When health is the topic of discussion, talk about weight and body size is sure to be included. Weight has become a synonym for health, but have you ever stoped to think how or why that connection was made? And is there a way of looking at health differently?

We live in a society that prizes thinness and the medical establishment has centered weight as one of the primary indicators of overall health, taking a weight-normative approach. But, contrary to popular belief, we have over 70 years of weight science studies that repeatedly demonstrate that weight and body size are actually not as significant to health status as other health behaviors. And, yet, the narrative persists.

Health At Every Size® (HAES®) is different. It’s a weight-inclusive paradigm shift that seeks to deemphasize weight, body shape, and size as indicators of health and promotes an expanded definition. It is an approach that understands health is not simply determined by the absence or presence of physical illness because there are a myriad of factors that can influence one's health status over a lifetime and to varying degrees. Moreover, HAES is a social justice movement which recognizes that, regardless of health status, every single body deserves to be treated with respect and dignity, and has the right to be cared for in whatever way the individual desires.

The Association for Size Diversity and Health (ASDAH) first developed the HAES principles in 2003, and updated them in 2013, to address the health disparities and discrimination experienced by those in larger bodies by the medical establishment and society as a whole. The aim was to provide a more holistic definition of health and decenter it as a moral imperative or status marker.

The framing for a HAES approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework. — asdah.org

So, let’s take a look at the five principles:

Weight Inclusivity

Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

Essentially, humans naturally come in all different shapes and sizes, but our society favors a very narrow idea of beauty, which is then reflected in our ideas about health. As such, those of us whose bodies do not fit within the “norm” are made to feel inadequate, shamed for not “trying hard enough”, or are outright discriminated against. We’ll get to fatphobia in a later post, but it’s a fear of fat that fuels the desire in our society to eradicate those in larger bodies and HAES seeks to do just the opposite.

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.

Health enhancement means expanding the picture of health to include a more holistic view of individuals. We are more than the presence or absence of disease and there are many more aspects of health has can be negatively impacted in the pursuit of weight loss. In fact, multiple studies have demonstrated that weight bias — discrimination based on weight and/or body size — is more indicative of poor health outcomes than higher weight as a whole. In addition, mental health often suffers significantly when actively pursuing weight loss, hence the rise in eating disorders as our society is increasingly obsessed with weight and and the pursuit of health. We need to reenvision health from a broader, more complete view of the human experience, not just see it from the narrow lens of disease prevention.

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.

Food is nourishment, food is fuel, and we cannot survive without it. Yet food and overconsumption are often seen as the primary drivers of higher weight and poor health outcomes, but it is just simply not the case. Weight cycling has repeatedly been shown to correlate with weight gain, which is informed by biological processes that we have little to no control over. This principle dovetails nicely with Intuitive Eating which emphasizes paying attention to your body’s cues about food, nutrition, and movement rather than listening to outsiders tell you what is right for your body. It really does know how to regulate itself, we just have to let it.

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.

Here is where a social justice lens comes into this paradigm. HAES recognizes that health outcomes improve when people are treated as the whole human being they are, not just a set of walking systems that tend to get sick. As discussed briefly earlier, poor health outcomes are associated less with higher weight and more with weight bias. In fact, many people in larger bodies often forego medical care for health concerns because of weight bias from providers they have encountered in the past, thus leading to diagnosis at later stages with a poorer prognosis. HAES seeks to change this by advocating for equity and inclusion, and re-envisioning health.

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.

A lot of what is called exercise is simply not accessible to the majority of people out there. Exercise videos, classes, and so-called fitness experts often tout movement that is incredibly ablest and the messaging is demoralizing. “No pain, no gain” sets a dangerous precedence and often turns people off from movement. Life-enhancing movement is different. It promotes moving in any way that feels good by listening to the body, moving when and how it wants, stopping when it hurts or is no longer enjoyable, and not feeling obligated in any way to move because someone else said so. So, whether you have a dance party in your living room, work up a sweat by doing chores, go for a hike, or run a marathon, do whatever feels good in your body!

This paradigm is a HUGE shift from everything we’ve been told, it truly is a better way to operate in the world. Over and over, I have the privilege of seeing the change in clients as they overcome diet culture and become more confident in their own skin.