What is Health At Every Size?

Approximately 7mins Reading Time 

Brief Article Overview

• Health at Every Size is a weight inclusive approach to public health that aims to shift the focal health goal away from weight loss, and towards the formation of healthy habits and behaviours.

• Health at Every Size aims to put an end to weight stigmatisation and dissociate weight from health, arguing that good health can be achieved independent of body weight.

• According to Lindo Bacon, author of Health at Every Size (The Surprising Truth About Your Weight); “Well-being and healthy habits are more important than any number on the scale”.

• Different interpretations of Health at Every Size amongst advocates and critics can confuse the discourse that surrounds it.

• Health at Every Size challenges current assumptions regarding bodyweight and health, arguing that the link between being overweight and ill health is exaggerated.  These challenges are being discussed within the scientific community. 

• The main tenants of Health at Every Size include; 

1. 1. Weight Inclusivity
   2. Health Enhancement 
   3. Eating for Wellbeing 
   4. Respectful Care 
   5. Life-Enhancing Movement

The Origins of Health at Every Size  

Health at Every Size was officially trademarked in 2010 by the Association for Size Diversity and Health (ASDAH). However, its seeds were sewn as far back as the 1960s, with the rise of fat activism and fat acceptance movements which were closely tied to the feminist waves at the time. 

In 1967, Lew Louderback wrote an article in the Saturday Evening Post called “More People Should be FAT” in response to the discrimination experienced by his wife at the time. The popularity of this article, along with protests at the time, led Louderback and William Fabrey to establish the National Association to Advance Fat Acceptance (NAFA) in 1969.  Since then, multiple books have been written on the subject and the scholarly discipline of Fat Studies (an interdisciplinary journal of body weight and society) was formed. These ideas have been developed and refined over decades and morphed into the Health at Every Size movement as we currently know it. 

This entire movement was initiated by a push-back against the perceived unjustified and unfair stigmatisation of overweight people and pervasive anti-fat bias within society. The Health at Every Size principles are now influencing scientific discourse, as well as the practices in multiple industries including health and fitness, marketing and public health. 

Health at Every Size Principles 

Health at Every Size has been in the mainstream since the early 2000s. Its advocates argue that society is unfairly imposing a moral obligation for overweight individuals to pursue weight loss as the only means for improving health, desirability and acceptability. It supposes that this “diet culture” is being reinforced by fear-provoking obesity narratives and unrealistic standards for thinness and beauty (made more pervasive on social media). This environment is blamed for causing unnecessary physical and psychological distress to those who don’t feel they “fit in” or meet these unrealistic ideals, resulting in a net negative effect on their health and wellbeing. 

According to the ASDAH website, the main tenants within with Health at Every Size framework are: 

Different Interpretations

One difficulty with Health at Every Size is that advocates and critics alike seem to differ in their interpretation and perceived purpose of the movement, leading to inconsistencies in the discourse that surrounds it. 

On one hand, there are those who may see the Health at Every Size movement as a way to justify their personal political views. For example, those who view society as actively discriminating and oppressing overweight people in order to maintain certain power dynamics. There is often a radical scepticism of scientific evidence (obesity data for example) in favour of one’s “lived experience” associated with this view. Marylin Wann (weight diversity speaker and author of FAT!SO?), for example, asserts;

“Every person who lives in a fat hating culture, inevitably absorbs anti-fat beliefs, assumptions and stereotypes and inevitably comes to occupy a position in relation to power arrangements that are based on weight. None of us can ever hope to be completely free of such training or completely disentangled from the power grid.” 

Other advocates, however, don’t entirely dismiss scientific consensus but do question certain biases and assumptions. They may agree, for example, that obesity is problematic to health, but argue that this is only true in extreme cases and question the extent to which fat itself is the problem. They may also think that the significance of being overweight is overstated and the alarmist reaction invoked by the “obesity epidemic” is ineffective and problematic. They also challenge the efficacy of the current weight-management paradigm. Lindo Bacon, the author of Health at Every Size (The Surprising Truth About your Weight), writes;

 “Fat isn’t the problem. Dieting is the problem. A society that rejects anyone whose body shape or size doesn’t match an impossible ideal is the problem. A medical establishment that equates “thin” with “healthy” is the problem.”

Many health and fitness professionals are now trying to integrate Health at Every Size principles into their everyday practice. This point of view is nicely summarised in the tag line; Science fortified with compassion, coined by health coach Dr Gabrielle Fundaro. In her Bridging the Gap Series, she states;

“Many people have strong opinions about Health at Every Size (HAES), Intuitive Eating, weight neutrality, anti-diet culture, and body positivity, often despite having read none of the books or literature. Let me be clear: I have seen misinformed, extremist voices yelling from both sides of this divide.”

And;

“Contrary to popular belief, HAES does not state that health is present at every size; rather, the central tenant of the paradigm is simply that a person’s size should not prevent them from engaging in health-seeking behavior. They accurately assert that weight is not predictive of health status and focus on health-seeking behaviors rather than outcomes (such as weight loss).”

For an in-depth discussion of the application of Health at Every Size within an evidence-based framework, we highly recommend reading Dr Gabrielle’s series (part 1 and part 2) on the Renaissance Periodisation website.

Challenging Biases and Assumptions

This is probably the most contentious part of the Health at Every Size movement. In 2011, Lindo Bacon and Lucy Aphramor wrote the paper Weight Science: Evaluating the Evidence for a Paradigm Shift, in which they attempted to put forth a scientific rationale for the use of Health at Every Size within public health guidelines. They challenged the following assumptions;

• Adiposity (body fat in itself) poses significant morbidity and mortality risk.
• Weight loss will prolong life.
• Anyone who is determined can lose weight and keep it off through appropriate diet and exercise.
• The pursuit of weight loss is a practical and positive goal.
• The only way for people living with obesity to improve health is to lose weight.
• Obesity-related costs place a large burden on the economic and health system, and this can be corrected by focused attention to obesity treatment and prevention.

It’s important to note that, at face value, many of these statements run against our current understanding of the weight/health paradigm (more on this in part 2). It’s also clear that Lindo Bacon has a vested interest (book sales) in promoting this paradigm shift. However, the devil’s in the details. Biases and assumptions require challenge. Different ideas and perspectives should be put forth for peer review and due process.

It is not our place to validate Lindo Bacon’s evidence here, but the attempt to pose questions and challenge long-held assumptions could be positive if it sparks healthy debate and offers utility. We don’t believe it’s worthwhile devolving into an “us vs them” narrative.

Weight Neutrality and Body Positivity

Health at Every Size is closely associated with the popular Body Positivity Movement as seen in many marketing (Dove’s Campaign for Real Beauty) and social media campaigns. But they differ in one important way.

The Body Positivity Movement encourages everyone to love and feel good about their bodies, no matter what their size, weight or shape. For some, this is a necessary and empowering push-back against decades of weight discrimination. It is an inclusive movement that helps people feel good in their own skin. For others, it may be seen to encourage unhealthy behaviours or discourage healthy ones for the sake of activism. 

Health at Every Size, on the other hand, is said to be “weight neutral”.  This means our body size/weight should bear no negative or positive connotations. The premise is that divorcing morality (good or bad) from one’s weight can be psychologically freeing in a way that helps individuals make more pragmatic decisions about their health and wellbeing.

Health and fitness practitioners are also being encouraged to adopt this weight-neutral approach. Meaning they should shift away from using weight loss as the most significant metric for success and focus more on healthy habits and behaviours. 

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