After nearly five years, I decided to leave my job in medical weight management to practice a Health at Every Size® (HAES®) approach.
Dieting does more harm than good. Research shows that dieting is more likely to lead to weight gain than weight loss. A review of 31 weight loss studies found that dieting was ineffective at producing long term weight loss, and one-third to two-thirds of dieters gained more weight than they lost (Mann et al, 2007). Calorie restriction leads to preoccupation with food, binge eating and weight obsession.
Weight loss messages contribute to weight stigma. Weight loss messages perpetuate the idea that anyone can lose weight, and that “overweight” people are lazy or lack willpower. In reality, weight is determined by a complex interaction between genes, environment and social influences. Once a set-point weight range is established, the brain works hard to defend it (Sumatran and Proietto, 2013). Size diversity should be respected and embraced, just like other types of diversity.
Weight loss is not necessary for health improvement. People who exercise regularly, eat a healthy diet, and practice other forms of self-care can improve their health, without losing weight (Matheson et al. 2012; Schaefer and Magnuson, 2014.)
What is HAES?
The Health at Every Size approach emphasizes:
- Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing 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 socio-economic 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.
My journey to embracing a HAES approach:
Reading Linda Bacon, PhD’s excellent book, Health at Every Size, was the first step that led me to question the weight-centered approach. But I still needed a few years to fully embrace the approach. When I finally saw the harm that dieting was causing my clients, I knew it was time for a change. (Note: I recently re-read this book, and it is awesome. I have given away at least 10 copies to friends, family and coworkers. The sequel, Body Respect goes into more depth on HAES and social justice.)
Sandra Aamodt, PhD’s TED talk, Why Dieting Doesn’t Usually Work, was another catalyst behind my decision to embrace a HAES approach. In this powerful video, Aamodt explains how the brain fights against lasting weight loss. She recommends mindful eating as an alternative approach to health.
In April, I attended Ditchin’ the Diet: Non-Diet Approaches in Nutrition Education, a seminar hosted by dietitians and university professors Dawn Clifford, PhD, RD and Michelle Neyman Morris, PhD, RD, which furthered my commitment. These amazing women are teaching HAES curriculum to students at California State University, Chico. These HAES videos recorded by Clifford are available for anyone to watch. I wish someone had taught me about the HAES approach when I was in school.
Tools to support a HAES practice:
Intuitive Eating is a method that is very helpful in supporting a HAES practice of normalized eating. I read the book and completed the Intuitive Eating Pro Skills TeleSeminar series.
Michelle May, MD has also been an influential figure. Reading her Eat What You Love, Love What You Eat books gave me new ideas and inspiration on how to teach mindful eating skills.
The book Wellness, Not Weight contains a wealth of information and is an amazing resource. Each chapter is written by a different health expert and backed by dozens of research articles.
The book Beyond a Shadow of a Diet by Judith Matz and Ellen Frankel is another great read for anyone providing counseling services. I love the way they integrate ideas from many experts doing this work.
The National Association to Advance Fat Acceptance (NAAFA) has published Guidelines for Nutritionists and Dietitians to help us adopt a HAES practice.
I am excited and proud to be taking a stand for Health at Every Size. If you have questions about HAES, please feel free to send me an email or post in the comments section.