Health At Every Size
What is Health at Every Size?
Health at Every Size (HAES) is a perspective - rather than a therapy type - that advocates for a weight-inclusive approach to health and wellbeing. “Health at Every Size” is owned and trademarked by a nonprofit organization called the Association for Size Diversity and Health (ASDAH). The organization’s vision is for,
“a world that celebrates bodies of all shapes and sizes, in which body weight is no longer a source of discrimination and where oppressed communities have equal access to the resources and practices that support health and well being”
HEAS arose from the thinking that traditional treatments, which focus on weight loss and dieting, do not always lead to health improvements for people, but can instead lead to regaining weight and a sense of failure.
There is widespread support for the healthy behavior and need for acceptance of people irrespective of their body shape or size that HEAS advocates for. However, the approach has also received criticism and continues to generate debate amongst health professionals and researchers.
Principles for Health at Every Size approach
The Association for Size Diversity and Health outlines five guiding principles for the HAES approach:
- Weight inclusivity: Acceptance of the diversity of body shapes and sizes.
- Health enhancement: Support for health policies that improve and equalize access to information and services, and personal practices that improve wellbeing, including individual physical, economic, social, spiritual, emotional, and other needs.
- Respectful care: Acknowledge biases and work to end weight-based stigma, discrimination, and bias.
- Eating for wellbeing: Encourage intuitive eating based on internal hunger and satiety signals, not external cues (e.g., HAES discourages eating although you are not hungry because “it’s lunchtime”).
- Life-enhancing movement: Support physical activity for movement and health to the degree that it is enjoyable, rather than to change shape or weight.
What can Health at Every Size help with?
What the application of HAES looks like during a therapy session depends on the therapist. That said, therapy is likely to include a focus on the following factors to decrease negative body image and disordered eating:
- Body acceptance
- Intuitive eating
- Physical activity for health, rather than for the goal of shape or weight control
Some other types of health professionals, like nutritionists, dietitians, or doctors, may also apply HAES principles to their practice, meaning that its impact reaches beyond mental health to broader physical health, too.
How does the Health at Every Size approach work?
The Association for Size Diversity and Health suggest that measuring body weight does not always accurately reflect an individual’s health; it may instead lead to ineffective treatments and social and emotional damage. Some researchers have argued that studies do not provide consistent evidence that dieting leads to significant improvements in health (2).
As such, the HAES approach is designed to increase the focus on health, and discourage any focus on changing weight, shape, or dieting. Proponents of the HAES approach suggest that this helps to destigmatize weight and promotes a body positive mindset. The hope is that this can decrease over-concerns with body size, problems with body image, eating disorders, discrimination, and stigma, for example. Losing weight is not the primary goal in HEAS, but seen as a beneficial side effect, if it does happen (1).
Currently, there is limited research into how HEAS-based treatment approaches might work. One study found that a HAES-based intervention was associated with longer-term behavior change in a sample of obese female chronic dieters, compared to those who participated in a dieting intervention (3). More research is needed for further exploration of the efficacy and longer-term impacts of HEAS.
Criticisms of Health at Every Size
Critics of the HAES approach argue that there is considerable evidence indicating that it is not possible to be healthy at every size. For example, being overweight or obese is associated with increased risks of a range of health problems (4).
Therefore, the risk of the HAES approach is that it encourages people to dismiss increases in weight and reduce the focus on potential health ramifications. This may make it more unlikely that people will take steps to appropriately manage their weight to reduce obesity (5,6).
What to look for in a Health at Every Size therapist
If you are looking for a therapist who is practicing the principles of the HAES model, there are several factors to consider:
Specialization: Look for a therapist who has:
- Experience treating the challenges you are seeking therapy for, whether it be issues related to eating, health, or body image, and,
- Is a member of the Association for Size Diversity and Health (ASDAH)
Therapists often include this information in their biography on their website or online profile.
Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist. This ensures that your therapist has completed the appropriate level of education to practice. All therapists on Zencare have already been vetted.
Personal fit: It’s important to work with a therapist in a therapy modality that’s a good fit for you. HAES might be a good fit if you’re looking for a treatment option for issues relating to eating, health, or body image that doesn’t focus on weight loss as a goal.
Additionally, the trusting relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. It’s important to work with someone you trust and feel understood by.
The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also allows you to ask about their training, experience, and what therapy will be like. Try to speak to a few different therapists before deciding.
Sources and references
- (1) Nicholson, Z., 2018, “Understanding the ‘health at every size’ paradigm”, https://www1.racgp.org.au/newsgp/clinical/understanding-the-‘health-at-every-size’-paradigm
- (2) Mann, T., Medicare’s search for effective obesity treatments. Diets are not the answer (2007). Accessed online February 2020 at https://psycnet.apa.org/doiLanding?doi=10.1037%2F0003-066X.62.3.220
- (3) Bacon, L., et al., 2005, “Size acceptance and intuitive eating improve health for obese, female chronic dieters”. Abstract accessed online February 2020 at https://www.ncbi.nlm.nih.gov/pubmed/15942543
- (4) World Health Organization, 2017, ”World Obesity Day: Understanding the social consequences of obesity”. Accessed online February 2020 at http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/news/news/2017/10/world-obesity-day-understanding-the-social-consequences-of-obesity
- (5) Sainsbury, A., & Hay, P., 2014, “Call for an urgent rethink of the ‘health at every size’ concept”. Accessed online February 2020 at https://jeatdisord.biomedcentral.com/articles/10.1186/2050-2974-2-8
- (6) Katz, D., 2012, “Why I Can't Quite Be Okay With 'Okay at Any Size’”, https://www.huffpost.com/entry/obesity-crisis_b_1967677
- Association for Size Diversity and Health, https://www.sizediversityandhealth.org/index.asp
- Penney, T.L., & Kirk, S.F.L., 2015, “The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward”, accessed online February 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386524/
- National Health Service, UK, 2011, “New approach to weight loss debated”, https://www.nhs.uk/news/obesity/new-approach-to-weight-loss-debated/
- “Health at Every Size” Wikipedia entry at https://en.wikipedia.org/wiki/Health_at_Every_Size