Health At Every Size (HAES): The Antidote to Weight Stigma?

Linda* battled her body for years. Growing up in the 1980s during the height of diet culture, she was told as a teenager that she could no longer eat the same foods as her male peers. Linda tried diet after diet, but none of them led to the long-term weight loss she was sure was the key to confidence and contentment.

In her twenties, Linda was advised to get gastric bypass surgery. At first, it seemed like the surgery was a “success” in that Linda was able to rapidly lose a significant amount of weight. Gradually, however, she gained the weight back, even though she continued to follow the restrictive diet prescribed by her doctor. When Linda also began to experience severe abdominal pain, her doctor accused her of “cheating” the diet and advised her to lose weight. Only after Linda switched doctors did she receive treatment for her ulcer.

Forty-two percent of U.S. adults have experienced weight stigma at some point in their lives. People who are perceived as overweight face discrimination at work, in their doctors’ offices, and in society at large.

The Health At Every Size (HAES, pronounced “hays”) movement aims to change this by systematically debunking myths about weight, diets, and health. Among its core principles are body acceptance and using intuitive eating and physical activity for well-being, not weight loss. Here is what you need to know about HAES, including how it can help your patients.

What is the history of HAES?

HAES has roots in the 1960s and 70s but gained momentum in the late 2000s after the CDC released a report showing that “overweight” people actually live longer than underweight people. This gave credence to what many nutritionists and medical professionals already knew: determining health and longevity isn’t as simple as putting someone on a scale. Healthcare workers joined forces with psychologists and activists, and the Health at Every Size Movement was born. Over the years, an increasing body of research has supported the HAES approach, showing that weight-centric approaches to health often lead to negative physical and mental health outcomes.

What are the key concepts of HAES?

1. Body acceptance: HAES encourages individuals to accept and appreciate their bodies, regardless of size or shape.

2. Respectful care: HAES advocates for compassionate and non-judgmental healthcare practices that treat individuals with dignity and respect, regardless of weight.

3. Size diversity: HAES recognizes that bodies come in various shapes and sizes, and that body size does not determine overall health.

4. Intuitive eating: HAES encourages individuals to listen to their bodies’ internal cues for hunger and satiety, rather than relying on diet trends, rules, or restrictions.

5. Joyful movement: HAES advocates for physical activity that is enjoyable, sustainable, and focused on improving overall well-being rather than weight loss.

How can I use HAES to help my patients?

1. Recognize weight bias:

Weight stigma affects all of us in the form of sub-conscious biases. People who are perceived as overweight are often assumed to be unhealthy, lazy, or undisciplined. By examining your own biases, you can help to create a more non-judgmental and inclusive environment for all.

2. Promote body positivity:

Help your patients to develop positive relationships with their bodies by focusing on function versus form, self-acceptance versus judgment and criticism. Empower them to develop self-worth that is not based on appearance.

3. Challenge diet culture:

Help your patients to be critical of diet culture. Talk about what happens in the body when we diet, including changes to metabolism and the release of stress hormones like cortisol, which can actually lead to weight gain. Encourage your patients to challenge the unrealistic beauty standards perpetuated by the media.

4. Focus on feeling good and overall health versus weight:

Encourage patients to adopt sustainable and healthy habits that promote physical and mental health, rather than striving for a specific number on the scale.

5. Help your patients find a HAES-informed healthcare provider:

The Association for Size Diversity and Health (ASDAH) has an online directory of HAES providers.

6. Stay updated:

Take advantage of opportunities to learn more about HAES. ASDAH is in the process of developing an updated curriculum for both providers and members of the general public who want to learn more about HAES.

Conclusion

At its core, the Health At Every Size movement is about eliminating weight stigma and promoting a more inclusive, compassionate, and evidence-based approach to health. As therapists, we can help further these ideals by recognizing and addressing weight bias, practicing body acceptance, and encouraging the development of sustainable habits centered around physical and mental well-being instead of weight loss. In short, aligning with the principles of HAES allows us to provide more holistic and effective care, ultimately helping our patients lead healthier and happier lives.