What is Health at Every Size?

Embracing the Health at Every Size Paradigm means we believe healthy people come in all shapes and sizes. Rather than focusing on weight loss, we focus on improved quality of life, on reduced health risks, on emotional and physical well-being, internally regulated, non-restrictive eating (no more dieting), on joyful activity and movement, and on size-acceptance. (Weight is seen as one single measurement that may or may not have a direct bearing on a person’s health.)

No matter what a person happens to weigh, choosing to engage in health-promoting practices and behaviors is likely to promote improved health, whenever possible. (Note…not all health risks can be avoided through the adoption of a healthier lifestyle. But many can be.)

Rather than buying into some cultural belief that states that everyone must be “thin”, we believe everyone has a natural weight range where his or her body functions well, feels good, and is free of the health risks that are within his or her control to avoid. That range could be anywhere on the weight continuum, including at the higher end.

In 2003, Karin Kratina, PhD, MPE, RD, and I co-wrote the following “Health at Every Size” Tenets, updated from the version originally written in her 1996 book, Moving Away From Diets. I still share these tenets with all of my clients.

5 Basic Tenets:

1. Health Enhancement – attention to emotional, physical and spiritual well-being, without focus on weight loss or achieving a specific “ideal weight”
2. Size and self-acceptance – respect and appreciation for the wonderful diversity of body shapes and sizes (including one’s own!), rather than the pursuit of an idealized weight or shape
3. The pleasure of eating well – eating based on internal cues of hunger, satiety, and appetite, and individual nutritional needs rather than on external food plans or diets
4. The joy of movement – encouraging all physical activities or the associated pleasure and health benefits, rather than following a specific routine of regimented exercise for the primary purpose of weight loss
5. An end to weight bias – recognition that body shape, size and/or weight are not evidence of any particular way of eating, level of physical activity, personality, psychological issue or moral character; confirmation that there is beauty and worth in EVERY body

More recently, ASDAH, The Association for Size Diversity and Health, broadened the HAES®Principles as follows:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

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Here’s a Journal Article About the HAES Paradigm You Can Share with Your Doctors Who Are Still Weight-Focused

A few years ago, several colleagues and I co-wrote a review of all of the current HAES Studies/Literature. It was published in The Journal of Obesity under the title, The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. The full text can be read and DOWNLOADED HERE

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The following article was written by Deb Burgard, PhD, a San Francisco Bay Area psychologist who created the website BodyPositive.com and is one of the founders of the Health at Every Size approach to eating/weight concerns. She and I started the Academy for Eating Disorders Special Interest Group on “Health at Every Size” in 2002. We served as Co-Chairs of that group for 10 years.

How to Tell If You Are Getting a Diet-in-HAES-Clothing

By Deb Burgard, Phd

Along with the increasing public recognition of the Health at Every Size(r) model, there is some confusion about what the HAES model is and is not.  Some discussions of the HAES approach are omitting or distorting aspects that are critical to its practitioners.  There are several renditions of the model’s tenets (listed at the end), but first I would like to offer some critical questions to ask when you see it being discussed in the media.

If you can answer “yes” to these questions, you may be reading an inaccurate or at least incomplete presentation of the model. 

Does the account you are reading:

Perpetuate the Pursuit of Weight Loss, e.g.:

• Promise weight loss?
• Fail to recognize the harms for people of all sizes of the existing interventions for changing weight?
• Create a new set of “rules” about how to eat?
• Shame some aspect of our inner selves by trying to “get rid of it, starve it, cut it out, imprison it”?

Perpetuate Healthism, e.g.:

• Present only fat people who are healthy as “poster children”?
• Create a class of “Good Fatties” vs. “Bad Fatties”?
• Collude with the notion that healthier people are morally better?
• Fail to demand quality medical treatment for fat people with health challenges?
• Fail to critique the moral corruptness of trying to eliminate health costs by eliminating people with health challenges?

Reduce the model to Individual Choices, leaving out the critique of Weight Stigma, e.g.:

• Omit any reference to the environmental sources of ill health, especially weight stigma?
• Fail to propose any policy or institutional solutions to the problem of weight stigma?
• Propose that individuals solve the problem of institutionalized weight stigma and shaming by losing weight and leaving the stigmatized group?
• Fail to connect the dots with weight loss efforts of people across the weight spectrum, including people who have disordered eating from the pursuit of weight loss?

Perpetuate the Misclassification of Diversity as Disease, e.g.:

• Explicitly or implicitly condone the use of BMI categories as a proxy for health?
• View higher-weight people as “diseased” based solely on weight?
• Attribute any health problems at higher weights to being at a higher weight?
• Fail to treat health problems regardless of weight?
• Overlook the health problems or fail to consider the health status of lower-weight people?
• Credit health improvements that are really the result of sustainable practices to incidental weight loss that may accompany those practices?

Perpetuate a Short-Term vs. Sustainability Focus, e.g.:

• Present as a “makeover”?
• Fail to incorporate the question of what is sustainable for unique individuals?
• Focus on outcomes rather than the quality of day-to-day life?
• Reduce the profound idea of body acceptance to the notion of “confidence”?

Perpetuate “Expertism,” e.g.

• Fail to include the input from members of the community itself, especially members who are trying to change institutionalized weight stigma?
• Place “expert” knowledge above people’s felt, embodied experience?
• Propose a specific eating regimen for all people that fails to incorporate the individual’s physical and psychological experience of food and eating?
• Fail to expose public policy and medical practice to the test of whether they themselves promote weight stigma?
• Present a “one-size-fits-all” perspective that is closed to update and revision, especially to the lived experiences of the community members?

Perpetuate a War with the Body, e.g.:

• Place more confidence in the mind’s ability to regulate eating and weight (ie “discipline”) than the body’s?
• Label normal body processes as diseased?
• Propose as “cure” the disruption of normal functioning of healthy organs?
• Fail to appreciate the biological value of having some members of our species be fatter/more fuel-efficient?
• Prescribe a particular body size that is not attainable through healthy living?

We ask that journalists and the public review the HAES ® model tenets and this list of critical questions to avoid confusion and give a common starting point for discussions. The people who have developed the Health at Every Size model have joined together in a grassroots movement , integrating decades of research and clinical practice, as well as the lessons of many social justice and civil rights movements, to find a path that reconnects us with our bodies, our life purposes, and each other.  

List of  Resources and information on the HAES Tenets:

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If you’re interested in working privately with a Health at Every Size Coach (HAES), please CONTACT ME.