Health at Every Size: Taking Weight Out of Wellness
Updated: Feb 26
Written by: Natalie Faella, MS, RDN, LDN | January 18, 2022
If you’ve been following my Instagram or blog you’ve probably noticed the common theme and that I am an anti-diet and anti-diet culture dietitian. This is a message I’m passionate about spreading not only because diets don’t work and can negatively impact our health (physically and mentally), but because weight is actually not an accurate indicator of health status at all.
I know that can be a bit shocking to hear because for SO long weight loss has been prescribed as a cure for most conditions — heart disease, diabetes, high blood pressure, joint pain… That is why I had a hard time really believing this at first, too. As a dietitian, I learned that BMI was an indicator of health status and that the goal was to help people achieve a “healthy” or “normal” BMI, always. Other medical professionals learned the same thing in their schooling, which has only been reinforced by the media over the years. But this is an old school way of thinking that is actually not backed by science at all. For one, we don't have the control over our weight that we've been led to believe, so a "healthy" BMI is not a realistic goal for everyone. Additionally, our weight or BMI does not influence our health the way we thought. (For more on BMI and why it is bogus, check out my blog The Surprising Truth About Your Weight).
So, what is the new school way of thinking that actually is backed by science? Hint: it’s in the title of this blog. Health at Every Size, or HAES, is an inclusive movement that supports people of all sizes in adopting healthy behaviors, with the focus being on health and not weight or size alterations. It also recognizes that social, economic, genetic, and environmental influences are the main determinants of our health status, and recognizes that body weight/shape and fat mass can be influenced by these factors, but are not the determinants of our health.
Here are 5 of the basic components of HAES in more detail:
1. HAES challenges current scientific and cultural assumptions about weight.
We’ve been led to believe that being overweight is unhealthy and an increased risk for mortality, when really, individuals with a BMI in that “overweight” range actually live longer than those in the “normal” range. We’ve also been led to assume that we are in 100% control of our weight through diet and exercise, when in reality biology dictates our set point, or the weight range our bodies naturally try to maintain through physiological mechanisms (more on this in my next blog!). Additionally, other factors, like socioeconomics, genetics, and stress have greater influence on weight than diet and exercise do.
HAES challenges these misconceptions so we can let them go and move on to make peace with our bodies.
2. HAES celebrates body diversity.
HAES honors the fact that differences in body size should exist and there is no “normal” or “ideal” weight, size, or shape. Often times health professionals and people in general will see a person in a bigger body and think they are unhealthy or they did something to make themselves that size and they can "fix" it through diet and exercise. This is actually not the case. Our set points exist on spectrum of sizes because we're all meant to be different sizes. Remember those growth charts for height and weight from when you were a kid or if you have kids currently? We all have different trajectories and aren't meant to be on that 50th percentile curve (that's why the 10th, 20th, 75th, 90th, etc. percentiles exist). Just like how it's normal that we're not all "average" height.
By letting go of the thin ideal, we’re able to work on and achieve self-acceptance and food freedom — two pillars of health that are necessary to shape our lifestyle habits into healthy (both physically and mentally) and sustainable ones.
3. HAES promotes health without promoting weight loss.
The HAES approach promotes healthy lifestyle habits that are individualized and not tied to a weight-loss goal. Examples include being physically active in ways that bring joy and feel good for one’s body (i.e., joyful movement), and eating in an attuned way that honors hunger, fullness, preferences, pleasures, and accessibility (much like intuitive eating).
You might be thinking "but if we take weight out of the picture, what is the goal?" This makes sense because achieving a weight/body change has been the goal and has been correlated to health improvement for so long. Sometimes weight does change when one takes the HAES approach, and sometimes it doesn't, but the point is that it's taken out of the equation — weight loss is no longer the goal. By removing this goal, we're able to focus on ways of incorporating nutritious foods and physical activity we enjoy, rather than meal plans and exercise routines we "should" or "have to" follow in order to lose weight. This removes the added stress and pressure of changing our bodies, and what a difference this makes not only in our attitudes towards wellness and ourselves, but in the sustainability of these new lifestyle habits.
4. HAES is essentially the opposite of diet culture.
The message from diet culture reads: you need to change yourself to be, look, and feel better, and to do this, you have to lose weight or eat and exercise in this very regimented way. HAES on the other hand, is a holistic approach that takes the entire human into consideration. It doesn’t just look at eating and exercise habits but stress, sleep, lifestyle, etc. It does not provide a one-size-fits-all “wellness” plan with an end goal of fitting the cultural size ideal (which for females today, I think is a size 0 waist and laws-of-physics-defying butt).
The good news about all of this is, there is scientific proof that it works. Lindo Bacon and others put it to the test in a year long study comparing a HAES approach to a traditional weight-loss diet approach in a group of 70 females with BMIs over 30. They found that biomarkers of health (like cholesterol levels and blood pressure) improved long-term in the HAES group, and that they ditched their diet mentality for intuitive eating and reported improved body-image, self-esteem, and energy levels. The weight-loss diet group did not show the same effects; their biomarkers either stayed the same or worsened, they continued to restrict their intake/have diet mentality, self-esteem was noted to decrease, and any weight they did lose was eventually regained.
You might be wondering, but did the HAES group lose weight and that's why they felt better? The answer is no — or at least not of statistical significance. Further proving that weight does not need to change in order for health status, body image, or self-esteem to improve. (Despite all of those weight-loss ads telling you that it does).
5. Perhaps most importantly to note, HAES is also a peace movement with the goal of ending weight stigma.
There is no denying that our society equates fat to bad, unhealthy, lazy, not good enough — you name it. You can see it in the way most movies are cast (the person in a bigger body is usually the silly or less intelligent sidekick, not the main character who finds love/success), products are advertised, medical professionals treat patients, and the billion dollar bank account of the diet industry that just keeps growing. Not to mention, the whole “war on obesity,” movement. That marketing certainly didn’t make us think more highly of individuals in bigger bodies.
All of this just keeps us in that vicious yo-yo dieting cycle and further and further away from making peace with our bodies. By accepting that we are meant to be different sizes and learning to accept and appreciate our bodies as they are, we can help reduce body discrimination, eating disorders, self-hatred, and the preoccupation we have with eating, exercising, and looking “perfect.” Side note: that preoccupation with looking perfect or being the "picture of health" can actually be the biggest deterrent to physical, emotional, and mental well-being.
Imagine a world where you didn’t think, or stress, or worry about the way you looked. What would you think about instead? Would your eating and exercise habits look differently? How would you feel about yourself? How would you feel about others?
This is why HAES is so important. I am fully in support of and aligned with this movement and it is the approach I pledge to take with all of my content and all of my clients.
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