Whether you call it “body positivity,” “non-diet,” “weight-neutral/inclusive” or Health At Every Size (HAES), the idea of shifting the focus away from weight and towards health has become—I hate to say this, but—trendy.
It makes sense—no one wants to see themselves as fat-shaming or causing harm, yet there’s a lot that’s misunderstood when it comes to Health At Every Size, even among health professionals. As part of her PhD dissertation, dietitian and researcher Fiona Willer found that while weight-neutral approaches were viewed more positively than weight-centric approaches amongst Australian dietitians, only 37% correctly identified that a weight-neutral approach is not compatible with a weight loss goal.
Here are some of the top myths that I often see, and the truths behind them.
Myth #1: “Surely you can’t be healthy at any size.”
Truth: It’s Health At Every Size, not “healthy” at “any” size.
One of the most common misconceptions is that HAES claims that everyone is healthy, regardless of their size. The distinction between “health” and “healthy” is important, because HAES is really about the ability of anyone to pursue health (if that is what they want,) not a commentary on a person’s health status. The HAES paradigm also rejects the notion that weight and body size are proxies of health. In other words, the pursuit of health doesn’t involve weight loss, or achieving a certain body size or shape.#HealthAtEverySize is about the ability of *anyone* to pursue health (if that is what they want), not a commentary on a person's health status. Click To Tweet
Myth #1a: “But surely there is a point where someone is too fat and would benefit from weight loss, or even too thin and would benefit from weight gain.”
Truth: No, it’s not possible to be too fat or too thin for HAES.
If listening to a 35-minute podcast is not your thing, here’s my answer:
While HAES practitioners recognize that higher body weights are associated with negative health outcomes, there is no evidence to show that weight itself causes these outcomes, nor is there evidence that weight loss prevents or improves these outcomes. In fact, there is evidence that weight stigma is associated with the same negative health outcomes that are often blamed on weight. Recommending weight loss as a medical intervention is ineffective not only because weight is regained for the vast majority of people, but can also cause harm by encouraging weight cycling, disordered eating, and reinforcing weight stigma.
Similarly, when it comes to thinness, it’s not about the absolute weight of the person; weight inclusivity includes both ends of the weight spectrum. If the lower weight is a result of poor health, such as restriction or malnutrition, then that is the concern that needs to be addressed, not the weight.
Myth #2: “It’s OK to be fat, as long as you’re healthy.”
Truth: Health, or the pursuit of health, is not a prerequisite for basic human decency and respect.Health, or the pursuit of health, is not a prerequisite for basic human decency and respect. #bodyliberation #HAES Click To Tweet
I would say this is like “Myth 1b,” but at this rate I would never hit five myths, so I’m making it its own. ?One of the reasons why some fat activists and allies actually feel uneasy about the Health At Every Size movement is its emphasis on health. The focus on health perpetuates what is often called a “good fatty/bad fatty” dichotomy—the idea that a fat person who is healthy, or pursuing health behaviours is more worthy or “good,” compared to a fat person who is struggling with health concerns, or not “actively” trying to improve their health.
This myth is actually particularly hard to overcome for health and wellness professionals, who are usually in the field because they value health. In fact, I’ve seen some o-word organizations try to differentiate between “fat” and “o-word” by defining the former as someone in a larger body without health concerns, and the latter as someone with health issues “because” of their weight or body fat. The reality is, everyone is worthy of respect, regardless of their health status or whether they value health. A fat person who runs marathons is not any more worthy than one who doesn’t.
Myth #3: “My practice is weight-inclusive—I never talk about weight, only wellness.”
Truth: Weight-inclusive care is not as simple as not talking about weight. Weight concerns are not going away any time soon (at least not in our current culture) and choosing to ignore them will simply make people feel invalidated and unheard.
I admittedly fell into this trap when I first made the shift to a weight-inclusive practice, and quickly learned that when your job title is “dietitian”, people will still come to you seeking weight loss, no matter what you write in your blog or share on social media. I’m still doing my own work when it comes to noticing my own reaction to weight concerns in session, and making sure my clients know that their concerns are valid, without agreeing that weight loss is the answer. (See points about ineffectiveness and causing harm above.)
So, how can you address weight concerns without promoting weight loss? I’ve been returning again and again to these words from fellow non-diet dietitian Josée Sovinsky:
What if my client *wants* to lose weight? Shouldn’t I be providing client-centred care? YES! You can:
- Validate the person’s desire to lose weight given our social and medical context.
- Help them explore their desire and discuss what they hope to achieve through changing their body.
- Look at various ways beyond weight loss they can achieve those goals.
- Help them explore the pros and cons of various strategies, discussing previous attempts to modify their weight and how it impacted them.
- Listen. Listen. Listen. And listen some more.
None of this is promoting weight loss or shaming a person for wanting to lose weight. All of it is centring a person’s experience.
Myth #3a: “You’re not allowed to talk about weight loss if you’re working with a HAES practitioner. In fact, they’ll shame you for wanting to lose weight.”
Truth: Though intentional weight loss is not aligned with HAES principles, respecting body autonomy is an important component of HAES and body liberation work.
Disagreeing that weight loss is the answer to a person’s weight concerns is the piece that some people use to paint HAES practitioners as “extreme,” “unreasonable,” or “not practicing client-centred care.” Fiona Willer has kindly allowed me to share her response to a post about how HAES practitioners think that “wanting to lose weight is a sign of self-hate:”
“Showing up to a health professional for assistance is a sign that you love yourself, wanting to have a smaller body is utterly understandable in the face of weight-centric bs (like this!) However, actively assisting someone to be temporarily smaller and giving them the impression that whether it lasts or not is solely in their hands is unethical. HAES practitioners refusing to support weight loss efforts is because they’re mostly ineffective and sometimes harmful.
And, people don’t actually want to go through the motions of losing weight, they want to BE a lower weight. They’re asking you to deliver for them a lower weight in the long term that will give them the things they think that it comes along with. It’s those things that are relevant, not the weight. That’s the stuff that needs unpacking. The desire for weight loss is an expression of the desire for positive change to something meaningful to them. It’s never just the kgs.”
A HAES practitioner should never make you feel ashamed for wanting to lose weight. Instead, our job is to help you unpack what is behind the desire to lose weight, what the research tells us about weight, and ultimately leave it up to you to decide your next steps.
Myth #4: “HAES is a relatively new concept, created by Dr. Linda Bacon.”
Truth: The history of HAES can be traced back several decades to the beginnings of fat activism in the 1970s.
Though Dr. Bacon may have popularized Health At Every Size with their book of the same name published in 2008, they were not the creators of HAES, nor do they own the trademark. That honour goes to the Association of Size Diversity and Health (ASDAH), which was formed in 2003. But even before that, the concepts that form the foundation of HAES can be traced back to the 1970s, with the start of the fat activism movement. When it comes to the history of science and healthcare, it can still be argued that HAES is a relatively new (and still evolving) framework, but it’s not as young as many people perceive it to be.
Myth #5: “HAES is anti-science.”
Truth: Being critical of how research is conducted and presented is not anti-science. In fact, continuous inquiry is the point of science and how our knowledge will continue to evolve and grow.
Many accuse HAES practitioners of being anti-science because we are often critical of conclusions that are drawn from studies that look at weight and health. For example, we may point out the small sample sizes, short follow-up times, research methods, and/or confounding factors that may amplify the “benefits” of intentional weight loss. Digging deeper into the history of science, we might even note the inherent biases of having researchers and subjects who are predominantly white, straight, cis-gender men.
In our current society, science has almost become its own religion. There is this belief that it gives us unbiased answers, when in reality, though science as a framework might be unbiased, research is conducted by humans, who hold biases and can make mistakes. Being critical of research is not about being anti-science, but rather it’s a call to continue to improve our methods so that our knowledge can truly evolve and grow.