What is the HAES Movement?
The HAES movement involves a paradigm shift in healthcare that is designed to help all people take care of their bodies despite their size. The HAES movement supports people across the spectrum (weight as well as socioeconomic) and seeks to end stigmatizing of health problems (healthism). HAES activists work to end weight-based discrimination, bias, and iatrogenic practices within health care and other health-related industries, and in other areas of life. It is a social justice movement that aims to support people of all sizes and backgrounds in having access to resources to support their health.
What does HAES mean?
HAES is an acronym that stands for Health at Every Size. It is pronounced “haze”. The Health at Every Size® (HAES®) approach is a registered trademark of The Association for Size Diversity and Health (ASDAH). This nonprofit organization originally developed in 2003 and revised its principles in 2013 to promote size acceptance and end weight discrimination and stigma.
ASDAH promotes the HAES movement to support all individuals in creating healthy environments by removing the barriers to the access of healthcare. They empower the individual and reject judgments that certain behaviors are good or bad. The focus is taken off weight as a primary health determinant and instead addresses the whole person.
When did this work begin?
The HAES movement framework has been around for decades. Fat activists and the fat liberation movements have been documented in the 1960’s. It began as a protest of the discrimination and lack of access to equal opportunities for individuals who were overweight. The anti-diet work started many years ago, and yet our healthcare systems today continue to be weight-centric, placing the focus on body weight.
The HAES movement is a continuously evolving alternative to the weight- centric healthcare and is a movement to promote size acceptance, end weight discrimination and lessen the cultural obsession with weight loss and thinness. The HAES model upholds the ethical principles of beneficence and non-maleficence by focusing on eradicating weight stigma, honoring human differences (size diversity) and focuses on interventions that promote physical health and psychological well-being.
Studies involving HAES principles (weight-inclusive approach) found participants had many improvements to their overall health. These improvements include decreased body dissatisfaction, decreased weight-cycling, reduced dysfunctional eating attitudes. As well as decreased total cholesterol, low density lipoprotein (LDL cholesterol), triglycerides and systolic blood pressure. And finally, improved mood, less social isolation, less disordered eating, and increased self-esteem. Overall greater desire for self-care and compassion lead to developing lifelong good health habits.
The HAES Movement approach
Is the HAES movement anti-weight loss?
The overall goal is to support the well-being of people without recommending weight loss. HAES movement is not against weight loss but the pursuit of intentional weight loss. Focusing on behaviors that all people can make to support self-care. When incorporating the HAES principles that include Eating for well-being and Life enhancement movement, you will likely stay within a more stable weight range that is right for your body.
Top reasons HAES does not promote intentional weight loss through strict diet restrictions
Intentional weight loss is only maintained in a small percentage of people. Restricted diets alter our set-point weight. They slow the rate at which your body burns calories. Our bodies are hardwired to prevent starvation. Fat loss will decrease the hormone leptin and this response increases our appetite and our ability to store fat and decreases our energy expenditure.
There are many health risks correlated with weight cycling (weight loss followed by weight regain- often gaining back even more weight than what was originally lost). Weight cycling leads to physical as well as emotional consequences and perpetuates weight stigma. Eating disorder behaviors may develop as well to try to maintain weight loss.
Focusing on weight loss heightens weight stigma. The stress that comes from weight stigma tends to perpetuate poorer lifestyle choices including emotional eating, binge eating. This stress may also encourage a decrease in exercise, and an increase in anxiety and body dissatisfaction. This often leads to shame and less preventative healthcare visits, and prolonging seeing a health care provider until a healthcare crisis.
What is the key to health and behavior changes?
Self-care and self-compassion are the key to promoting behavior change that will improve health outcomes. How can we help someone want to take care of themselves? Accepting that we are all unique and have a completely different hard drive so to speak. Everyone’s health is a sum of a set of completely unique circumstances (genetics, socio-economical, gender, religious, trauma responses, food supply) to name a few.
What can people change? What are we capable of doing differently? We can learn about why we make certain choices and work towards behaviors that may impact our health more positively independent of the number on a scale.
Why doesn’t the current weight-centric approach work?
The challenge is that because of the widespread emphasis on weight loss above all else, when people make beneficial behavior changes and then do not see weight loss, they may stop these healthy behaviors. HAES rejects the use of weight or BMI and works to support compassionate ways for self-care. The focus on health and well-being, rather than weight promotes positive physical and mental health behaviors.
What is different about the HAES movement?
HAES movement approach to healthcare digs much deeper than the current weight-centric approach. HAES practitioners look at the underlying cause of all health disparities to get to the root cause of health issues. Shifting from a weight loss focus to a body acceptance/health-based focus and improving the overall physiological/psychological health and overall well-being. True well-being includes improving social-connections, meaningful work, fulfillment in our lives and a sense of purpose.
Not only does HAES focus on behaviors you can adopt to help improve your health, but it also reduces the toll of weight stigma. If we are not focusing on the numbers on the scale, we will be less triggered to feel our value is connected to this number on the scale. Many people with weight stigma prolong going to a doctor until they are going through a medical crisis.
Body acceptance does not mean the HAES movement promotes obesity. And HAES is not anti-good nutrition. HAES encourages healthy behaviors and habits to help improve overall health and is a weight-neutral approach to health. In-fact, HAES practitioners believe that whatever your body’s weight does because of improving health behaviors and prioritizing self-care is the right weight for your body.
The 5 HAES principles
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.
The HAES principles are outlined in my previous blog HAES: Part One. A brief overview of Health at Every Size – Waistline Dietitian
What makes the HAES movement difficult for people to accept?
Many people feel resistance to the idea of giving up intentional weight loss. The traditional approach to health care has emphasized the role of body weight as one of the main determinants of health. The weight-centric approach rests on the assumption that weight and disease are linearly related and emphasize personal responsibility for healthy lifestyle choices. The problem with this weight-centric approach is that it has been ineffective at producing and maintaining weight loss. It also has unintended consequences including food and body preoccupation, repeated cycles of weight loss followed by weight gain (weight-cycling), distraction from health goals, reduces self-esteem, eating disorders and weight stigma/discrimination.
Why should we adopt the HAES approach?
The HAES movement is an evidence based practice which provides compassionate and respectful care, making space for people of all body sizes to support physical and mental health. Better health outcomes happen when we focus on the steps toward health behaviors, irrespective of a person’s size. This paradigm helps support our patient’s health by prioritizing self-care, rather than another set of strict rules to follow.
The key is for both health care professionals and patients to appreciate the extent to which body loathing and shame are associated with a REDUCED engagement in self-care. If patients begin self-care practices that enhance physical health, they will likely feel better psychologically as well; and these psychological gains are linked to future increases in self-care practices that enhance health! Celebrating body diversity does not glorify fatness or reinforce unhealthy behaviors! It teaches people to trust and respect their bodies so that they will be motivated to care for them!
Summary
Through education and acceptance, we can improve the health and overall well-being of our patients by promoting safe non-stigmatizing environments, respectful care for people of all shapes, sizes, colors, genders, socio-economic and religious backgrounds. The HAES movement digs deeper into the underlying cause of health disparity and works to provide safe and affordable access to healthcare. It also helps people find sustainable practices that support individual and community well-being.
For more information on the benefits of a weight-inclusive approach for overall health and well-being see my blog: HAES. HAES: Part 2 Weight-Inclusive Health for Overall Well-Being and Doing No Harm – Waistline Dietitian
References
What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift – Lily O’Hara, Jane Taylor, 2018 (sagepub.com)
Strategies to decrease fat stigma in women’s health – Women’s Healthcare (npwomenshealthcare.com)
What Is Intuitive Eating? The Good, the Bad and the Key Takeaway for Success! – Waistline Dietitian
HAES: Part One. A brief overview of Health at Every Size – Waistline Dietitian
Bacon, L., Aphramor, L. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutr J 10, 9 (2011). https://doi.org/10.1186/1475-2891-10-9
Do No Harm: Moving Beyond Weight Loss to Emphasize Physical Activity at Every Size (nih.gov)
Association for Size Diversity and Health: ASDAH | Committed to Size Diversity in Health and HAES®
