What is Health At Every Size?
Health at Every Size (HAES®) is a weight-inclusive healthcare paradigm that represents a radical alternative to the mainstream weight-centric paradigm. Essentially, HAES is an approach to healthcare that focuses on optimising individual health behaviours, rather than seeking to change an individual’s bodyweight.
HAES recognises that individuals can pursue health regardless of their body size and that health is not necessarily tied to weight in the way we have been led to assume. You simply cannot base a person’s health on the size of their body alone. Also, contrary to popular belief, many of the supposed risks to health associated with higher weight can be explained by the effects of weight cycling (AKA yoyo dieting) and the stress caused by experiences of weight stigma.
Not only that, but our weight is actually not within our control to the extent that we have been led to believe and most attempts at weight loss are not maintained long-term. Weight is primarily determined by genetics and social factors beyond our ability to control. Just like we accept that people have different heights or shoe sizes, everyone has a natural weight range where their body wants to be, and this means there’s a huge diversity of body shapes and sizes amongst us.
The Origins of HAES…To Today
HAES originated in the fat acceptance movement, which was founded by fat black activists in the 1960s. Since then, the HAES movement has grown and is now more widely embraced by individuals and health professionals than ever before. At its heart, HAES is inherently a social justice movement focused on fat liberation and the dignity of all people regardless of their size or other marginalised identities.
The Five Principles
Health at Every Size is underpinned by five core principles. These are:
- Weight Inclusivity
Embracing and respecting the inherent diversity of body shapes and sizes. HAES rejects language, policies and actions that pathologize, stigmatize and/or discriminate against certain body sizes.
- Health Enhancement
Supporting health policies that promote equitable access to health information and healthcare. Encouraging individual practices that improve all aspects of health – physical, mental, emotional, social, financial, cultural and spiritual.
- Eating for Wellbeing
Promoting eating for self-care, enjoyment and nourishment rather than weight control. HAES encourages flexible and individualised eating based on hunger, fullness and satiety, nutritional needs, cultural and religious practices, preferences and pleasure, rather than following external rules around eating.
- Respectful Care
Emphasising the importance of working to end weight discrimination, weight stigma and weight bias in all settings. This is especially important in healthcare systems in which medical weight stigma continues to be a barrier to appropriate healthcare for people in larger bodies.
- Life-Enhancing Movement
Encouraging individuals to engage in movement to the degree that they choose. HAES supports movement that is accessible, inclusive and enjoyable to people of all sizes, backgrounds and abilities.
How does HAES Inform Eating Disorder Treatment?
Increasingly, eating disorder treatment providers are recognising the harms of a traditional weight-centric approach, with many adopting HAES in their practice. In practice, the HAES philosophy is translated into the non-diet approach. Clinicians vary in their implementation of non-diet principles. However, the following elements are often incorporated into eating disorder treatment.
- Clients are not weighed. This is because a non-diet approach doesn’t use bodyweight as the focal point of treatment and instead focuses on eating patterns and health behaviours that promote overall wellbeing irrespective of a person’s weight.
- If weight loss is a goal, the client may be asked to put this desire on the back burner whilst they are receiving treatment for an eating disorder. This is because focusing on intentional weight loss can get in the way of recovery. It is important that eating patterns are stabilised before any desire to alter weight is addressed. ‘
- Working towards intuitive eating. Dietitians working within the non-diet space will often work with clients in eating disorder recovery to move away from a disordered relationship with food and towards intuitive eating.
- Language such as ‘overweight’ and ‘obese’ are generally avoided. This is because many people view these terms as stigmatising. Instead, clinicians may use the terms ‘larger body’ or ‘higher weight’.
- An emphasis on body autonomy. This means clinicians will listen to and respect a client’s self-determination and autonomy to decide how they nourish and move their body.
Personal Experience of HAES and Recovery
In my own recovery, discovering HAES was key to me breaking free from my eating disorder. I came across HAES early into my recovery and was fortunate that my psychologist happened to already work with this approach. As someone who struggled primarily with Orthorexia, which developed – among other factors – out of messages I had internalised about ‘health’, I was immediately curious (and admittedly sceptical) about HAES and the alternative it represented.
I did my research and was quickly struck with a sense of cognitive dissonance between the beliefs my eating disorder was based on and this new approach to health that challenged everything I thought was true. I lived in that place for a while and drew on my newfound knowledge about health to help make progress in my recovery. It was by no means easy, and I definitely struggled with moving beyond intellectually ‘knowing things’ to actually being able to apply them in my life.
A little later on, after having read some books about HAES, intuitive eating and the non-diet approach, I actively sought out a HAES-aligned dietitian to add to my treatment team. It was important that my clinicians where on the same page. My dietitian blind weighed me, which helped me let go of numbers and gave me the confidence to get rid of my scales. I followed HAES and fat liberation accounts on social media, listened to insightful podcasts and gradually moved away from the diet culture environment that perpetuated my eating disorder.
For a while, I was stuck in a place of ‘quasi-recovery’, afraid to let go of all my rules and scared of gaining weight, despite wholeheartedly embracing HAES. I write this because I think it’s important to normalise the experience of so desperately wanting to support HAES but finding it hard to trust our bodies to change. But, after an amazing holiday that gave me a taste of freedom, I took a leap of faith and let my eating disorder gradually fade into the distance as my authentic self took its place.
I can’t be certain, but I honestly don’t think I could have recovered without the influence of HAES in my treatment and recovery process. It was the knowledge that HAES gave me, reinforced by my clinicians, that reassured me that gaining weight wasn’t going to ruin my health or that doing movement I enjoyed was more important that pretending to like some socially celebrated form of exercise. It was even HAES that led me to learn more about social justice and why I went on to study my master’s in social work.
Today, despite being fully recovered, I still have work to do to unlearn my own internalised weight stigma. I’m not perfect. I’m sure I still have unconscious biases like we all do. I’m also conscious of the thin privilege I hold and that HAES is a movement that wasn’t designed for me, but for those without this privilege. But with this in mind, the person I am today owes a lot to HAES and the people, knowledge, perspective and freedom it has brought into my life.
Written by Sophie Smith – Student Social Worker and Eating Disorder Advocate.
Useful References
The Association for Size Diversity and Health https://asdah.org/
HAES Australia https://www.haesaustralia.org.au/
Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating by Christy Harrison
