In a recent interview I was asked “How is the idea of “health at every size (HAES)” not just permission to be fat?” As a therapist working primarily with binge eating disorder (and one who is recovered), when I hear this question I being to hyperventilate, and want to scream from the rooftop while kicking something and burning diet books. Usually when this happens it means “Amy, go do some breathing and work on letting go” or “write a blog post”. So, here we go.
Actually, I can see completely how the question came to be. Given the culture in which we find ourselves, there can hardly be another possibility. The question is of course predicated on the notion that “thin is intrinsically better.” Frankly, nothing in medical or psychological research actually bears this out. Time and again, studies show that folks in the “overweight” category of BMI live longest. [private_membership circle]In addition, while medical issues are correlated with obesity, we have yet, in most cases, to prove causality. Psychologically, given this belief, we have the highest rates of eating disorders ever known, 80% of women dislike their bodies “a great deal”, and in several studies, women would rather lose years off their lives than be fat. Without this as a given part of our way of thinking about our physical selves, the question by this reporter makes no sense.
Interesting too is the idea that given “permission” (I think the interviewer means a moratorium on dieting), people would naturally just get fat. I find that curious. We have the highest rates of obesity ever recorded, and also the highest rates of dieting. Strikes me that one possibility is that the more people are taught to hand eating and physical movement decisions over to someone else, say Weight Watchers or Jenny Craig, the greater the “obesity” problem has proven to be. With a 98% failure rate for diets, can you imagine buying such a product if it were a television or a car? Not hardly. But with diets, we “blame the victim.” For clearly, if you stick with the plan, it does result in weight loss (usually). True enough. But no one can stick to an outside set of rules forever, and that is the requirement for permanent weight change. And, again, it is all predicated on the notion that “thin” is somehow intrinsically better. Bear in mind too: if you are happy with your body, who stands to lose? I’m thinking Florine and Jenny are at the top of the list.
Imagine a system where you are encouraged to stop trying to control your body, and to just listen to its cues. Imagine eating in response to hunger and fullness most of the time (not perfectly!), and keeping a gentle eye toward nutritional needs. How would we look over time? If female 5’9″, 120 pounds, white and young? Or if male, 6’4″, 180lbs., every muscle developed? Of course not. We would be short, tall, dark, light, old, young, round, lanky, pear-shaped, the gamut. In my recovery from BED, I have been every weight on my 5’8″ body possible, from 120 pounds to 270 pounds. When, at my top weight, I gave up on dieting, slowly my weight did drop. I now weigh about 170lbs, and have for a number of years. I am still “obese” according to my BMI, bear in mind. According to the BMI chart and the cultural message, I still have about 35 pounds to go. My body, however, seems perfectly healthy and happy right here. I figure she knows better.
So “HAES” is NOT about “permission to get fat”. It is about each of us individually listening with body and mind, letting our unique bodies find the way to the weight they are happy to be, and valuing whatever the result. It is a focus on overall health and well-being, not weight loss. Here are the basic tenets of HAES, developed by pioneer Deb Burgard PhD:
Acceptance of and respect for the diversity of body sizes and shapes
A recognition that health and well-being are multi-dimensional, and that they include physical, social, spiritual, occupational, emotional and intellectual aspects
Promotion of all aspects of health and well-being for people of all sizes
Promotion of eating in a manner which balances individual nutritional needs, hunger, satiety, appetite and pleasure
Promotion of individually appropriate, enjoyable life enhancing physical activity, rather than exercise that is focused on a goal of weight loss
I find myself more and more grateful, every day, that I have no idea what I will eat tomorrow. That I know my body actually wants to eat well, and feels stifled and restless if I don’t get in a run, or walk, or some playing in the sand. The journey is not easy. Often we are explorers without a map at first, just learning how to recognize basic cues. But for the majority of us, listening with our physical and nutritional awareness is wisdom. Listening to anyone else is like expecting someone to tell you when you need to sneeze. Trust yourself. You have actually always known what to eat and when to move. You still do.
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Amy Pershing LMSW, ACSW, Clinical Director, The Center for Eating Disorders, Director, Bodywise Binge Eating Recovery Program and The Bodywise Intensive www.thebodywiseprogram.com , Board Member, Binge Eating Disorder Association (BEDAonline.org)
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