Principles of Health At Every Size® (HAES)
photo cred: Lindley Ashline - Body Liberation Photos / bodyliberationstock.com
As an outpatient practice made up of dietitians and therapists specializing in eating disorders, disordered eating, and body image, our clinicians operate from a Health At Every Size® (HAES®) approach. HAES® is an approach to health that is counter to diet culture, as it aims to address biases, challenge stigma and discrimination, provide education, and more. Today, we are reviewing what Health At Every Size® is and why it’s important.
What is Health At Every Size® (HAES)?
Health At Every Size® is a weight-inclusive public health approach, rooted in social justice, that aims to reduce weight stigma and size bias by focusing on weight inclusivity, life-enhancing movement, health enhancement, eating for well-being, and respectful care for people of all body shapes, sizes, and abilities.
The HAES® framework was designed to center those with marginalized identities and is rooted in fat activism [3]. Understanding the intersection of HAES®, identity, and body size helps underscore the barriers and gaps in treatment for individuals who hold marginalized identities. Repeated exposure to discrimination can lead to mental and physical illness and increased levels of perceived discrimination are associated with negative mental and physical health [5]. Specifically with eating disorders and disordered eating, we know that BIPOC, LGBTQIA+, disabled individuals, and people in larger bodies are typically less likely to receive a diagnosis, supportive treatment, and care [9].
Weight Stigma, Bias, Discrimination
We’ve shared the harms of diet culture on the blog before. Diet culture perpetuates weight stigma and weight/size bias, among other things, that has created a culture where morality is tied to body size. Weight stigma is the discrimination of an individual based on their body size, whereas weight bias refers to negative attitudes or beliefs about weight. Weight bias perpetuates weight stigma. Studies show that people who experience weight discrimination have increased “daily stressors, physical symptoms, and negative emotions [6].” Weight discrimination is associated with poor health outcomes and may shorten life expectancy [7]. Weight stigma is also associated with adverse physiological and psychological outcomes [8].
Health At Every Size® Principles
HAES® aims to challenge the idea that it’s possible to tell the health based on their body size. Similarly to the Social Work value and ethical principle of Dignity and Worth of a person, HAES® also aims to advocate for the dignity and worth of all people, and their principles show how this can be done.
Weight Inclusivity | The Association for Size Diversity and Health states ‘that health care must be accessible to people no matter their size, and no matter why they are any given size. [1]’. Size bias and weight discrimination can be clearly seen in the medical field when doctors bypass the symptoms and needs of people in larger bodies by recommending weight loss as a ‘cure-all’ for everything. Weight loss should not be the default recommendation. Especially because we know that 95% of those who engage in intentional weight loss via dieting will gain it all back and more in 5 years. Weight cycling is also the biggest predictor of future weight gain [4].
Weight inclusivity doesn’t just focus on a decrease in recommendations for weight loss. Our world is set up for people in smaller bodies. Consider waiting room seats, medical equipment and gowns, airplane and restaurant seating, size availability at clothing stores, and more for people in fat bodies. Never having to consider those things highlights the lack of weight inclusivity and prevalence of weight stigma and discrimination.
Respectful Care | This principle focuses on body autonomy and informed consent [1]. In order to give consent, individuals, including those in fat bodies, must understand all the risks and possible outcomes. This means the provider sharing educational resources, engaging in discussion with the individual, and sharing information based on the intersecting identities of the individual.
Life-Enhancing Movement | Movement and exercise should not be rooted in punishment and body change, yet both reasons are prevalent in diet culture. Not only can movement be intuitive and joyful, but it should be accessible for people in all bodies.
Health Enhancement | This principle focuses on the impact of oppression on health. We’ve touched before on social determinants of health and how weight is only one, small determinant. The impact of systems of oppression on health is significant. Another component of this principle is the idea that health-enhancing behaviors can be pursued without focusing on intentional weight loss. While these feel intertwined in diet culture, it’s crucial to be able to separate the two.
Eating for Well-Being | Just as movement should not be rooted in punishment or body change, the same is true of food. Like HAES®, we believe in an individualized approach to food that focuses on honoring hunger/fullness cues, satisfaction, and preferences, free of rules, labels, and rigidity. This is why we are such big proponents of Intuitive Eating as it offers an anti-diet, weight-neutral approach to food.
Continued Learning
If HAES is new to you or you want to learn more, we highly encourage you to do more research from anti-diet, body liberation, HAES® creators.
Resources Used:
[1] ASDAH. (2023, April 1). The Health at Every Size® (HAES®) principles - ASDAH. https://asdah.org/health-at-every-size-haes-approach/
[2] Weight stigma. (2023, October 3). NEDC. https://nedc.com.au/eating-disorders/eating-disorders-explained/weight-stigma/
[3] Ashline, L. (2023, March 21). Health at Every Size® (HAES) 101. Body Liberation Photos. https://bodyliberationphotos.com/health-at-every-size-haes-101/
[4] Kroke, A., Liese, A. D., Schulz, M., Bergmann, M. M., Klipstein‐Grobusch, K., Hoffmann, K., & Boeing, H. (2002). Recent weight changes and weight cycling as predictors of subsequent two year weight change in a middle-aged cohort. International Journal of Obesity, 26(3), 403–409. https://doi.org/10.1038/sj.ijo.0801920
[5] Pascoe, E. A., & Richman, L. S. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135(4), 531–554. https://doi.org/10.1037/a0016059
[6] Sutin, A. R., Stéphan, Y., Grzywacz, J. G., Robinson, E., Daly, M., & Terracciano, A. (2016). Perceived weight discrimination, changes in health, and daily stressors. Obesity, 24(10), 2202–2209. https://doi.org/10.1002/oby.21598
[7] Sutin, A. R., Stéphan, Y., & Terracciano, A. (2015). Weight discrimination and risk of mortality. Psychological Science, 26(11), 1803–1811. https://doi.org/10.1177/0956797615601103
[8] Wu, Y., & Berry, D. (2017). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. Journal of Advanced Nursing, 74(5), 1030–1042. https://doi.org/10.1111/jan.13511
[9] Giachin, G. (2023). Eating Disorder Statistics | General & Diversity Stats | ANAD. National Association of Anorexia Nervosa and Associated Disorders. https://anad.org/eating-disorders-statistics/
Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!
