® is a new paradigm to view people in bodies of all sizes. The principles of HAES® are: Weight Inclusivity, Health Enhancement, Eating for Well-Being, Respectful Care, and Life-Enhancing Movement. Below is a breakdown of what the HAES® principles are:

• Weight Inclusivity includes accepting and respecting bodies of all sizes and shapes and rejecting an "ideal" body shape or size. It also means working to end the stigma and pathologizing of certain weights.

• Health Enhancement means supporting people and policies that improve and provide equal access to services and information and practices that improve well-being, attending to our social, emotional, spiritual, economic, and physical needs

• Eating for Well-Being means we reject rigid diets and one-size-fits-all weight control plans for individualized and flexible ways of eating that are based on satiety, hunger, nutrition, and pleasure.

• Respectful Care means individually and as a group we acknowledge and combat the biases that are promoted by society that stigmatize weight, promote weight discrimination and weight bias. It means that services provided by those who sign the HAES® pledge provide information and services understanding the impact that socio-economic, race, gender, sexual orientation, age, and other intersecting identities have on such stigma. It means that we support more equitable environments that attempt to address these inequities and take steps to build competence to better understand their impact on the whole of the person

• Life-Enhancing Movement means supporting physical activity that allows people of all sizes, interests, and abilities to engage in meaningful and enjoyable movement to the degree they choose. (principles taken from ASDAH.org).

Why is HAES® important? It provides a perspective that runs at times parallel and sometimes counter to the popular beliefs held by modern medicine that is often fat-phobic. The medical field has long held the belief that larger bodies = unhealthy and this stigma has often led to iatrogenic (healthcare provider-induced) trauma and illness. Disordered eating is sometime a result that is iatrogenic as certain diets are given to patients in the hopes that they will change their eating habits to promote health.

Once these diets invariably don't work, cause malnourishment, and build disordered eating habits and emotionally charge eating with negative associations--which many doctors themselves admit "rarely work"--they then propose even more extreme interventions that involve even more extreme diets, fasting, or weight-loss surgery. This rarely, if ever, treats the mind-body connection involved in disordered eating, often induces or makes malnourishment worse. That is to say nothing of the trauma these interventions cause on getting long-term health benefits from making movement punitive, making eating fraught, creating a negative body image and poor self-esteem. Once patients experience the harmful stigma outside of the service provider's office, society at-large can then take over and provide a constant, unrelenting, barrage of harmful images, policies, and bias against those that do not fit the body norm.

If disordered eating, exercising, etc. results in what service providers were hoping for (a body that matches the socially acceptable ideal), they often treat health conditions as apart from the disordered behavior and often praise the person thus maintaining and solidifying potentially harmful behaviors.

In the case of people in larger bodies, such health conditions (equally iatrogenic and maintained by service providers, policies, and social bias) are treated as a result of being in a larger body. It seems there could be no other cause to a person's conditions and weight loss is the only treatment for such illness. This can result in the true etiology of such conditions being overlooked and patients feeling a sense of failure and shame which only reinforces negative self-concept and once again solidifies these internalized beliefs and disordered behaviors. It may also prevent healthcare access. This means that instead of risking shame and embarrassment by a provider who will point out someone's weight and the patient's failure to change one's body shape or behaviors, the patient will wait until physical or social-emotional health becomes untenable. This can result in much worse health outcomes. Cancer might be further along, diabetes might cause secondary health effects; depression, anxiety, or social isolation might become more extreme.

The HAES paradigm might represent a new shift in how we conceptualize people's health especially those of certain weights and shapes. We can begin to undo the harm that society's stigma of certain weights and sizes has caused for untold decades. It is important to remember the medical community has also bought into this bias and ASDAH and those in the HAES community have committed themselves to informing fat-phobic providers. If you are interested in finding a HAES-pledged service provider, there are two places I have found one can visit. One resource maintains a directory currently https://haescommunity.com, and one will likely maintain a directory beginning in the Summer of 2022 https://asdah.org.

I hope you will join me in promoting this movement to bring health equity to everyone and reducing the pathologizing of people of certain body sizes. Only when we can all live happy and healthy lives, free of the stigma and pain, and full of joyful and meaningful movement, have we done our jobs to create a more just and healthful society.