I am reading Dr Jennifer Gaudiani’s ‘Sick Enough’ at the moment. It is an exceptional book covering medical complications of eating disorders. In this book, Dr Gaudiani is evoking weight stigma and how, as a medical doctor living with thin privilege, she had to develop a lot of self-awareness to ensure weight bias was not affecting the way she diagnoses and supports her patients in their ED recovery, with compassion and inclusivity. In her book, she cites a study published by Lavie, De Schutter and Minali in 2015 that really resonated with me : ‘evidence continues to grow that healthy people in larger bodies, with cardiovascular fitness, may indeed live longer than those in thinner bodies.’[i]
It reinforced what I wrote earlier about BMI being pretty much useless as an indicator of health (read my piece for Goodness here). This is why separating weight and health is something that informs my coaching practice. It is the reason I am officially listed as a ‘Health At Every Size’ (HAES) practitioner and a member of the ‘Association for Size Diversity and Health’. But I know HAES is still a foreign concept to many of my clients or relatives. So it felt right to dive into this concept more in details.
So, what does ‘Health at every size’ (HAES) mean?
First, it does not mean every one, regardless of their size, is healthy. HAES is in fact a new paradigm for health, that is size-inclusive and non-weight centric. That means it takes into account there is a natural diversity of sizes and bodies out there, and that, as scientific evidence has demonstrated times and again, reaching an arbitrary ‘ideal’ weight by any means possible won’t automatically enhance a person’s health.
HAES was created by a group of clinicians whose most recognised representative is Dr Linda Bacon, who started her career as an eating disorder and body image therapist, went on to get a master in exercise science and then earned a PhD in nutrition and weight regulation. Throughout years of independent research, Dr Bacon realised that weight and BMI are no good predictors of health and longevity, and that conventional dieting (as in periodically restricting food intake and upping exercise until reaching a lower weight) was not only ineffective for sustainable weight loss, but also causing more harm than good in the long run.
Indeed, restrictive diets are proven to slow down metabolism, reduce muscle tissue, introduce guilt and shame in our relationship with food and enhance the moral stigma our western societies attach to heavier bodies. Two decades ago, Dr Bacon went on to prove her HAES theory in a ground-breaking experiment, where a group of women with a BMI between 30 and 45 were encouraged to improve their health indicators (cholesterol, blood pressure, etc): half of them were put through ‘conventional’ dieting and exercise rules, the other half was taught the HAES principles (read more about these below). After a year, the results were staggering: in the conventional dieting group, not only half of the women dropped out (if you ever tried to hold on to a diet for a year, you’ll know why) but remaining dieters were back at their starting weight and (poor) health markers. In the HAES group, although the participants’ weight had not changed that much either, their health indicators and mental outlook were largely improved, AND they had learned sustainable ways to care for their health and body from a self-compassionate, empowered, guilt-free perspective. What is the magic behind this?
HAES rests on four key principles:
Principle #1: Accepting there is a diversity of bodies, and honouring all differences
Have you ever noticed that it is socially accepted for people to be ‘naturally thin’ but that ‘naturally fat’ people are constantly shamed into losing weight ‘out of health concerns’? That’s called weight bias. It pushes us to believe that thinner is always better.
But what scientific evidence suggests, is that we all have a set point weight, which is more like a ‘range’ of weight where our body, metabolism, health are at their optimum state, without us having to obsess about food or exercise. And as usual, this set point weight can be found across the complete weight spectrum, at the exception only of a small minority of extremes.
Research also shows that whenever the body is contrived into restriction, it believes it is being starved and, as a result, our metabolism intuitively slows down in order to hold on to whatever energy it receives. Our bodies are programmed to protect us this way, and it means that, just like with height, there is not much we can truly do when it comes to dramatically reducing our weight, long term. The powerful weight control and management industry (expected to grow globally to 279 Billion USD by 2023, according to Orbis Media) will have you believe the opposite, because there is big money to be made out of people’s insecurities.
Yet, over 95% of people who lose weight end up gaining it all back (and more) within two to five years. And it is also clear that yo-yo dieting is a lot more harmful to your health than staying stable at a ‘higher’ weight, especially if sustainable health practices are in place (see more on that below). If we are shaming people in heavier bodies because we are truly mindful of their health, it is time we all put in the work to accept body diversity is a reality, whether bodies ‘fit’ the narrow standards of beauty or not, and to start reviewing our internal biases in order to avoid weight stigma. Because shaming people into weight loss, even for health reasons, certainly hasn’t helped annihilate the so-called ‘obesity epidemic’. Nope, not at all. It actually contributes to worsen obesity rates.
Principle #2: Health isn’t just physical
Because health is not only about food and exercise, it cannot be reduced to a number on the scale. Health encompasses social, emotional, mental balance, but also financial health, access to safe and sufficient foods, an ability to move safely and regularly, access to healthcare etc.
Principle #3: Attuned eating, for pleasure and wellbeing
Letting go of weight control and rigid meal plans gives us a chance to reconnect to our natural hunger and satiety cues, but also to pleasure. Did you know that pleasure can dramatically affect the nutritional value of our food?
In a study conducted in 2000, researchers from Sweden and Thailand explored how cultural preferences for food affects the absorption of iron from a meal. Thai and Swedish women were fed a typical meal from their country (thai curry, for the Thai group vs hamburger, string beans and mashed potatoes for the Swedish group), both containing the exact same amount of iron. Thai women absorbed significantly less iron from eating the Swedish meal, and more iron from eating the Thai meal they knew and loved. The same thing happened for the Swedish women eating Thai curry. And the experiment went one step further, serving each group their ‘national’ dish but blended into a…juice (cringe). Same results: low iron absorption was observed in the absence of enjoyment around the food consumed [ii].
HAES advocates for us to reconnect to our body’s feedback: the unique, innate way our bodies can tell us what they crave, need and enjoy. And shock horror: this has typically nothing to do with counting calories, macros or grams of fat[iii]. Think about it: babies don’t need to ‘learn’ how to manifest hunger and experience fullness, they are born with this knowledge.
Principle #4: Joyful movement over punishing exercise
When exercise is conceived from a weight control perspective, it is rationalized into calories burned, into heart rates goals and into workout minutes. What experience shows us time and again, is that when exercise happens with the goal of losing weight or changing the body’s appearance instead of enjoying a sense of wellbeing, it can only last for a specific period of time. Individuals go to the gym fearing the session ahead and feel a sense of relief when it is finally over. This approach is not sustainable on the long run, as it carries a strong element of shame and guilt that will typically fail to bring the long term health benefits expected through ‘conventional’ weight loss.
HAES encourages each of us to find our own ways to move, not from a rational ‘numbers’ perspective, but in a way that sparks joy and pleasure, so working out integrate in our lives seamlessly, and become long term health practices, that we effortlessly love to return, as a form of self-care. Joyful movement can be any type of movement (gardening counts, as does tending to toddlers or walking the dog) and it does not have to make you sweat to be effective. You can reap health benefits by simply integrating your favourite way to move as a regular practice in your everyday life.
For more about HAES, take the online pledge to support these values here, or read more about it at the ASDAH website or through Linda Bacon’s books, listed here. If you have questions about implementing this in your own life, do reach out to me and let’s schedule your free evaluation session of eating psychology coaching.
[i]Lavie CJ, De Schutter A, Milani RV, Healthy obese versus unhealthy lean: the obesity paradox. Nat Rev Endocrinol, 2015 January, 11(1): 55-62. doi: 10.1038/nrendo.2014.165
[ii] “Food that tastes good is more nutritious” reported in Tufts University Health and Nutrition Letter, October 2000
[iii] NB: being more intuitive around food doesn’t apply to diagnosed eating disorders during recovery, because hunger and satiety cues are skewed by the disorder. In this case, a recovery meal plan will guarantee enough food is consumed, at least until health markers and cognitive function improve.