Health at Every Size

Health at Every Size (HAES) is a political movement that "supports people in adopting health habits for the sake of health and well-being (rather than weight control)."^[1] Proponents claim to improve standard of living for people who are overweight or obese and reduce what they believe is discrimination against the obese. HAES advocates believe, despite some evidence to the contrary,^[2] that traditional restrictive dieting does not result in sustained weight loss for some people.^[3] Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average, obese people have a greater energy expenditure than their healthy-weight counterparts due to the energy required to maintain an increased body mass.^[4][5] HAES proponents believe that health is a result of behaviors that are independent of body weight and that favouring being thin discriminates against the overweight and the obese.^[6] HAES ideas have recently gained popularity among proponents of the fat acceptance movement as an alternative to weight-loss.^[7][8]

Overview

HAES proponents believe that:

1. In many cases, fad diets do not lead to sustained weight loss.^[9]
2. Self-acceptance promotes improved mental health and happiness.^[10]

HAES proponents also believe that obese people who are unhealthy may in part be unhealthy not because fat in and of itself is unhealthy, but because years of attempting to lose weight and gaining it back (a process referred to as yo-yo dieting) purportedly causes health issues.^[11] However, scientific studies show a causal link between obesity and increased morbidity.^[12]

History

The history of Health At Every Size first started in the 1960s as a focus on the changing culture of aesthetics and the repercussions of such a change of fat people. On November 4, 1967, Lew Louderback wrote an article called “More People Should Be Fat!” that appeared in a major national magazine, The Saturday Evening Post.^[13] In the opinion piece, Louderback argued that:

1. "Thin fat people" suffer physically and emotionally from having dieted to below their natural body weight.
2. Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
3. Dieting seems to unleash destructive emotional forces.
4. Eating without dieting, allowed Louderback and his wife to relax, feel better while maintaining the same weight.

Bill Fabrey, a young engineer at the time, read the article and contacted Louderback a few months later in 1968. Fabrey helped Louderback research his subsequent book, Fat Power, and Louderback supported Fabrey in founding the National Association to Aid Fat Americans (NAAFA) in 1969, a nonprofit human rights organization. NAAFA would subsequently change its name by the mid-1980s to the National Association to Advance Fat Acceptance.

In 1982, Bob Schwartz wrote Diets Don’t Work, a book that was based on his program of the same name.^[14] Schwartz said people who ate unrestricted diets were not worried about food and weight, and advocated "intuitive eating". Molly Groger wrote a book about her training program, Eating Awareness Training, which also advocated intuitive eating. Both Groger and Schwartz however, suggested that by following this program people would end up losing weight.

At about the same time, two more books were published; The Dieter’s Dilemma by William Bennett, MD, and Joel Gurin, and Breaking the Diet Habit, by Janet Polivy and C. Peter Herman. Bennett and Gurin claimed that nearly all people had set weight points, which regulated each person’s body fat and weight, and that dieting resulted in lowered metabolic rates and rebound weight gain, which made dieting useless. Polivy and Herman discussed the “natural weight” range, which varied by individuals in a species, and recommended intuitive eating and accepting one’s natural size, as an alternative to struggling with dieting. They also re-framed dieting as “restrained eating,” wherein one ignored body signals and instead responded to external cues.

Science

Proponents claim that evidence from certain scientific studies has provided some rationale for a shift in focus in health management from weight loss to a weight-neutral approach in individuals who have a high risk of type 2 diabetes and/or symptoms of cardiovascular disease.^[15]

Obesity has been linked to a wide variety of health problems.^[16] These problems range from congestive heart failure,^[17] high blood pressure,^[18] deep vein thrombosis and pulmonary embolism,^[19] type 2 diabetes,^[20] infertility,^[21] birth defects,^[22] stroke,^[23] dementia,^[24] cancer,^[25] asthma and chronic obstructive pulmonary disease^[26] and erectile dysfunction.^[27] Having a BMI greater than 30 doubles one's risk of congestive heart failure.^[28][29] Obesity is associated with cardiovascular diseases including angina and myocardial infarction.^[30][31] A 2002 report concluded that 21% of ischemic heart disease is due to obesity^[16] while a 2008 European consensus puts the number at 35%.^[32] Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year^[33] (including increased morbidity in car accidents).^[34]

In one observational study, weight loss was associated with increased mortality, although the number of deaths was very small. They recommended prevention of obesity as the best course of action.^[35] In another observational study, intentional weight loss had a small positive benefit for those classified as unhealthy obese (or those with overweight risk factors) with a slight increase in mortality. While for those who are obese but healthy saw no increase in mortality from weight loss. Controlled interventions are required to distinguish the "influence of physical activity, diet strategy and body composition".^[36] In another study with a middle-aged to elderly sample, personal recollection of maximum weight in their life time was recorded and an association with mortality was seen with 15% weight loss for the overweight. Moderate weight loss was associated with reduced cardiovascular risk amongst obese men. Intentional weight loss was not directly measured, but it was assumed that those that died within 3 years, due to disease etc, had not intended to lose weight.^[37] This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.^[38]

Criticism

Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept,^[39] arguing it is not possible to be and remain truly healthy at every size, and suggests that a HAES focus may encourage people to ignore increasing weight, which her research states is easiest to lose soon after gaining. She does, however, note that it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes.

David L. Katz, a prominent public health professor at Yale, wrote an article in the Huffington Post entitled "Why I Can't Quite Be Okay With 'Okay at Any Size'",^[40] which while it does not explicitly name HAES as the topic of the piece, it could easily interpreted as such. While he applauds the confrontation and combating of anti-obesity bias, his opinion is that a continued focus on being 'okay at any size' (which may be an allusion to HAES) may normalize ill-health and prevent action being taken to reduce the burden of disease that is caused by obesity.

References

Further reading

Advocates

• Bruno, Barbara. "The History of the HAES Movement, Part I".  "Part II".  "Part III".  "Part IV". 
• Bacon, Linda (2010). Health at Every Size: The Surprising Truth About Your Weight. Dallas: BenBella Books. ISBN 978-1-933771-58-8. 
• Bacon, Linda (2014). Body Respect: What Conventional Health Books Leave Out, Get Wrong or Just Plain Fail to Understand about Weight. Tx: BenBella Books. ISBN 978-1-940363-19-6. 
• Campos, Paul (2004). The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health. New York: Gotham Books. ISBN 978-1-59240-066-9. 
• Campos, P.; Saguy, A; Ernsberger, P; Oliver, E; Gaesser, G (2005). "The epidemiology of overweight and obesity: Public health crisis or moral panic?". International Journal of Epidemiology 35 (1): 55–60. doi:10.1093/ije/dyi254. PMID 16339599. 
• Ernsberger, P; Haskew, P (1987). "Health implications of obesity: An alternative view". Journal of Obesity and Weight Regulation 6 (2): 55–137. ISSN 0731-4361. 
• Garner, David M.; Wooley, Susan C. (1991). "Confronting the failure of behavioral and dietary treatments for obesity". Clinical Psychology Review 11 (6): 729–80. doi:10.1016/0272-7358(91)90128-H. 
• Saguy, A. C. (2005). "Weighing Both Sides: Morality, Mortality, and Framing Contests over Obesity". Journal of Health Politics, Policy and Law 30 (5): 869–921. doi:10.1215/03616878-30-5-869. PMID 16477791. 
• Jonas, Steven; Konner, Linda (1997). Just the Weigh You Are: How to Be Fit and Healthy, Whatever Your Size. Shelburne: Chapters. ISBN 978-1-57630-026-8. 

Criticism