Health at Every Size Is About Giving Up

Nobody panic, I’m not pulling a Jess Weiner or anything.  One of my readers asked me to respond to this blog [Warning:  triggering in many ways]. Basically, it is the response of a blogger who does a weight loss challenge on her blog, to one of my readers who suggested that she educate herself about the Health at Every Size(r) concept.

I have a policy of not going to other people’s blogs and trying to convince them that they are wrong.  My work is more about creating a safe space here where people can come for support, information, a point of view outside the mainstream (that is not funded by corporations) and respectful discussion (one of my favorite things about this blog is how respectful the regular commenters are).  I did find the blog interesting and so, in keeping with my policy, I’ll blog about it here.  If you want to skip the possibly triggering bits you can skip the indented material and just read my responses:

What is HAES (Healthy at Every Size)?
From the website and an excerpt from Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD:

” Let’s face facts. We’ve lost the war on obesity. Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier. The war on obesity has taken its toll. Extensive “collateral damage” has resulted: Food and body preoccupation, self-hatred, eating disorders, discrimination, poor health… Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat.”

We’ve lost the war on obesity so is she saying we should just give up? I don’t agree with that philosophy at all. However, I do agree “food and body preoccupation, self-hatred, eating disorders, discrimination, poor health” are the results of being obsessed with losing weight and trying to be thinner. But believe it or not, I don’t believe the diet industry is the root cause. It is certainly a huge part of the problem, but I personally feel all of it has deep roots in patriarchal society. The problem is that we are trying to fit an ideal that doesn’t exist and that was originally created by men. Women buy into it and perpetuate it. We absolutely should work on accepting ourselves as we are, building self-esteem, and loving ourselves. But that does that mean that we stop improving ourselves? Of course not. We need to do it for ourselves. Not for society, or a man, or because we think we are supposed to look a certain way.

This issue I have here is the confusion of the concept of “improving ourselves” with the concept of weight loss.  The scientific truth is that weight loss has an abysmal success rate.  It doesn’t matter if you’re doing it for yourself, society, a man, or to meet expectations.  It doesn’t matter if you call it a diet, a lifestyle change, an eating plan or something else.  Almost everyone who attempts weight loss fails at weight loss and the majority end up heavier than they started within a few years.  I’ve talked before about the idea of HAES as “giving up”.  In a way it is.  It’s giving up the goal of being thin, giving up on a fantasy that leads to exactly the opposite of what we are trying to achieve most of the time and, instead, choosing a goal of better health which is possible for almost everyone.  (Since health is multi-dimensional and not entirely within our control, we can never guarantee health with our behaviors, but we can give ourselves our best chance for a healthy body with healthy behaviors.) Although I am a fan of  Linda Bacon I’m not a fan of the phrase “we’ve lost the war on obesity”.  I think the truth is that there is no real enemy to fight and we never should have had a war on body sizes, and that we will win the “war on obesity” in the  exact moment that we stop fighting it.

[From Dr. Bacon’s book]”Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors.”

I agree that adopting healthy behaviors is the most important thing you can do for your body and yourself, regardless of size. I agree 100% that you should focus on adopting healthy behaviors first and worry about losing weight and getting thinner second. However, I do not agree that you should just give up on reaching a healthy body weight and a healthy body size.

Again here she is conflating the concepts of weight and health.  There is no such thing as a healthy weight or healthy body size.  There is no weight or body size that you can attain that will assure your health.  Thin people get all of the same illnesses that fat people do and so being thin is neither a preventative nor a cure.  Knowing that healthy behaviors are our best chance for a healthy body, and knowing that the most common outcome of weight loss attempts is actually weight gain, it does not make sense to focus on weight if your goal is health.

Wikipedia says:

The major components of HAES, as described by Jon Robison, are:

1. Self-Acceptance: Affirmation and reinforcement of human beauty and worth irrespective of differences in weight, physical size and shape.
2. Physical Activity: Support for increasing social, pleasure-based movement for enjoyment and enhanced quality of life.
3. Normalized Eating: Support for discarding externally-imposed rules and regimens for eating and attaining a more peaceful relationship with food by relearning to eat in response to physiological hunger and fullness cues.

I absolutely love the idea of promoting self-acceptance and I will admit that I felt I did not focus enough on that during the first round of this challenge. I fully intend on making self-love and acceptance part of the challenge in the future rounds. As a pagan and a feminist, this is a significant part of my philosophy. But at the same time, I believe that wanting to be thinner doesn’t make you bad or wrong. Maybe it’s just me, but I feel like HAES wants me to feel shame for wanting to be fitter and thinner.

I can’t speak for every HAES practitioner but I don’t know any who believe that wanting to be thinner makes you bad or wrong and I don’t know anybody who would want anybody to feel ashamed of wanting to be thinner.  In a society where being fat comes with a tremendous amount of stigma, and being thin comes with a tremendous amount of privilege, it makes a lot of sense to want to move out of the stigmatized group. I’ve been very clear about my support of people’s right to choose dieting.   All HAES does is offer an alternative based on the facts.  I want to be able to fly but that’s not currently possible so I’m not going to spend my time throwing myself off of buildings and flapping my arms really hard.   If you want to be thin you should know that the research says that it’s probably not possible and that it’s likely that your attempts will leave you fatter than when you started, you then get to to decide if you want to spend your time dieting.

I have no issue with supporting social, pleasure-based movement for enjoyment. However, this is not the only type of exercise that I support. For example, I happen to like grueling weight training and I prefer to exercise in solitude. I truly enjoy challenging my body and feel that I am invoking the beautiful archetypical goddesses such as Athena, Artemis, and The Morrigan. When I am working out, I am not thinking “Wow, I’m going to look so hot in a bikini and I will get a great husband.” I am thinking “Wow, I bet this is what it is like to be strong and independent like Artemis.”

The idea that a workout can either be pleasurable or difficult is an often misunderstood part of HAES.  Evidence shows that we only need about 30 minutes of moderate exercise 5 times a week for health.  Most people are more likely to get this amount of exercise regularly if they do something that they enjoy.  For some people that is gardening or walking, for some it’s interval training and powerlifting.  HAES doesn’t preclude difficult or solitary workouts, it simply seeks to disabuse us of the incorrect notion that if you’re not miserable and killing yourself alone in the gym then you’re not contributing to your health.

What is normalized eating anyway? The fact that HAES even uses that word “normal” contradicts the entire philosophy! Why? Because they are claiming that the way they say you should eat is what is normal. Isn’t that the problem in the first place? That someone out there decided what is normal for us women? HAES is doing the exact thing they are criticizing everyone else for doing!

First of all, he does not say “Normal” he says “Normalized”.  This term, used in the HAES context, is about letting go of the idea that your information about eating must come from an external sources and instead encourages eating based on your body’s cues.  Normalized here relates to each person individually, not to everyone as a whole and speaks to the fact that due to dieting many people have lost connection with their internal cues.  HAES practitioners come to their eating a number of different ways.  Some work with a HAES based nutritionist, some use intuitive eating practices, still others have to account for allergies or a health diagnosis when they eat so their eating may be very different from someone else.  Normalized is used as opposed to the diet mentality where you ignore your bodies hunger queues and use external information (calorie counting, weight loss programs etc.) to tell you what to eat.

Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD says in the manifesto:

Find the joy in moving your body and becoming more physically vital in your everyday life.

Eat when you’re hungry, stop when you’re full, and seek out pleasurable and satisfying foods.

Tailor your tastes so that you enjoy more nutritious foods, staying mindful that there is plenty of room for less nutritious choices in the context of an overall healthy diet and lifestyle.

Well of course! This is common sense. I have been watching the diet and fitness industry for the last decade and while there are still snake oil salesmen out there, the fact is there are some very good fitness experts that are sharing this exact same philosophy! This philosophy is actually the mainstream now. Extreme dieting no longer is. I do not understand why HAES chooses demonize the entire industry rather than acknowledging that there is good, sound advice out there.

HAES criticizes the weight loss industry because they say the same thing that HAES does but then add “and then you’ll lose weight”.  Except that the vast majority of people will not maintain weight loss. Advice is neither good and sound if it is wrong almost all the time.  In fact, a study of fitness and fatness found that the obese people who did not have health issues “were more likely to be physically active and eat more fruits and vegetables” and “less likely to report engaging in weight loss practices.” (emphasis added)

In fact, Dr. Bacon tells all the experts in a message for fitness professionals that what they are doing is wrong and damaging their clients. She says tells them that everything they have learned may not supported by scientific evidence. This would be the equivalent of me telling everyone who reads my blog that “the way you have been practicing paganism may be wrong and I am here to tell you how to do it right.” Is that an extreme metaphor? I don’t think so. I don’t understand where Dr. Bacon gets off thinking she is the be all and end all to nutritional and fitness knowledge. Her holier than thou attitude is extremely off putting and arrogant. Why is she so angry and full of judgement? How ironic that she is trying to spread a message of peace, love, and self-acceptance.

I have trouble wrapping my head around this because I’ve met Dr. Bacon and she is one of the least arrogant, angry or judgmental people I have ever met.  I’m admittedly surprised that anyone would compare giving advice about religion (which is based on faith and unprovable) and giving advice about science (which is evidence-based and all about proof).  Do you feel that science teachers telling students that the Earth revolves around the sun and not the other way around is the same as telling them that they aren’t praying correctly?

Telling people that they are practicing their religion incorrectly is very different than saying that a health practice is not supported by research.  Would you have asked the doctors who pointed out that thalidomide causes birth defects why they were so “angry and full of judgment”?  Would have have called them “holier than though and arrogant”? Linda Bacon earned her doctorate in physiology, specializing in weight regulation. She also holds graduate degrees in psychology, specializing in eating disorders and body image, and kinesiology, specializing in exercise metabolism, and has professional experience as a professor, researcher, psychotherapist, exercise physiologist, and consultant, so when she gives advice it’s from a basis of an extremely highly educated expert who is steeped in the research around the issue.

While I agree with the overall message of HAES, I find the delivery quite disturbing. In fact, that is just one of the messages that she has. Here is an entire list of messages for different groups where Dr. Bacon proceeds to tell every person or group in the entire industry just what they are doing wrong. I’m sorry but her arrogance makes Donald Trump look humble.

Do you find Copernicus arrogant?  Galileo?  Mendel?  I observe that Dr. Bacon is part of a time honored scientific tradition of looking at evidence, observing that the popular opinion is not supported by that evidence, making that information known, and then being roundly criticized for it.  I guess we are lucky that she can’t be forced to recant and be put under house arrest like Galileo.

In my research, I have learned the the #1 cause of illness is stress. The media ignores this and chalks us up to New Age nuts. However, there are facts that cannot be ignored regarding obesity and health.

Some of these facts include:There is a very clear link between diabetes and obesity – 80 per cent of people with type 2 diabetes are obese. Hypertension is approximately three times more common in obese than normal-weight persons.

I take exception to these statistics but let’s just say that they are true.  First, we have to be aware that there is also a clear link between disease and the stress of constant stigma.  Further, doctors test obese people earlier and more often for these diseases and often ignore the symptoms in thin people erroneously believing that they are “immune” because they are thin.  If you have two groups and you test the first group earlier and more often for a disease and ignore the symptoms in the second group you cannot be surprised if the first group has higher incidence.  Finally, healthy habits have been shown to mitigate these risks whether or not the people lose weight and weight loss fails 95% of the time, so even if these statistics are correct, weight loss is still not the answer.

Obesity also interferes with mobility. Quite simply, extra weight makes movement more difficult and, often, uncomfortable. People who are obese often experience pain in the knees and back due to increased pressure on the joints and vertebrae.

Feel free to see this video to observe my mobility as a Type 3 Super Obese Person. We’ve talked about obesity and joint pain already. Thin people get joint pain and we treat it with health interventions.  Fat people get joint pain and we treat it with a rarely successful body size intervention. Regular exercise can help these issues and more fat people would probably get regular exercise if they weren’t stigmatized when they go, and if they could find appropriate affordable workout wear in their size, and if they didn’t give up because it doesn’t lead to weight loss which they incorrectly believe is the path to health.  Once again, dieting does not predict weight loss but it does predict weight gain and obesity so  encouraging dieting means that you put people at 95% greater risk of having any issues that are associated with obesity.

Obesity:

• raises blood cholesterol and triglyceride levels.
• lowers HDL “good” cholesterol. HDL cholesterol is linked with lower heart disease and stroke risk, so reducing it tends to raise the risk.
• raises blood pressure levels.
• can induce diabetes. In some people, diabetes makes these other risk factors much worse. The danger of heart attack is especially high for these people.

This is simply misinformation.  While these things have been shown to be correlated with obesity, they are not shown to be caused by obesity, reinforced by the fact that not all obese people have them and many thin people do.  As I mentioned previously, all of these issues have also been correlated with the stress of constant stigma.  Once again, a Health at Every Size approach where we remove size stigma and encourage healthy behaviors is a much better approach then to tell people that the way to be healthy is to try something that leaves them less healthy almost all of the time.  We do not know how to make people thinner (as much as we would like to believe that we do) but we do know how to make them healthier.

My conclusion about the HAES (Healthy at Every Size) philosophy is it has good intentions and some great aspects. It definitely deserves further study. However, the delivery of the message has underlying anger, judgement, and arrogance. In the end, it may also do serious harm by continuing to keep people in denial about the real state of their health. While they are “fat and happy” they may continue to be at risk of severe illness or death. Ironically, the natural effects of eating healthy and getting exercise that HEAS promotes is weight loss. The very thing it seems to be trying to avoid in the first place.

If the natural effects of eating healthy and getting exercise were weight loss, then we would not see a 95% failure in weight loss.  Weight loss is a possible (but not guaranteed), typically temporary side effect of healthy behaviors.  I also cannot imagine how someone would research HAES and come away with the idea that promoting healthy behaviors is tantamount to keeping people in denial about their health.  The tremendous amount of denial that I see is the fact that there are still people encouraging weight loss when we know that it almost never succeeds.

Research from the University of Minnesota found that “None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors, including significant weight gain. These findings demonstrate that these behaviors should not be viewed as innocuous and should be addressed in primary and secondary prevention efforts.”

“There isn’t even one peer-reviewed controlled clinical study of any intentional weight-loss diet that proves that people can be successful at long-term significant weight loss.  No commercial program, clinical program, or research model has been able to demonstrate significant long-term weight loss for more than a small fraction of the participants. Given the potential dangers of weight cycling and repeated failure, it is unscientific and unethical to support the continued use of dieting as an intervention for obesity.” — Wayne Miller, an exercise specialist at George Washington University (emphasis added)

You are the boss of your own underpants and I support everyone’s right to do what is right for their bodies.  However, I think that it’s absolutely irresponsible for anyone to promote weight loss without telling the truth – that 95% of people who attempt weight loss fail, that weight loss attempts don’t predict weight loss but do predicts weight gain, obesity and eating disorders; and that healthy habits have been shown to mitigate issues associated with being overweight and obese   even if they do not result in weight loss.

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