I got a question from reader Iroshi asking how to discuss the transition from a weight centered approach to health to a Health at Every Size approach. I’ll absolutely give my opinion about that but first let’s take it all the way back and discuss why someone might want to do that in the first place.
In a weight centered approach body size is used as a proxy for health – assuming that a thinner body will be a healthier body and so if someone is above what is considered a “healthy” weight, weight loss is advised to increase health. There are several issues with this:
- Weight is correlated with some diseases, but weight is not causally related. There are no “fat people” diseases and so using weight as a proxy for health instead of using the simple tests for actual health means that people are either misdiagnosed or undiagnosed. I once had a doctor try to prescribe blood pressure medication before taking my blood pressure (which was completely normal). I have a friend who was begging to be tested for Type 2 Diabetes (which it turns out that she has) but her doctor told her that it was impossible for a thin person to get T2D.
- It gives fat people the incorrect message that their healthy habits won’t make them healthy unless they make them thin. That is not what the evidence like Matheson et. al, Wei et. al. and The Cooper Institute studies tell us. In Matheson et. al. for example, fat people who practiced healthy habits had the same hazard ratio as thin people who practices healthy habits and a dramatically better hazard ratio than thin people who didn’t practice healthy habits.
- There is no statistically significant study that shows that people who lose weight have better long term health outcomes that those who stay fat but practice healthy habits or those who were never fat.
- Even if there was proof that weight loss makes us healthier, there is not a single study that shows that weight loss is possible for most people long term. The vast majority of people regain their weight within five years and many gain back more than they lost, even if they keep up their diet habits. (Increasingly the evidence shows that the body has a multitude of mechanisms that are designed to regain and maintain weight that is lost.) Weight loss fails the vast majority of the time and often has the exact opposite of the intended effect, and there is no proof that it will make us healthier even if it does work. Weight loss simply does not meet the criteria for evidence-based medicine.
A prescription of weight loss suggests that we do something that nobody has proven is possible for a reason that nobody has proven is valid, and for which failure is a near statistical certainty.
Health at Every Size (HAES) is a health practice where the focus is on health rather than body size, based on the evidence that habits are a much, much, better determiner of health than body size. (HAES is not to be confused with Size Acceptance, which is a civil rights movement that asserts that people of every size deserve to be treated with respect and live free from shame, stigma, oppression, and bullying due to their size). Health at Every Size acknowledges that health is multidimensional, some aspects of which are within our control and some aspects beyond our control. Health includes genetics, effects of past behaviors, current behaviors, and access to things like healthy foods, safe movement options and affordable evidence-based healthcare. With HAES the focus is on practicing healthy habits and allowing your body to settle at whatever weight it settles.
The transition from a weight-centered health practice to a health-centered health practice can be difficult. The problem that I most often hear from people initially is how to set goals. In a weight centered practice the scale is our judge and jury. All eating and movement activities are centered around changing the size and shape of the body. In HAES our activities are focused around nurturing our bodies and giving them their best chance for health. Goals can be set around movement – I want to be able to life my grandkid, I want to be able to walk around the block etc. They can be set around the habits themselves – I want to get 150 minutes of activity a week, I want to eat 5 servings of vegetables a day etc.
It should be noted that HAES is an option, not an obligation, and that health is a very personal thing and so people get to choose how highly to prioritize their health and what path to take to get there and it’s absolutely none of anybody else’s business.
I think that movement is the easiest place to start. A lot of research shows that 30 minutes of moderate movement 5 times a week is the magic number. It doesn’t have to be 30 minutes all at once, you can spread it into 3 10 minutes sessions and it doesn’t have to be miserable. Choose whatever makes you happy – walking, gardening, dancing around your living room etc. If you haven’t exercised in a decade then 5 minutes of exercise might be a great starting goal – you don’t have to run a mile tomorrow and you probably don’t want to be the healthiest person in traction. I’m a fan of getting a baseline (what can you do now without wanting to die) and then working and setting goals from there. If you’re looking for a resource, my friend Jeanette Depatie (aka The Fat Chick) is a certified fitness professional who has a book and DVD for beginners or those getting back into exercise. (DancesWithFat members get a special discount on either or both). If you want support on your journey, check out the Fit Fatties Forum which has over 900 members of all levels of fitness, and includes discussions, groups, and a photo and video gallery.
Figuring out how to eat in ways that nurture your body rather than in ways that try to change your body’s shape can also be tricky. I started with intuitive eating, I also kept a food journal (after I had worked through issues so that it wasn’t triggery) so that I could track how I felt after eating certain foods. This is a place that is far beyond my expertise and where I think it’s definitely good to get some help. I just saw today that Golda Poretsky is doing a special deal this weekend on her “How to Heal from Emotional Eating” home course, and Michelle at The Fat Nutritionist has tons of awesome information. (In the interest of full disclosure – none of these people compensate me in any way, I just happen to think that they are awesome.)
So there are lots of nuts and bolts to work out but for me the biggest step was deciding to stop hating my body for not fitting an artificial, impossible societal stereotype of beauty, and start appreciating it for everything it does. This simple thing did more for my journey to health, happiness and body love than anything else that I’ve done. Once you make the decision to focus on your health and let your weight fall where it may, you’ve taken a huge step toward a HAES approach. After that it’s all about trying things. Years ago I was talking to a business consultant friend of mine about how he gets “unstuck” when he’s working with a client and he’s not sure which path to take and he said, quoting someone else I’m pretty sure: Try something, anything. If things get better then do more of that, if they get worse try something else.
So on your health journey you’ll try stuff – some things will be spectacular successes (like that time I took up dancing) and some may be spectacular failures (like that time I tried to overcome the fact that I despise distance running) and that’s ok. This is a lifelong journey and there is no right or wrong , there are just experiences and what you’re going to try next.
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