Health at Every Size May Challenge Your Doctor

But it May Help You in Ways That Dieting Can't

To describe the Health at Every Size (HAES) philosophy, in which a person moves toward health with an acceptance of body shape and size, consider a key question.

Would you rather be thin, or would you rather be healthy?

Somewhere, someone is saying, "You can't be healthy (or happy, for that matter) without being thin," or, "Aren't those the same thing?" We are conditioned to believe that in order to be healthy and happy, we have to be under a certain weight. But those who subscribe to the Health at Every Size philosophy look past this "conventional wisdom" and turn elsewhere for direction.

The Health at Every Size Approach

The HAES philosophy boils down to three key points:

• Accepting and respecting the natural diversity of body sizes and shapes.
• Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
• Finding the joy in moving one’s body and becoming more physically vital.

Note that HAES proponents do not hold that everyone is currently at a healthy weight. Instead, they suggest that changing living habits as above will take people to their own healthy weights, but that these weights will be wide-ranging.

If you've read much on this site, you know that dieting generally fails. Ironically, dieting can leave many people vulnerable to gaining more weight than they lose.

HAES proponents pursue health and enjoyment of life rather than weight loss. They look for ways to move their bodies freely and without shame (since heavier people can be ridiculed when they elect to exercise at gyms, for example). And they learn how to pay attention to hunger and satiety cues with intuitive eating.

Health at Every Size Versus Conventional Dieting Wisdom

A study in the Journal of the American Dietetic Association compared two groups of 30 to 45-year-old women with body mass indexes of at least 30 (considered "obese"). One participated in the Health at Every Size protocol. The second group was a diet group, instructed to restrict food intake moderately and monitor food choices and weight. Both groups met for 24 weeks.

At follow-up after two years, the diet group maintained a weight loss of 3.2 kg, or about 7 pounds. This decrease was not statistically significant.

What about the HAES group? Their weight remained essentially unchanged at every checkpoint (no weight loss). But unlike the diet group, they gained these benefits (which were statistically significant) at the two-year follow-up:

• Lowered overall cholesterol
• Lowered systolic blood pressure
• Lowered pressure to restrict eating
• Lowered susceptibility to hunger
• Decreased drive for thinness
• Decreased binge eating
• Decreased body dissatisfaction
• Increased ability to respond to the body's hunger cues
• Increased physical activity
• Lowered levels of depression
• Increased self-esteem (while the diet group's self-esteem lowered significantly)
• Greater likelihood of sticking with what they'd learned
• Zero sense of failure (as opposed to 53% of the diet group)

Also, it's worth noting that many of the diet group dropped out before the treatment phase ended. Not so for the HAES group. The study did have one major weakness -- its size. Were more people in the test, the results would be more powerful. Regardless, further research will validate or challenge these initial results.

Evidence of Increased Freedom With Health at Every Size

A second study appearing in Obesity, the journal of the Obesity Society, also suggests benefits to HAES. Compared to a control group and a group that received social support, a group following HAES principles proved less susceptible to hunger and more able to exercise “flexible restraint,” or the ability to choose away from certain foods without adhering to rigid rules.

Worth Considering?

In short, the idea behind Health at Every Size is freedom to pursue health without worrying about how it affects (or doesn’t affect) weight. Freedom is an important word here; it’s obviously very different from the standard mantra stating that if you’re overweight, you’re “at risk” for health problems of various kinds.

Still, it remains to be seen whether the benefits of Health at Every Size are attractive enough for the overweight population to try. Those with eating disorders, in particular, are often more than willing to compromise their health in order to lose weight or avoid gaining it. Health at Every Size intentionally takes the opposite view. In many circles, it won’t be a popular concept. But it’s a different voice. And given that 95% of diets end up in failure, is it crazier to try a new idea, or to keep trying the old one?

Should Weight Loss Ever Be Prescribed?

According to HAES creator Dr. Linda Bacon, no. Naturally, this is a weighty claim, given the strength of the weight-loss message in our culture. But Bacon maintains that in every case, lifestyle changes are more effective for improving health than weight loss. And though there are as yet few studies specifically employing HAES, some investigators point to significant research supporting health improvement without weight change.

Let the studies continue: It may be that the call for weight loss will eventually ring hollow.