If you’re new here, you’re probably poking around my website (welcome!) and learning more about my approach to nutrition and wellness. Maybe you stumbled across the words “Health at Every Size” and wondered what in the heck I was referring to. Don’t worry, you’re not alone. There was a time when I was also confused by Health at Every Size and had many questions to ask.
I hope this blog post clears up some misinformation and tells you more about my values as a clinician.
What is Health at Every Size?
The Health at Every Size framework is a non-diet approach to health and wellness that focuses on overall health and well-being, rather than weight loss alone. It is rooted in the belief that health is not determined by weight, and that everyone should have the opportunity to improve their health regardless of their body size.
Health at Every Size or HAES® was founded by the Association for Size Diversity and Health, a non-profit organization dedicated to uplifting the voices of the most marginalized in our healthcare system.
A core goal of HAES® is to fight back against the harms of weight stigma: the big and small ways those who live in larger bodies are “othered” in our society. This in-turn fosters a health care system that offers respectful and compassionate care to all humans. All of us, but especially those of us in larger bodies, deserve better than restrictive and harmful weight loss interventions as the only offer.
Why I Support a Health at Every Size Approach
The road to embracing Health at Every Size as a dietitian is sadly not as straightforward as I wish it was. I wish I could say that I learned about Health at Every Size at the beginning of my education and avoided perpetuating weight stigma from the get-go in my career. Unfortunately, I, like many other dietitians (and medical professionals), was trained through a weight-normative lens. The weight-normative approach is one that uses BMI as a tool to pathologize higher weights and emphasizes weight loss as a reliable path to improved health. It also downplays the negative consequences of pursuing weight loss at any cost.
One of my early jobs as an RD was conducting dietary assessments for research studies. Some of the largest studies were investigating dietary interventions for weight loss (yes, diets). I would call up participants in these studies and go through everything they had to eat and drink in the last 24 hours. Doing this, I witnessed over time how their stress about food increased, their overall intake sometimes decreased to a shockingly low amount, and how they prioritized processed foods high in fiber, low in calories, and low in nutrition.
Did these people lose weight? Probably. But no one seemed to be concerned about the overall picture of their health, their stress levels, how their hormones or sleep were affected, their fertility… or how their relationship with food would affect them for years to come after the study ended.
Working in the diet-y research space was a big wake up call for me. I began to realize how harmful the obsession with weight loss can be, and just how much is overlooked when we focus so much on it alone.
When I began seeing clients in the outpatient space, I listened to client after client share with me their struggles with dieting and weight loss. Diets just don’t work for most people, yet they are continually “prescribed” by medical providers as a path toward better health. Rather than focus on actual health promoting behaviors, our medical system over-emphasizes weight and BMI and creates more problems for those who are stigmatized in this system.
Now, I embrace the Health at Every Size approach in my work with clients. HAES allows me to meet my clients where they are, truly listen to them, and provide non-stigmatizing guidance.
Rather than focus on weight loss, my work with clients includes:
- Increasing nutrient density in the diet
- Improving consistency with nutrition
- Incorporating a balance of macronutrients
- Eating to support energy levels
- Dismantling food fears and disordered eating behaviors
- Developing a healthy relationship to movement and exercise
- And so much more
Common Questions I Get Asked as a Health at Every Size RD
Does this mean you are anti-weight loss?
Although I do not believe that weight loss is the only way to improve health, I am not anti-weight loss, or anti-people-who-lose-weight. I cannot and will not judge or shame anyone who wants, pursues, or has a history of weight loss. I want to make sure everyone I work with is treated with respect, truly listened to, and educated about the risks and benefits of any medical or lifestyle intervention, including pursuing weight loss.
What contributes to someone’s weight and body size is complicated and often diagnosing weight as the core problem leads us to miss the root of the issue (or, more often, create new ones while individuals try everything to reduce their weight, depleting the body of energy and resilience). Sometimes when we do address the root of someone’s issues WITHOUT dieting or putting weight loss as the main focus, we might see weight loss as an outcome. BUT – this is the important part – we prioritize HEALTH above weight, and sometimes by doing this we don’t see weight changes at all, and in some cases weight may need to increase for the body to be most healthy. And all of this is OK.
My doctor says I need to lose weight for my health, can you help me?
First of all, I am sorry that you are experiencing such pressure to lose weight for the sake of your health. You are absolutely not alone, as this is a common recommendation from physicians. Unfortunately, the BMI has become incredibly entrenched in the healthcare system and doctors are encouraged to discuss weight loss with clients in the overweight and “obese” categories of BMI.
It is really common for OBGYNs and other doctors to recommend overweight clients lose weight in order to improve fertility and have a healthy pregnancy. The big red flag here, is that this advice often leads women to engage in restrictive dieting or over-exercise that actually leads to a stress response in the body that can be counterproductive to fertility. It is far better to enter pregnancy in a nourished body than a starving one, and you’re much more likely to successfully get and remain pregnant by taking care of your body – not fighting it.
As a Health at Every Size RD, I can help you learn how to support your body with truly health-promoting behaviors without stress over the scale.
Isn’t it unhealthy to be fat?
Contrary to what is often seemingly shouted from the rooftops in the media, there is no scientific evidence to support the claim that being fat is unhealthy in and of itself. While there are some increased health risks associated with living at a high BMI, these risks can be reduced by establishing health-promoting routines, such as eating a nourishing diet and getting regular physical activity.
There are a few important points to remember in thinking critically about the association between weight and health. First of all, more and more evidence is supporting the influence of weight stigma (the stress of living in a larger body in our thin-obsessed society) in influencing rates of disease. We all know that stress is bad for us. People who are marginalized for their race, ethnicity, and body size, all experience poorer health outcomes because of stigma.
Second of all, not only fat, or larger-bodied people, experience disease. There is no disease that ONLY people of high BMI get. People can be sick at any size, and – this is a big one – whether someone is healthy or sick does not have any bearing on their worth as a human. I’m sure you’d agree if you got diagnosed with cancer tomorrow.
Finally, while we (as a society) are quick to express concern about someone’s “health” if they are overweight or “obese”, we celebrate behaviors that are actually quite harmful to health. We applaud starvation when it is veiled as a “medical weight loss intervention” and encourage people to mutilate perfectly healthy organs via bariatric surgery. I can’t keep track of the number of clients who have come to work with me who have shared that their health was actually at its worst when they were most actively pursuing weight loss, or even had achieved their smallest body size.
What you can expect working with a Health at Every Size Dietitian
Not all of my clients know about HAES when they start working with me. In fact, most of my clients have never heard of the HAES approach before.
As a Health at Every Size dietitian, I can help you to develop a healthy relationship with food and your body, and to focus on overall health and well-being, rather than weight loss. I want to know what is truly important to you, and will help you create a plan to achieve your goals that prioritizes all aspects of your health and your values.
While I don’t focus on weight loss with my clients as an outcome, I welcome the conversation about the desire for weight loss. I want to know how pursuing weight loss has affected your life and health. So weight loss is not a dirty word around here, it’s just not something that I will be giving you a plan for!
If you have any other questions about the HAES approach, or are curious about what it would look like to work together, I invite you to reach out!
