WHAT IS THE HEALTH AT EVERY SIZE MOVEMENT?
Updated: Jul 26
By Melani De Sousa, Founder, Wellness & Intuitive Eating Coach at The Wellness Workshop.
The Health At Every Size approach; Ever saw your Doctor to ask about new symptoms like migraines or body aches, or perhaps the common cold – only to be questioned about your height and weight and wonder how one earth this relates to the reason you booked the appointment? This exact scenario is why thousands of Australians avoid seeing their GP or other Medical Practitioners because in some way or another their weight (mainly that of someone in the ‘overweight’ or ‘obese’ category according to the BMI scale) has dictated the direction of the care they receive, even if largely unrelated to the complaint at hand. This is what’s termed as ‘weight prejudice’ in our health care system, and it’s exactly what the Health At Every Size (HAES) movement aims to stop.
WHAT DEFINES THE HAES APPROACH?
The Health At Every Size approach, or HAES for short “rejects both the use of weight, size or BMI as proxies for health, and the myth that weight is a choice.” (HAES Australia) Put simply what this means is that your weight is not used to determine how healthy, or unhealthy you are, and the pursuit of weight loss does not always translate into better choices or habits. In fact, according to the American National Eating Disorders Association, yo-yo dieting (repetitive cycles of gaining, losing and regaining weight) has been shown to have a variety of negative health effects including (but not limited to) increased risk of heart disease, thinning hair, loss of coordination, loss of muscular strength and endurance, preoccupation with food and weight leading to poorer working memory and higher levels of depression, low self-esteem and increased stress. HAES (Health At Every Size) is focused on providing weight neutral care by addressing and improving the behaviours and habits of individuals across all aspects of physical, mental and emotional health, and is underpinned by five core principles:
THE 5 HEALTH AT EVERY SIZE PRINCIPLES:
Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealising or pathologising of specific weights.
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.
Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socioeconomic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
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.
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 IS HAES DIFFERENT TO TRADITIONAL WEIGHT-CENTRIC APPROACHES?
Over the past 50 decades, the western world’s obsession with dieting, weight-loss and the “war on obesity” has shaped the belief that thin equals health, and fat equals poor health, regardless of a person’s background, ethnicity or biological makeup. This assumption, together with others like “overweight people don’t exercise” or “overweight people eat too much” steers the direction for various healthcare consultations, where an overweight or obese person’s body mass becomes the primary focus in addressing their complaint. Let’s use an example to demonstrate the difference…
EXAMPLE OF A WEIGHT-CENTRIC APPROACH WHEN ASSESSING KNEE PAIN IN A “NORMAL” WEIGHT RANGE PATIENT VERSE AN “OVERWEIGHT” WEIGHT RANGE PATIENT
Patient A – "Normal" Weight Range
Patient A books an appointment to see a Doctor about recurring pain in her knee. On seeing the Doctor, she is weighed, and her height is taken. Patient A’s results show that her BMI is “normal”. The Doctor then continues to ask Patient A about her lifestyle, medical background, has she had any previous injuries or surgeries, does she play sport, was the pain sudden or did it build up gradually? Patient A thinks about these questions and responds accordingly, trying to think of any examples or recent events which may have contributed to the pain. Unsure about the exact cause, the Doctor recommends an MRI scan to identify any hard or soft tissue damage, as well as a consultation with a Physiotherapist to assess whether Patient A may be walking or exercising in a way that is aggravating the joint. Patient A is then asked to book a follow up appointment in a few weeks to discuss the results of the scan and physiotherapy.
Patient B – "Overweight" Weight Range
Patient B also books an appointment to see her Doctor about recurring knee pain. On seeing the Doctor, she is weighed, and her height is taken. Patient B’s results show that her BMI is “overweight”. Concerned that her body mass is above what is considered “normal”, the Doctor then asks Patient B about her diet and exercise, and if she recently has been eating more energy dense foods. The Doctor goes on to explain that excess weight can put strain on the knee and in order to improve the knee pain she should consider losing weight by eating less and exercising more regularly. The Doctor provides Patient B with a guide to healthy eating brochure, and requests she start making modifications to her diet and lifestyle immediately. He then asks for to book a follow up appointment in four weeks to ascertain whether she has lost weight and if this has reduced the pain in her knee.
LIMITATIONS OF A WEIGHT-CENTRIC APPROACH
Although the above example may seem normal to you, consider this:
Patient B’s weight was immediately assumed to be the reason for her knee pain
Patient B was not asked about her lifestyle, medical background, injuries or surgeries, participation in sport, or onset and duration of the pain
Patient B booked an appointment to identify the cause of knee pain, and walked out with a brochure on healthy eating and advice to lose weight
The Doctor did not prescribe any scans to identify structural issues with Patient B’s knee
Patient B was not given any recommendations on how to manage the knee pain
This example is what happens to “overweight” or “obese” patients every day. It highlights how, purely because of their size, these individuals may receive lower quality care due to the assumption that the number on the scale is the primary reason for their health issues. On the contrary, the HAES (Health At Every Size) approach would ensure both Patient A and Patient B receive the same quality care by asking various questions related to their overall health and lifestyle, medical history and any other contributing factors that may be causing the knee problem. Weight may be discussed at some point in relation to the issue, but as a consideration, rather than the primary factor.
DOES HAES PROMOTE OBESITY AND POOR HEALTH?
An often-heard opinion of the Health At Every Size approach is that it promotes obesity and poor health by encouraging acceptance of weight gain and larger bodies. This opinion, in my opinion, is often coupled with the fact that either a) this person doesn’t understand or cares to learn and understand the principles behind HAES (Health At Every Size) and b) already has a pretty bias opinion towards larger bodies, and the role weight plays in health in the first place. In fact, now more than ever new research is showing us that ‘the link between health and excess weight isn’t as strong as we might think’ and a fixation on weight and weight loss is having ‘disastrous effects on the public, leading to an increased prevalence of weight discrimination, eating disorders, and internalized stigma’ (Dr Deb Burgard, Medical Daily 2016) Truth of the matter is, healthy behaviours and sustainable habits like eating for wellbeing and pleasure, moving in ways you find enjoyable and nurturing your body, rather than punishing it, are much more conducive to good health than obsessing over numbers and scales. After all, if the past few decades has taught us anything about diets, it’s that the more we restrict and the more we focus on size, the greater our health problems become.
ABOUT THE AUTHOR
Melani De Sousa is driven by her passion to stop the glorification of weight obsession and disordered eating in today’s health and fitness industries. She is an accredited Wellness Coach and founder of The Wellness Workshop. She is also an Intuitive Eating Coach, helping sufferers of Eating Disorders move on with their life through recovery. Melani is also a Personal Trainer, and was awarded the 2019 Australian PT of The Year 2019 by Fitness Australia, the nation's peak industry body.