The Problem With The Health At Every Size (HAES) Movement

The Health At Every Size (HAES) perspective is one fraught with controversy in the health field. As you might have gathered from the name, HAES encourages people to adopt healthy habits for the sake of health and well-being, rather than for weight control. At its core, there are three primary components (via):

    1. “Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.”
    2. Finding the joy in moving one’s body and becoming more physically vital.”
    3. “Accepting and respecting the natural diversity of body sizes and shapes”

This is a tricky topic to cover, because I run the risk of sounding like a pretentious fat-hating bitch. But I’m really not, I swear. What I am is a nutrition grad student who has worked with a behavioral weight loss researcher for the past two and a half years. But, I am also in recovery from anorexia—so you could say I have a unique perspective to bring to the table.

The first two statements are essentially a non-dieting approach that HAES encourages, called intuitive eating. It is designed around the “everything in moderation” mantra, and encourages a healthier relationship with food and exercise. Believe me, this approach to eating sounds fantastic and I’m all about healthy relationships with food and exercise. Many individuals freak out a bit though when they see this because they think that they’ll “flexibly” just eat junk for the rest of their lives because that’s what they crave. But, HAES proposes that people crave what they feel that they can’t have. So what if you allowed yourself to have it, rather than restricting it, and ate a moderate amount of everything? While we’re at it, let’s dance on rainbows and lay in fields of flowers.

One of the primary issues I have with the HAES and intuitive eating approach is that they are assuming that everyone is at risk for developing an eating disorder. This is simply not true. As with any disease (because yes, eating disorders are diseases) there are many factors that go into its development, and genetics are a significant component. The majority of people who need to lose weight are NOT going to plummet into obsessive-compulsive eating-disorder land. The amount of people who are overweight or obese, and are struggling with associate comorbid diseases is vastly higher than the percentage of the population that has an eating disorder. Being at an above-normal weight is not an eating disorder, and should not be treated as such.

I am all about their third point of respecting the natural diversity of body sizes and shapes, because I’ve seen far too many people that are bullied and fat-shamed. I think it’s wrong that BMIs are measured in schools, as health-related diagnoses belong in the doctor’s office. As with so many things, our bodies are a product of our genetics. Some people are naturally going to be thinner or heavier; shaped like a stick, hourglass, or pear; big-boned or small-boned, and you get my point. Thin does not necessarily mean healthy, and “fat” does not necessarily mean unhealthy. If someone is content to have their body be at a weight that society thinks is too high, then more power to them. Health goes beyond size and aesthetics.

BUT, lab values (blood sugar, cholesterol, triglycerides, cortisol levels) are a much better indicator of health. Also, many people that are very obese are in pain because their joints and feet are protesting their current weight. Some people have significant digestive issues because of their weight and their diet. Individuals will develop related diseases, such as heart disease and diabetes, which open up a whole ‘nother can of worms. Furthermore, many people are unhappy with how their body feels because they remember a time when they felt better. How one feels in their own body is very personal, and if it is appropriate for them to lose weight, who am I to deny them that goal?

HAES contends that there is “only” a correlation between those related diseases and weight, and thus it’s unethical to advise weight loss without further more rigorous research studies. Yes, it’s a correlation, but it’s a really strong correlation. Furthermore, when people lose weight and increase their activity (which also usually helps with weight loss), their risk for those diseases decreases. I don’t care that it’s “only” a correlation—it still plays out in a way that supports weight loss for those who are obese. I’ve seen too many people dealing with severe obesity-related diseases and chronic pain to not help them responsibly lose weight.

In the weight loss field, we know that even just losing 5 to 7 percent of your starting weight can result in health benefits (improve your cholesterol, triglycerides, blood glucose). Do the math—5 to 7 percent is really not that much. But, in order to lose that amount of weight you have to eat less and move more. No matter what you hear from Dr. f***ing Oz, it still comes down to that. To lose weight, you’re going to have to eat less and move more than what you’re used to and you’re going to be hungry. No amount of fiber, tea, or water is going to allow you to avoid that fact of weight loss. Your body will adjust after the first couple of weeks, but the process is difficult and a good treatment provider will talk through some coping skills with you. Honoring internal cues of hunger, satiety, and appetite is another one of those things that sounds great at face value, but is actually a very difficult thing to achieve. During the weight loss process, if you were to listen to your hunger cues, they would be telling you to EAT DAMMIT because the famine is coming. Our bodies are not designed to be OK with losing weight, and honoring your internal cues of hunger, satiety, and appetite will not be conducive to losing weight. Period. Hunger, satiety, and appetite are complicated concepts that are influenced by a wide range of factors, and cannot be simplified to “tuning in” to one’s internal state.

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I believe that a crucial component to achieving a healthier body is to have an individualized approach. Under this umbrella, people can honor their behavioral tendencies. Are you prone to being obsessive? Maybe a less structured plan would be better for you. Do you find that structure and making a schedule helps you be successful? Well then let’s come up with a plan that will honor that. Do you only want to lose enough weight to get off your blood pressure medication? We can respect that and I’ll help you along the way. What do you want to do for your activity? Finding something that is enjoyable increases the likelihood that you’ll continue to do it. Do you want to make room in your plan for sweet or salty snacks? We can do that too. A skilled treatment provider will help you make a plan for weight loss and moderate physical activity, and also help you come up with a different plan for weight maintenance. But, they will also let you direct the plan while they offer their professional advice.

What’s The Final Verdict?

Essentially, it comes down to what approach is best for you. For some people the HAES mottos might be life-changing and help them be very successful. But for most people, behaviorally, they might need a little more “umph” to help them lose weight, and the HAES approach is too “hippy-dippy” for them. Losing weight is not bad if you need to lose weight, you’re doing it responsibly, and it’s something you want to do. There are very real, negative, health effects that frequently (but not always) accompany obesity, and to neglect their presence is foolish. Respect and love your body, no matter its size and shape, and base your health decisions on your internal goals and values. You’re the one that’s ultimately going to be dealing with your body!

What are your thoughts on the HAES perspective? Comment below or tweet us @litdarling!

Kelsey
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View Comments (6)
  • Astute points. I’ve been in recovery from my ED for close to six years (!!) now, and I still have trouble figuring out when I’m hungry until I’m FAMISHED. It’s truly annoying at this point and is something I know is 100% a side effect of my disease. Eating Disorders and disordered eating aren’t always correlated; one is a disease, one is a learned behavior; both are harmful. I will never think that the Health of Every Size movement is a bad thing for the very medical reasons you pointed out as well as the ridiculous misconception that thinness=health among a host of other things, but I do think that it’s way too easy today for things to be reduced to the length of a tweet for click bait and that the meat of the issue left by the wayside for most who encounter it. so, kudos.

    • Hi, C! Well first off, congrats on being in ED recovery for this long! It’s weird, right? I know for myself, I have to have some semblance of a meal “plan” because my tolerance of hunger is pretty high. So yea, it’s not super noticeable until I’m like I WILL EAT AN ELEPHANT, KTHANXBAI.
      I really appreciate your constructive feedback, as I know this can be a touchy topic. All of the best to you!

      • Thanks! And I meant to specifically say how much I appreciated your discussion of intuitive eating. This is a topic that should most definitely be open to conversation and not one way or the other, so I commend your bravery to weigh in. My hope is the more it’s discussed, the less sitgma and power it will hold!

        • I appreciate your encouragement! I tried to be as complete as I could but I knew that it can be a touchy subject to cover. I had one person tell me on tumblr that I have a “nutritionist god complex” so you win some and you lose some =P
          I completely agree though that this needs to be more widely discussed. Best practice is always a fluid state and I hope that everyone can take into account all the different sides and what the evidence shows is best for different patient populations.

  • Hi there, great article! I see you’re wanting work with those dealing with E.Ds. Am really wanting to speak to a professional about my habits and wonder if you could possibly help..?

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