What is HAES?
HAES stands for “Health At Every Size”. It is an approach to health that does not pursue the goal of a particular body weight, but rather concentrates on what health benefits and improvements can practically be achieved for individuals. Please note that HAES is not a guarantee, but an approach. It does not assert that everyone is healthy at any size (a popular misconception), but supports the goal of health, for bodies for all sizes. For the typical person, following HAES includes size acceptance, listening to internal body signals and taking care of the body with nutritious varied eating and enjoyable exercise.
How did HAES come into being in the first place?
HAES has gained popularity in the last couple of decades within the size acceptance movement as an alternative to dieting for larger people. It has been, and continues to be, popularized by a wide variety of people including researchers and health care professionals who have looked at the scientific literature and seen how the evidence supports a body-size-neutral approach to health.
Can thin people do HAES or is it only for fat people?
HAES is something that anyone can do, regardless of their size. Fat people are not the only ones affected adversely by Western society’s relentless promotion of an “ideal” body shape, and everyone can benefit from an approach to health that is size-accepting.
Is HAES a one-size-fits all kind of programme or is it tailored to individuals?
Whilst there are certainly aspects of HAES that are applicable to most people, HAES is very much an approach that can be tailored for the individual. Just as there is no one body size that is perfect for every single person, there is also no one approach to health that works for everyone, due to individual bodies, circumstances and preferences.
Justification for HAES
Why is weight loss excluded from HAES?
There are many varied reasons. Firstly, the scientific literature shows very clearly that significant long-term weight loss is not possible for the vast majority of people (Garner & Wooley 1991
; Mann 2007
). So rather than waste effort on weight loss attempts, it makes more sense to put any efforts into health goals that are
realistically achievable. Secondly, the evidence that weight loss itself
causes health improvements (as compared to health improvements resulting from lifestyle changes intended to cause weight loss) is almost non-existent. Thirdly, there is some scientific evidence that weight loss attempts can produce damage to health. Various studies have shown a range of undesirable side-effects such as higher risks of heart attacks, gall-stones, as well as effects directly from dieting such as hunger, low energy levels, poor self-esteem. Fourthly, focusing on a goal of weight loss is counter-productive to the goal of appreciating and caring for your body as it is. Attempts to lose weight are often wrapped up in thoughts of a particular body size being unacceptable (otherwise why would you be trying to change it?), which doesn’t promote good self-esteem and a positive body image. Fifthly, weight loss is the wrong goal. The goal of a health programme should be health, not weight loss. Having weight loss as a goal can lead to two kinds of problems:
- Those who attempt weight loss through lifestyle changes can feel that they’ve failed even though their lifestyle changes have made some substantial positive improvements in their health.
- Those who have a thin body to start with might assume that that must mean they are in good health and have low health risks, even though that might not be the case.
Why bother with HAES? Is it even possible to be fat and healthy?
Healthy people come in a great variety of shapes and sizes. Whilst there is unfortunately a common perception that it is not possible to be healthy unless one’s size is a slim “ideal”, this is extremely unhelpful idea: given that long-term significant weight loss is impossible for the vast majority of people, pursuing a goal of a certain weight or size is futile. Instead, a better approach to health is to ask “What can I do for my health at my current size?”, which is the HAES approach. Fortunately, there are lots of practical achievable answers to that question. For example, McAuley (2011)
and Miller (1999)
show that increasing physical activity and fitness is a better strategy for improving health.
What evidence is there to show that HAES works?
There is plenty of evidence to suggest that HAES has a beneficial effect on health (Bacon 2010
); this evidence comes directly from scientific studies, and also from more indirect sources. (A good place to start looking at the evidence is in the books and articles mentioned on the resources page
.) Direct evidence comes from research studies that directly test the HAES approach. In one study, Linda Bacon studied a group of large women (Bacon 2005
), half of whom followed a dieting approach, and half of whom followed a HAES approach involving encouraging size acceptance, reduction in dieting behavior, and increased awareness of internal body signals. Whilst the dieters lost weight, the weight returned within 2 years, whereas the HAES group maintained their health improvements. Another study (Provencher 2009
) assessed the health effect of HAES on eating behaviours and found that for women, HAES produced a sustainable improvement in eating habits as compared to a control group. The indirect scientific evidence comes from papers in medical journals reporting on results that were not from specific HAES testing, but from examining various other aspects of weight and health. Many of these studies produced evidence to suggest that health could be improved even if no weight changes happened. To give a couple of examples,
- Exercise can lead to a drop in blood pressure even if weight does not alter (Krotkiewski 1979).
- Fitness lowers the risk of death (within a certain timespan) more than being a particular size (Blair 1989).
Isn’t HAES just giving up?
It depends on what you think is being given up. HAES does explicitly give up on the idea that there exists some attainable “ideal” body weight or size, and it does give up the idea that individuals have an obligation
to be a certain society-approved size, but HAES does not give up on health, quite the contrary. Giving up on the idea of long term significant weight loss being possible means that health efforts can be directed towards effective treatments that do improve health, not ineffective weight loss treatments that promise undeliverable goals. For more information about the problems of dieting, see Campos (2005)
Can I do HAES even if I weigh more than 20 stone?
Can people at high weights really be healthy? Can health really be found at all weights and sizes?
People in good health come in all sorts of shapes and sizes. Besides, HAES isn’t a certificate of good health (a common misconception), it is an approach to health. Anyone at any size can try to improve and/or maintain their health using HAES. It is not a question of putting a number of pounds as some kind of a limit for health, it is a matter of looking at it from another angle and saying “For this individual, what can be done practically to improve health?”
Surely HAES isn’t a good idea if I weigh more than 30 stone? Surely weight loss must be a goal?
Whilst there are certainly some disadvantages to being a large weight, remember that medical science does not know
a way to enable people to lose significant amounts of weight permanently. The most effective weight loss method known of is weight-loss surgery, and even that typically involves early weight loss followed by significant quantities of lost weight regained in the longer term. In addition, the surgery is a dangerous undertaking with a significant risk of serious side-effects, e.g. death, complications from surgery, and nutritional deficiencies (Strauss 2001
). Rather than setting a goal that is unachievable, it is better to focus on what can be productively achieved for health. The idea is that by concentrating on good nutrition and enjoyable exercise, body size will naturally settle at a weight that is right for that individual.
How can HAES possibly ignore the links between body weight and illnesses? Surely HAES is just misguided?
Ignoring is not what HAES does. When there is a correlation between body weight and an illness, HAES does not ignore this. But neither does it jump to the conclusion that that means that the weight has to be changed to fix/avoid the illness. In particular, HAES does not make the mistake of assuming that weight change is possible and safe. HAES is based on evidence, not on confusing correlation with causation. Here are a couple of examples of how body weight can be taken into account in a HAES way:
- Being heavy and being athletic are risk factors for plantar fasciitis (an inflammation of a muscle on the underside of the foot) so someone heavy and doing vigorous exercise could check that they had properly supportive footwear in order to minimise the risk of plantar fascia injury
- A thin woman might be concerned that she is at higher risk for getting osteoporosis later on in life, so rather than trying to gain weight to lower the risk (long-term weight change being very difficult anyway) she could instead choose weight-bearing types of exercise to try and minimise the risk.
Further HAES Details
What HAES resources are there available?
There are some listed on our resources page
. More resources are becoming available all the time; a Google search for “HAES” will probably turn up lots more.
My doctor is really really keen on me losing weight. How do I cope with this and follow a HAES approach?
An easy answer would be to say to change doctors. Many local GP practices have more than one doctor so an initial step could be to try changing to another doctor in the same practice, before trying elsewhere. However it isn’t always that easy to find someone who is supportive. If you can’t find a HAES-supportive doctor, then you could try explaining to your doctor the approach you would like to take. It might help to look at this Letter to a Doctor
by Hanne Blank, as a guide. Try also looking at the fat-acceptance literature for advice on how to deal with a doctor who keeps trying to weigh you and give you weight loss lectures.
I have a problem with eating particular foods, how do I cope with this and do HAES?
Concerning the avoidance of certain foods for reasons such as food allergies or unwanted side-effects, these kinds of restrictions are perfectly compatible with HAES. Other ways of eating, such as vegetarianism or veganism, can be compatible with HAES as they allow for eating a wide variety of foods in ways that are compatible with internal body signals. On the other hand, if you are describing some kind of an eating-disordered problem with eating certain foods, then HAES isn’t directed at helping you solve that problem; for that you need an eating-disorders specialist. If you can manage to find a HAES-friendly practitioner, that would help.
Does HAES really allow me to eat junk food?
The HAES approach to food is to eat a wide variety of foods, encompassing good nutrition and with paying attention to body hunger and fullness signals. It does not support the idea of labelling foods with “good” or “bad” labels, nor does it advocate banning a particular sort of food. So whilst HAES doesn’t ban so-called “junk” food, it doesn’t promote it either. If people are truly following their body signals and eating a variety of nutritious foods, then such food tends to get consumed in only modest quantities.
What’s intuitive eating, how does that relate to HAES?
Intuitive eating is about paying attention to internal body signals and eating (or not) in response to them. As humans we do this naturally when we come into the world, but sometimes we later get distracted by external ideas of what we “should” be eating, e.g. calorie-controlled diets, and we lose touch with our body’s needs. Intuitive eating is about getting back in touch with our bodies.
I really don’t like exercise. Do I really have to do it?
For the vast majority of people, undertaking suitable exercise is something that can bring huge health benefits, so it is important. Having said that, it is no fun feeling like you are being forced to do exercise you don’t want to do. So the HAES approach involves finding an exercise-incorporating activity that you enjoy doing. If that’s the treadmill at the gym, great, but if that’s not your thing, then there are plenty of other activities and sports out there, there must be one somewhere that you’d like! Maybe you fancy a spot of salsa dancing? Or perhaps gardening is your thing?
I have some medical problems with exercise; is HAES still for me?
Yes. HAES is not a compulsory fitness approach; individuals have individual approaches to what is best for their health, and not everyone can do exercise and benefit from it. However, a medical problem doesn’t necessarily mean it is impossible for you to do some suitable exercise; you may have more options than you think. For example, if you can’t stand for very long, then there are chair exercises that you could do. If you can’t manage standard yoga positions, then there might be alternative positions you can do instead. Ask your doctor what kind of exercise might benefit you, bearing in mind your medical condition.
Why is body size-acceptance a big part of HAES?
Body acceptance is important for health. Firstly, appreciation and liking of the bodies we have can help us to take care of our bodies better. Secondly, in Western society people are typically subjected to a huge amount of influence from the media concerning body size, which tends to have the widespread effect of making us dissatisfied with our bodies. This relentless negativity is very bad for our mental health, and can lead to being out of touch with our bodies’ needs, or to eating-disordered behaviour.
Can I diet as well as doing HAES?
If by “diet” you mean a food plan like a diet designed to cope with allergies, or like a vegetarian diet, then yes, you can do HAES with a particular food diet. If however, you mean a calorie-controlled diet for the purposes of weight loss, then no, that is incompatible with HAES. Firstly, external measures of how much food you “should” be eating doesn’t help you to be in tune with what nourishment your body needs. Secondly, the aim of weight loss is not conducive to loving and appreciating your body as it is.
Will I lose weight as a result of doing HAES?
Some people do find that they lose a little weight; some people find that their weight stays the same. Large changes are more rare. However, if you’re hoping to lose weight from HAES, that’s not the point of HAES. The idea is to concentrate on health, and let the weight take care of itself to settle at a weight that is healthy for you personally. You can’t love your body fully if you keep wishing it is something different.
What about weight loss surgery? Can I do HAES if I’ve had WLS?
It is certainly possible for someone who has had WLS in the past to decide to follow HAES.
Can weight loss surgery be incorporated into HAES?
Actively choosing to have WLS goes against HAES principles, for several reasons:
- Mutilating body parts is certainly not compatible with loving your body as it is.
- Stomach alteration can impair good health, by making it harder for the body to absorb the nutrients it needs.
- The usual internal body signals of hunger and satiation get altered with WLS, so intuitive eating is disrupted.
Can I do HAES even if I’ve got diabetes?
Yes. Whilst it may be that you get more concern about weight issues from your diabetes health-care professionals, being diagnosed with diabetes doesn’t suddenly mean that weight loss is a sensible or achievable goal any more than it was before you were diagnosed. You can still concentrate on taking care of yourself, in ways attuned to your needs as a person with diabetes. The HAES approach is perfectly compatible with the practical things a diabetic patient needs to do on a day-to-day basis.
What about pregnancy? How can I do HAES whilst pregnant? Isn’t the amount of weight change really important for the baby?
Yes you can do HAES whilst pregnant. Whilst it is true that medical professionals often use weight change as an indirect measure of how the baby is growing, weight numbers are still not helpful as goals, because it is still the case that a pregnant woman doesn’t have any direct control over her weight, and it is much more important to concentrate on making sure the growing baby gets good nutrition and the mother-to-be gets good care.
What about eating disorders and HAES?
In our weight-obsessed society, a significant number of people have or have had eating disorders, and the promotion of an “ideal” weight can help to fuel eating-disordered behaviour. HAES can be an important component in recovering from an eating disorder for some individuals because it takes the emphasis away from body size; however not all programmes for eating disorder recovery follow an approach compatible with HAES. Some eating disorder professionals do use HAES in their work so if you have an eating disorder and want to use HAES then it is worth trying to find someone who specialises in this area.
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Gastric bypass surgery in adolescents with morbid obesity
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