Health at Every Size: Toward a New Paradigm of Weight and Health

Jon Robison, PhD, MS

Disclosures

Promoting weight loss through exercise, dietary restriction, and behavior modification rarely succeeds. It often results in cycles of weight loss and gain, with the potential for serious physical and psychological health risks, and contributes to body hatred, dangerous eating disorders, and exercise addiction.[1,2] Yet we believe that if we continue to use the same approaches, we will somehow obtain different results. Indeed, this is the definition of insanity put forth by Alcoholics Anonymous.

There is, however, an exciting, effective, alternative approach to this problem. It is called Health At Every Size (HAES). The basic conceptual framework of this approach includes acceptance of the:

  • Natural diversity in body shape and size

  • Ineffectiveness and dangers of dieting for weight loss

  • Importance of relaxed eating in response to internal body cues

  • Critical contribution of social, emotional, and spiritual as well as physical factors to health and happiness.

The Table contrasts the underlying assumptions of traditional weight management approaches with those of HAES.[3]

The HAES philosophy promotes the concept that an appropriate, healthy weight for an individual cannot be determined by the numbers on a scale, by a height/weight chart, or by calculating body mass index or body fat percentages. Rather, HAES defines a "healthy weight" as the weight at which a person settles as they move toward a more fulfilling and meaningful lifestyle. This includes, but is not limited to, eating according to internally directed signals of hunger, appetite, and satiety and participating in reasonable and sustainable levels of physical activity.

Although research and experience have clearly demonstrated that focusing on weight loss as a primary goal is most likely to produce weight cycling and, over time, increased weight,[4,5,6,7,8,9] the HAES approach certainly does not suggest that all people are currently at a weight that is the most healthy for their circumstances. What it strongly purports, however, is that movement toward a healthier lifestyle over time will produce a healthy weight for that person.

It is important to understand that removing the focus on weight does not imply ignoring health risks and medical problems. When heavy persons present with medical problems, HAES suggests that health professionals offer the same approaches that they would for a thin person presenting with similar problems. In the case of a thin person with essential hypertension, for example, conventional wisdom suggests dietary changes, increases in aerobic physical activity, and stress management followed by medication if necessary. Yet a heavy person presenting with the same diagnosis is told to lose weight, regardless of all that is known about the most likely consequences of this recommendation.

The HAES approach supports a "holistic" view of health that promotes feeling good about oneself; eating well in a natural, relaxed way; and being comfortably active.[10] The following list outlines the major foci for helping people with eating and weight-related struggles from the HAES perspective[3]:

  • Self-acceptance: affirmation and reinforcement of human beauty and worth, regardless of differences in weight, physical size, and shape;

  • Physical activity: support for increasing social, pleasure-based movement for enjoyment and enhanced quality of life; and

  • 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 physiologic hunger and fullness cues.

The overarching goal for health professionals is to help people live healthier, more fulfilling lives by caring for their bodies they presently have.

HAES offers an effective, compassionate alternative to the failures of traditional approaches. There is a significant body of literature that clearly demonstrates that most so called weight-related problems can be treated effectively with little if any weight loss.[11,12,13] Even in type 2 diabetes, blood glucose can be normalized without weight loss even when the patient remains markedly obese by traditional medical standards. This finding is further strengthened by the growing body of research showing that obese individuals who are active and fit have lower mortality rates than normal-weight persons who are inactive and unfit.[14,15,16] Finally, recent research shows that the HAES approach is clearly superior to state-of-the-art, behavioral weight-loss intervention for improving the long-term health of obese participants.[17,18]

Although HAES may not always help make people thinner, by embracing this new approach we can help people of all sizes to be healthier. By not promoting weight loss as a primary goal, we can prevent future generations of children, women, and men from developing eating problems, loathing their bodies, engaging in risky weight-loss strategies, and dying to be thin.

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