By Alex Raymond, RD, LD.
As some of you may know, Bobbi and I presented to the University of Maryland senior dietetic class. We actually spoke on their last day of their class, Issues and Problems in Dietetics, which is the “capstone” course. Rebecca taught the class and had a TON of guest speakers ,who are “rockstar” dietitians.
Anyway, Bobbi and I presented on the Health at Every Size ® (HAES ®) approach and weight stigma. We chose this topic because its not commonly addressed. But its SO important.
We strongly believe the lack of discussion of this approach is one of the top 5 “issues and problems” in not only the nutrition community, but also the health community. At the beginning of the class, I asked the students if they ever learned about the HAES principles, and they all shook their heads no. I wasn’t surprised. I am a graduate of UMD and everything I learned about the HAES approach in school was through my own research, most of what I learned was really post-grad (again through my own research). To be clear, I received a wonderful education from Maryland, I’ m a nerd and absolutely loved all the science courses.
However, I’m not condoning the fact that it’s not uncommon for nutrition classes to have a very weight loss centric approach.
The vast majority of dietetic programs (and health field programs in general) are focused on weight as an indicator of health. They teach that weight loss automatically equates to improved health. And this is something that totally needs to change. Why? Well, 95-98% of diets fail. (Also, please note that I use the term “diet” very liberally. Any type of “lifestyle change” for the purpose of weight loss is a diet).
Please note. The tips outlined in this blog just brush the surface of the HAES approach. This blog was not intended to dive deep. I encourage you to read up some more. Linda Bacon’s website and ASDAH’s website are great places to start.
What is the HAES Approach?
Health at Every Size and HAES are actually trademarked terms from the Association of Size Diversity and Health. HAES is an evidenced based approach to supporting an individual along his/her health journey. This approach puts weight on the shelf and it does not use it as an indicator of health. Recommendations for change are based on behaviors as opposed to looking at the number on the scale (weight is not a behavior). Below are the principles of HAES:
1. Weight Inclusivity
Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. 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.
3. Respectful Care
Acknowledge our biases. 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. Support environments that address these inequities.
4. 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.
5. 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.
How can you practice the HAES Principles? And what is the basic information you should know? Read more to find out. 🙂
1. Weight stigma prevents people from getting medical care.
a) What is weight stigma? It is the discrimination/stigmatization of individuals who live in larger bodies. You may be able to think of some examples if you picture the way larger people are portrayed in our society. (Lazy, unhealthy, people fearing weight gain…etc). Studies show that in the healthcare field, health care providers thought of clients with “obesity” as non-compliant, lazy, awkward, weak-willed, dishonest, lacking in self-control, sloppy, unsuccessful and unintelligent.
If that is the signal someone is getting from a health care provider, no wonder he/she is avoiding medical care.
In addition, there was actually a study done called “Obesity Stigma: Important Considerations for Public Health”. And in that study the finders said “Adults who face weight stigmatization and discrimination report consuming increased quantities of food, avoiding exercise and postponing or avoiding medical care (for fear of experiencing stigmatization.).” (ps I learned about this study on Haley Goodrich’s instagram account).But then, avoiding medical care may leaves certain illnesses to go untreated. And this can lead to health complications. Which is so awful! Everyone deserves unbiased care when going to see a provider.
2. Fat is not a bad word.
Most often, this term is used as an insult or criticism. Even the well-intended Jennifer Lawrence said, “It should be illegal to call someone fat”. Rather than seeing the word “fat” as bad, those of us in the fat positive movement work to reclaim this word as a description, just like “freckled nose” or “blue eyes.” We don’t need to get rid of the term “fat”. We need to change the connotation and stigma around it.
3. It is a MYTH that being “overweight” or “obese” puts individuals at significant health risk.
Yes, studies may find connections between weight and disease. BUT, many times these studies do not control for weight cycling, fitness/activity level, nutrient intake, or socioeconomic status when looking at this relationship. When studies control for these factors, the increase risk disappears! Or may even be slightly reduced. So, isn’t is possible that these other factors increase disease risk as well as weight gain risk? You cannot control your weight (only in extreme measures does weight change). It’s possible to follow a healthy lifestyle and make amazing changes to better your health and STILL not lose weight but that doesn’t mean you are doing something wrong.
4. Weight loss is not sustainable
Weight loss can be a very detrimental goal, when weight loss is pursued and emphasized in a society there is an increase in weight cycling, which increases morbidity and mortality. See below for a list of consequences from dieting:
b) Dieting reduces bone mass, which leads to osteoporosis.
c) Dieting increases cortisol and psychological stress→ increased disease risk.
d) Increased anxiety about weight → eating disorders/dieting.
e) Body dissatisfaction is linked to binge eating, lower levels of physical activity, and increased weight gain over time
5. Take a look at your own possible weight stigma/relationship with food
a) We can only take our clients as far as we have gotten. We need to be aware of our own biases and how they impact our language and practice.
- How do I feel about my own body?
- What do I feel about other people’s bodies?
- How do I think and feel about people living in larger bodies?
- How do I talk to others about weight, shape and food.
In summary, the HAES principles advocate for adopting and maintaining healthy habits at every and all sizes. Weight is not an indicator of health. Every person can learn about habits that improve health. And every person can implement habit changes to feel more energized and healthy. Let’s be aware of our biases that can affect how we practice. AND let’s work to change them. Let’s be more inclusive and health focused.
ASDAH’s Trademark Notice must be prominently displayed on all publications utilizing the trademarked term/service: “Health At Every Size and HAES are registered trademarks of Association for Size Diversity and Health and used with permission.
The HAES movement is doing wonderful things and is making amazing progress with how we view health. If you have any questions, reach out to us at (240) 670-4675 or email me at firstname.lastname@example.org