What is Health at Every Size + Why does it Matter?
My weekly eating disorder supervision group is reading Health at Every Size (HAES) together and discussing one chapter a week. I first read the group a few years ago, and it quickly became a favorite. While I was already familiar with many of the HAES concepts by that point, reading the whole book, research, and really interesting chapters on fat and food politics fascinated me.
I fully believe in and use Health at Every Size concepts in my practice as a non-diet, eating disorder dietitian. Since I'm immersed in this week everyday, I sometimes forget that a lot of people are unaware of HAES and the real truths behind weight, health, and our bodies. I've noticed that with emails and client calls I've had in the past few months - people understand that "diets don't work" but still want to lose weight for their health.
So, here's an intro to HAES and why it really matters in the world these days. Yes, this is just an intro, so please pick up the book (Health at Every Size or Body Respect) for the entirety.
First of all, the basic concepts of HAES are respect, critical awareness, and compassionate self-care. It breaks down to include respecting body diversity, challenging assumptions, joyful movement, flexible and attuned eating (basically intuitive eating), and more.
How can you argue against those wonderful ideas? I'm all for honoring your body with nourishment, movement, and celebrating all bodies.
Weight Loss Doesn't Work
Let's start here. Most of us have heard the idea that "diets don't work," but also keep hearing from news, books, and their doctors to lose weight. Regardless of how you try to lose weight - through a diet plan, calorie counting, or eating low fat/carb - your body is focused on resisting weight loss.
There is no scientific evidence to show that long-term weight loss is sustainable or health-promoting for the body. Sure, many people can lose weight initially, but within a few years, a huge majority have re-gained all that weight back and usually more.
On top of that, people have to endure all the negative physical, mental, and emotional side effects of dieting from feeling fatigued, irritable, hangry to potentially rebound binge eating, and feeling distrustful of themselves around food. It's why so many people have a hard time moving away from dieting into an intuitive eating approach - after so many diets, they have lost that innate connection to their body's inner cues and have created so many food rules that lead to guilt and shame when broken.
The body wants to defend your natural set-point weight. There's an idea that you can "control" your weight or body shape and size through diet and exercise, but in reality, your body is doing its job pretty well already. If you've "failed" at weight loss in the past, it's not your fault at all - it just means that diets and restrictions don't work.
Your set point weight is estimated to be a range of 10-20 pounds that your body will be comfortable in and easy to maintain. It's like your body's own thermostat. Your body is just trying to keep you alive and surviving. If there were a famine, your body's survival would be threatened, so it would attempt to compensate by decreasing your metabolism and your motivation to move.
Your body views a diet the same way it views a famine - it adjust by lowering your metabolic rate and decreasing your motivation to exercise. If your body drops below your set point, you'll likely feel tired, cold, and with no energy to workout. Your brain also compensates by increasing food thoughts, so you think about food all the time to increase your desire to seek out food. If you were in a famine, this would be a great thing! You'd be motivated to seek out food to keep you alive. Yet, in our culture, we view it as a "lack of willpower."
It's more complicated than that and related to our appetite regulation hormones like leptin and ghrelin and regulated by your hypothalamus in your brain.
All you need to know is: You can't fight your biology!
A note on weight fluctuations. Since your set point weight is a range, you may lose and gain 5-10 pounds easily without these side effects because you're within your range. Some people are above their set point weights as well, so some people are able to maintain weight loss easily (key words: some people). Yet, for the vast majority of the population weight loss won't be sustainable or good for your health.
Change your Focus: Weight to Health
This matters because our culture promotes weight loss at all costs. It's scary that some doctors promote extremely restrictive diets by leading very low-calorie diet programs in order for patients to lose weight when science shows us that they'll likely gain it all back. As providers, given the evidence we have, it is unethical to promote weight loss plans.
If they don't gain it all back, it will become their full-time job to maintain a lower weight than their body wants it to be by overexercising and restricting their diet. This is disordered eating and dieting itself is a risk factor for eating disorders. I'm not kidding about this - in my internship, a dietitian was extremely proud of the very low calorie diet weight loss program she led.
What we need as a culture is to switch our focus off of weight and onto healthy habits. There are many ways to support our health without putting the focus on our weight.
Move your body in a way that you enjoy and that feels good to you. Instead of exercising to lose weight or control your body shape or size, find movement that you love! There are so many benefits to your health from movement, including improving bone health, moods, and energy levels, that have nothing to do with weight loss.
Attuned or intuitive eating listens to and honors your body cues in a flexible manner. By tuning into your body's hunger and fullness cues throughout the day, you can nourish your body. You are born with this innate skill to nourish your body, and it just takes time and patience to re-connect to it. This is a practice of flexibility as well and is free of food rules and guilt. Learn to connect to your internal signals without turning it into another diet.
Through nourishing your body with a variety and balance of all foods, you'll fuel yourself with all the essential macronutrients (yes, carbs are essential despite what you may read) and micronutrients. There are plenty of benefits from eating a balance of all foods with plenty of fruits and vegetables, proteins, carbohydrates, and fats. There's also no need to restrict anything, except for a clear medical reason like a validated food allergy, intolerance, or sensitivity.
I want to be clear that these are only a few ways to build healthy habits, and that they should only take up part of your life. These are focused more on your physical health, but spending energy on your mental, emotional, and energetic health is just as important.
Empowering Yourself + Body Acceptance
When you switch your focus from weight to health, you're empowering yourself. You're stepping away from our cultural weight focus towards a supportive way for you to take care of yourself.
You can choose to work towards healthier habits around your nourishment and movement patterns, if you'd like, rather trying to control something you really have no control over (your weight).
I know this may be difficult to hear and understand at first because there is so much focus on weight, health, and an "ideal" body in our culture. Right now, a thin body is culturally accepted while fat bodies are shamed and discriminated against for being "unhealthy" or "unappealing." We all struggle with body image as a culture, and stepping out of that culture is hard!
It's sad and horrible to hear other humans not being respected because of their body shape or size. All bodies deserve to respected and celebrated, regardless of their shape, size, health, and more, and everyone deserves to feel comfortable in their bodies.
Our bodies are a wonderful part of us, but it's not who we are as a person. It's your home for your Self. Body acceptance is a much longer blog post, but know that understanding HAES and incorporating it into your life also may include working on body acceptance, self-care, and self-love along the way.
Throughout your whole life, your body has always tried to take care of you. It's your home along this journey of life. It may be a long journey, but set a commitment towards feeling comfortable in your body and accepting it. You don't have to proclaim "I love my body" today, but explore body positivity and acceptance.