Health At Every Size: Because Health is NOT a Size
By: Ashlyn Ahner, Dietetic Intern
What exactly is Health at Every Size or HAES®? It is an approach to healthcare that prioritizes health, not weight. As an intern coming from an undergraduate dietetics program, this is not a concept we learned about. While we haven’t directly touched on the topic in my grad/internship program yet, I was happy to see the HAES® principles from the Association for Size Diversity and Health provided for us in an additional resources module. In my own experience as an intern with KJN and further research on the topic, there seems to be a lot of misconceptions out there about what it is, and you may even be thinking, like I once did…“Oh, it's just that new fad in the realm of social justice.” I’m happy to admit my naive thought is, well..quite naive.
The more I have come to learn and understand HAES, I see it as basic respect and understanding of everyone’s unique circumstances. In my eyes, there's not another way to approach healthcare, as it simply helps you truly connect with individuals and put them first. By detaching a person’s perceived ‘health’ from their weight, it helps to meet clients where they are at, better understand and communicate how to create sustainable, health-promoting habits that are based on what actually matters and is within their control.
I hope you’re getting the picture that “health” is so multi-faceted, and the HAES paradigm shines light on the fact that what fits into one person's definition of health, may not necessarily fit into another’s. This emphasizes the importance of finding what you enjoy and what makes you feel your personal best, since each individual circumstance is so unique.
To give you a proper definition: Health at Every Size®, a trademarked term from the Association for Size Diversity and Health (ASDAH) is a research based approach to healthcare that is devoted to continuously evolve to stay up to date with changing times and new research, versus the more traditional weight-centered approach. It is devoted to rejecting weight and BMI as a measure for health and instead focuses on promoting sustainable, healthful habits for all sizes. ASDAH has recognized that their current five principles of Health at Every Size® do not reflect their complete evolution, as they were last updated in 2013. However, they are still important and certainly preferable to weight-centered care.1
The 5 HAES® principles are as follows: 1
Weight Inclusivity
Accessible health care for all people regardless of what size and why they are that size
Weight inclusive vs. weight centered care
Respect size diversity and recognize a person's genetic blueprint
Health Enhancement
Support health policies aimed at equalizing access to information and services & personal practices for human well being
Recognizes the many social determinants of health
Reduce weight stigma and biases, especially in healthcare! (Check out our other blog all about this topic)
Engaging in healthy habits > BMI
Respectful Care
Directly address personal implicit or explicit weight bias
Provide care from an understanding that socio-economic status, race, gender, sexual orientation, age and other identities can impact weight stigma
Informed consent of care- especially consent of weight loss recommendations (risk, outcomes, what is involved, etc.)
Eating for Well-Being - Soon to change to a tool and not a principle
Flexible, individualized eating
Not solely focused on weight control
Honor hunger, satiety, nutritional needs & cravings
Intuitive eating
Life-Enhancing Movement - Soon to change to a tool and not a principle
Enjoyable body movement/physical activity for all sizes, abilities and interests
Now that you know what HAES® is, let’s also touch on what HAES® is/does NOT:
Anti-weight loss
Anti-science- it is backed by research! 2,3
Judge personal choices (body autonomy)
Doesn’t mean you have to be body positive…body neutrality is just fine
Doesn’t mean, “It’s okay to be larger-bodied as long as you’re healthy”
“HAES® isn’t anti-weight loss, but anti-prescribing weight loss as an intervention”
~Haily Goodrich, RD, LDN, CEDS-S founder of InspiRD Nutrition
For all the people out there like, “...but weight is so important to health!” The HAES® model still acknowledges that in some cases, weight may affect health, but advocates offering someone in a larger body the same evidence-based treatment as someone in a smaller body. Take the example of prescribing physical therapy for knee pain. Someone in a thinner body may get referred to physical therapy, while someone in a larger body will likely get told their knee pain is directly correlated with their weight, therefore prescribed weight loss as an intervention. HAES® would advocate that a person in a larger body receive the same evidenced based treatment, regardless of their weight. I know what you’re probably thinking–don’t we have research to support the fact that excess weight is harmful for health? Well, funny thing…there aren’t any long term weight loss studies that support it as an effective intervention, and better yet, we’ve found that weight loss is only successful 3-5% of the time. That's a 95% failure rate for something that is prescribed over and over and over again.
If you’re like me and enjoy visually seeing a concept broken down in a more elementary, but awesome way- you should check out the Poodle Science video created by ASDAH that explains HAES® using different dog breeds.
Instead, HAES puts the focus on the multi-faceted and unique to every person ‘health’ umbrella: equality of all body shapes and sizes, having social support systems (at least one person), access to food (and yes I mean just simply food, not ‘healthy foods’ or ‘fresh foods,’ just food), a safe place to enjoy body movement, adequate sleep and health care. These areas of importance can have a major impact on our health and wellbeing.4
Weight loss is so often prescribed, which can be stressful for people and make them feel like they should change all of their life habits overnight. This is not how behaviors are sustained and adopted for a lifetime. We live in this time of an “Obesity Pandemic.” Our world has shifted from placing the blame on one person and company to the next, yet no approach has truly helped and many have adverse health effects, with recommendations staying the same for the last 30 years. The HAES® approach attempts to evolve with the changing times and helps to achieve enjoyable, continuous health-promoting behaviors for everyone and anyone who wants to. It focuses on the access to care, how we treat one another and the behaviors themselves without making weight as an outcome relevant in the equation.
It is a controversial topic, but I think no matter where you stand, you’ll be able to resonate with some of its concepts. Basically, using this HAES® approach can help show clients that we honor, respect, and value them as they come. It can be combined with an effort to use more inclusive language and provide a caring, stress free and safe environment in all counseling sessions. It shifts the focus from weight to habits and behaviors that will enhance clients’ lives, such as enjoying body movement, getting enough sleep, managing stress, and eating to nourish the body and satisfy cravings.
HAES® Principles. Association for Size Diversity and Health. Accessed November 16, 2022. https://asdah.org/health-at-every-size-haes-approach/
Gagnon-Girouard MP, Bégin C, Provencher V, et al. Psychological Impact of a "Health-at-Every-Size" Intervention on Weight-Preoccupied Overweight/Obese Women. J Obes. 2010;2010:928097. doi:10.1155/2010/928097
Ulian MD, Aburad L, da Silva Oliveira MS, et al. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018;19(12):1659-1666. doi:10.1111/obr.12749
Poodle Science. Association for Size Diversity and Health. Youtube. 2015. Accessed November 16, 2022. https://www.youtube.com/watch?v=H89QQfXtc-k&ab_channel=AssociationforSizeDiversityandHealth%28ASDAH%29
Bassaganya-Riera J, Berry EM, Blaak EE, et al. Goals in Nutrition Science 2020-2025. Front Nutr. 2021;7:606378. doi:10.3389/fnut.2020.606378