HAES: Part One. A brief overview of Health at Every Size

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What does HAES mean?

HAES is an acronym that stands for Health at Every Size. It is pronounced “haze”. I have heard this term many times over the past decade. I thought it implied that we could be healthy at any size.

I had taken it literally, and that it was possible to be healthy at a wide range of sizes. If we felt well physically and emotionally, and had normal blood pressure, Lipid profile, Glucose and Hemoglobin A1c, and other health tests/vital signs were in a normal range, then if we were considered under or overweight we could still be considered healthy. Well, I was wrong, and there is so much more to Health at Every Size!

HAES is a social justice movement.

Health at every size (will be referred to HAES throughout this review) is a social-justice movement that is working towards ending weight discrimination, weight stigma and weight bias. HAES aims to help people of all sizes have access to resources that will support their health

The HAES activists work towards promoting a weight-inclusive approach to health care and they support acceptance of size and body diversity. This means that all body sizes can see benefits to behavior change.

The purpose is to support health behaviors and access to health resources and respectful care for people of all body sizes. The HAES approach rejects the use of BMI, weight or size as indicators of health and the myth that your weight is a choice.¹

About the Association for Size Diversity and Health® (ASDAH®).

The Association for Size Diversity and Health or ASDAH is a non-profit organization with international membership that has developed and promoted the Health At Every Size or HAES approach as a central element of its advocacy to end discrimination and stigma related to weight, lessen the cultural obsession with weight loss and thinness, and promote acceptance of diverse weights and sizes.

Originally developed in 2003 and revised in 2013, the HAES approach has become both a social justice movement and a weight-inclusive approach to health, thus offering a new paradigm in weight management science.  Their members are committed to the Health at Every Size principles. ASDAH holds the trademark for both terms “Health at Every Size” and “HAES” in the USA.     

ASDAH’s community support.

The ASDAH’s mission is to partner with service providers, educators and advocates dismantling weight-centered health care policies and practices and ensuring that all people with multiple forms of oppression have access to health services. 

They envision a world that celebrates bodies of all shapes and sizes, in which body weight is no longer a source of decimation and oppressed communities will have equal access to resources and practices that support health and well-being.²

HAES Basics: The Five Principles of Health at Every Size.

Below are the five principles of HAES taken from the official website of the Association for Size Diversity and Health.

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, 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.

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.

**check out my previous blog about Intuitive Eating by clicking this link What Is Intuitive Eating? The Good, the Bad and the Key Takeaway for Success! – Waistline Dietitian

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. ³

Current healthcare centers on “weight management”.

Weight management is a central component of health improvement and health care today. HAES activists believe the current weight policies that center on weight loss fall prey to several assumptions and stigmatize those with higher body weight.

This stigmatization can drive poor health and ironically weight gain. Many weight-based policies begin with the premise that a person will accept a weight reduction plan when told that they are “overweight”, when the evidence demonstrates that self-perception of being overweight may actually perpetuate weight gain and other negative health outcomes. 

HAES activists do not believe weight should be part of the health assessment.

5 misguided assumptions with the current weight-normative approach.

The current weight-normative approach is not working.

They feel the current weight-normative approaches that have been around for over 4 decades have been ineffective at promoting health and have likely fueled weight stigma and contributed to poor health outcomes.  This traditional approach to health care has emphasized the role of body weight as one of the main determinants of health.  This weight-normative approach rests on the assumption that weight and disease are linearly related and emphasizes personal responsibility for healthy lifestyle choices.⁶ 

The focus is primarily on weight loss and weight management as the method for preventing and treating health problems. The problem is that today the number of people considered obese continues to grow.  From 1999-2000 through 2017-2018 the prevalence of both obesity and severe obesity increased from among adults.  The prevalence of obesity increased from 30.5 to 42.5% and severe obesity increased from 4.7% to 9.2% among adults.⁵ So, basically the weight-centered approach has not helped improve the world’s obesity problem.⁶

Warning: Authors opinion.

I was surprised to learn about the 5 misguided assumptions about weight, weight loss and weight loss maintenance.

Let me give you a brief view from my lens. I have worked as a clinical dietitian for 28 years primarily in the hospital setting. I see people when they are sick and often on their worst days.  I assess patients that have been flagged as having an unintended weight loss prior to their admission for nutrition intervention.  I also receive consults to assess patients that are considered obese (BMI >30.0) and other patients for MNT (medical nutrition therapy) for diabetes and end stage kidney disease. I use this opportunity to talk to the patient about how they feel about their diet and health and see if they have any questions or concerns. I let the patient guide our discussion. We talk about food and medication access, their daily habits and try to work on what changes they would be willing to make in their daily routine to help improve their health.

Fad diets are not sustainable.

Throughout my career I have never promoted restrictive or fad diets, juice detoxes or any diet that promotes a quick weight loss. This is partly because I couldn’t promote something that I would not be able to do myself and I consider them unhealthy, possibly dangerous and not sustainable! They may produce temporary weight loss, but not permanent weight loss unless new eating habits and healthy behaviors were included and sustained.

I had always believed the reason these fad or restrictive diets did not work was because they did not instill new healthy lifelong habits in place of the old habits.  Quick fixes don’t teach us to how to eat properly or how to eat during busy stressful days or on the run. Restrictive diets cause us to feel deprived, which in turn can set us up for overeating or “binging” later on.  This can lead to weight cycling, weight loss followed by weight gain potentially putting us at even a higher weight than we started out at.   

What I love about HAES.

Disclaimer.

References:

1. The Health at Every Size® (HAES®) Approach | ASDAH
2. About the Association for Size Diversity and Health | ASDAH
3. Health At Every Size: The 5 Principles of HAES | Konsyse
4. An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy (jeffreyhunger.com)
5. Adult Obesity Causes & Consequences | Overweight &   Obesity | CDC
6. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss (hindawi.com)