Health at Every Size

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Health at Every Size (HAES) is an idea that "supports people in adopting health habits for the sake of health and well-being (rather than weight control).".[1] It hopes to remove discrimination of obesity and improve standard of living for people who are overweight. HAES believes that traditional restrictive dieting does not result in sustained weight loss for some people,[2] HAES suggests that this method is not always healthful. HAES proposes that health is a result of behaviors that are independent of body weight and submits that societal obsession with thinness does not allow for diversity in body shapes.[3] HAES has recently gained popularity among proponents of the fat acceptance movement as an alternative to weight-loss.[4][5]

Overview[edit]

HAES does not pursue the goal of a particular body weight, but rather concentrates on what health benefits and improvements can practically[clarification needed] be achieved for individuals. Typically, practicing HAES includes listening to internal body signals[clarification needed] and taking care of the body with nutritious varied eating and enjoyable exercise. Scientific studies show a causal link between obesity and increased morbidity.[6] HAES proponents believe that obese people who are unhealthy may in part be unhealthy not because fat in and of itself is unhealthy, but because years of attempting to lose weight and gaining it back (a process referred to as yo-yo dieting) purportedly causes health issues.[7] Today there are over 8,000 pledges to HAES.

HAES proponents believe that:

  1. In many cases, fad diets do not lead to sustained weight loss.[8]
  2. Self-acceptance promotes improved mental health and happiness.[9]

History[edit]

The history of Health At Every Size first started in the 1960s as a focus on the changing culture of aesthetics and the repercussions of such a change of fat people. On November 4, 1967, Lew Louderback wrote an article called “More People Should Be Fat!” that appeared in a major national magazine, The Saturday Evening Post.[10] It is one of the earliest, if not the first, critical writings in American media.[citation needed] In the article, Louderback discussed a variety of issues, including:

  1. There are “thin fat people” who suffer physically and emotionally from having dieted to below their natural body weight.
  2. Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
  3. Dieting seems to unleash destructive emotional forces.
  4. Eating normally, without dieting, allowed Louderback and his wife to relax, feel physically better, and normalize and stabilize their eating and weight.

Bill Fabrey, a young engineer at the time, read the article and contacted Louderback a few months later in 1968. Fabrey helped Louderback research his subsequent book, Fat Power, and Louderback supported Fabrey in founding the National Association to Aid Fat Americans (NAAFA) in 1969, a nonprofit human rights organization. NAAFA would subsequently change its name by the mid-1980s to the National Association to Advance Fat Acceptance.

In 1982, Bob Schwartz wrote Diets Don’t Work, a book that was based on his program of the same name.[11] Schwartz noticed how people who ate unrestricted were not worried about food and weight, and taught what would be later called intuitive eating. Molly Groger wrote a book about her training program, Eating Awareness Training, which also helped people return to intuitive eating. Both Groger and Schwartz however, suggested that by following intuitive eating, people would end up losing weight.

At about the same time, two more books were published; The Dieter’s Dilemma by William Bennett, MD, and Joel Gurin, and Breaking the Diet Habit, by Janet Polivy and C. Peter Herman. Bennett and Gurin posited that nearly all people had set weight points, which regulated each person’s body fat and weight, and that dieting resulted in lowered metabolic rates and rebound weight gain, which made dieting useless. Polivy and Herman discussed the “natural weight” range, which varied by individuals in a species, and recommended intuitive eating -which had not been given a name yet- and accepting one’s natural size, as an alternative to struggling with dieting. They also re-framed dieting as “restrained eating,” wherein one ignored body signals and instead responded to external cues.

Scientific evidence[edit]

Proponents claim that evidence from certain scientific studies[12] has provided some rationale for a shift in focus in health management from weight loss to a weight-neutral approach in individuals who have a high risk of type 2 diabetes and/or symptoms of cardiovascular disease.

This study of around 3000 Finns over an 18-year period showed that while "weight loss in the obese improves risk factors for cardiovascular diseases and diabetes"[13] there is a small amount of evidence that weight loss from dieting can result in slightly increased mortality in those who are moderately overweight, while those who maintained their weight (but did not gain any additional weight) fared the best.[13][14] The study states, "overall, preventing people, especially children, from becoming overweight in the first place seems crucial, since this work suggests that once weight is gained losing it again may not be good for health."[13] Finally, the study concludes, "This conclusion does not contradict the possible beneficial effects of planned weight loss in obese individuals who have already developed co-morbidities of their obesity, such as type 2 diabetes and symptoms of cardiovascular disease."[13]

Similar conclusions are drawn by other studies where intentional weight loss was found to be associated with slightly increased mortality for healthy weight individuals and the slightly overweight but not the obese, while for those who are obese but otherwise healthy the effect of weight loss is neutral.[12][15][16] This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.[14]

Criticism[edit]

Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept,[17] arguing it is not possible to be and remain truly healthy at every size, and suggests that a HAES focus may encourage people to ignore increasing weight, which her research states is easiest to lose soon after gaining. She does, however, note that it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes.

David L. Katz, a prominent public health professor at Yale, wrote an article in the Huffington Post entitled "Why I Can't Quite Be Okay With 'Okay at Any Size'",[18] which while it does not explicitly name HAES as the topic of the piece, it could easily interpreted as such. While he applauds the principles of anti-obesity bias, his opinion is that a continued focus on being 'okay at any size' (which may be an allusion to HAES) may normalise ill-health and prevent action being taken to reduce the burden of disease that is caused by obesity.

Scientific criticism[edit]

For more details on this topic, see Obesity.

Studies show that obesity causes a wide variety of health problems.[19] These problems range from congestive heart failure,[20] high blood pressure,[21] deep vein thrombosis and pulmonary embolism,[22] type two diabetes,[23] infertility,[24] birth defects,[25] stroke,[26] dementia,[27] cancer,[28] asthma and chronic obstructive pulmonary disease[29] and erectile dysfunction.[30] Additionally, obesity complicates any operation and can cause significant postoperative wound care problems.[31] Having a BMI greater than 30 doubles one's risk of congestive heart failure.[32][33] Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[34][35] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[19] while a 2008 European consensus puts the number at 35%.[36]

References[edit]

  1. ^ http://www.haescommunity.org/
  2. ^ Mann, Traci; Tomiyama, A. Janet,Westling, Erika, Lew, Ann-Marie, Samuels, Barbra, Chatman, Jason (April 2007). "Medicare's search for effective obesity treatments: Diets are not the answer.". American Psychologist 62 (Eating Disorders): 220–233. doi:10.1037/0003-066x.62.3.220. 
  3. ^ Brown, Lora Beth (March–April 2009). "Teaching the "Health At Every Size" Paradigm Benefits Future Fitness and Health Professionals". Journal of Nutrition Education and Behavior 41 (2): 144–145. doi:10.1016/j.jneb.2008.04.358. 
  4. ^ "NAAFA Policy Recommendations". National Association to Advance Fat Acceptance. 
  5. ^ "Activists See Diet Industry as Drain on Money, Self-Esteem". USA Today. Associated Press. August 2, 2004. 
  6. ^ Shields, Margot; Gorber, S. Connor; Tremblay, M. A. (September 2008). "Associations between obesity and morbidity: effects of measurement methods.". Obesity Reviews 9 (5): 501–502. doi:10.1111/j.1467-789x.2008.00496.x. 
  7. ^ "Does sustained weight loss lead to decreased morbidity and mortality?". International Journal of Obesity 23 (S5): S20. 1993. doi:10.1038/sj.ijo.0800982. 
  8. ^ http://www.clinsci.org/cs/124/0231/cs1240231.htm
  9. ^ Robison, Jon; Kelly Putnam; Laura McKibbin (2007). "Health At Every Size: a compassionate, effective approach for helping individuals with weight-related concerns--Part II". American Association of Occupational Health Nurses 55 (5): 185–192. 
  10. ^ Louderback, Lew (Nov 4, 1967). "More People Should Be Fat". The Saturday Evening Post. 
  11. ^ Bob Schwartz (1996). Diets don't work. Breakthru Pub. ISBN 978-0-942540-16-1. 
  12. ^ a b Bacon L, Aphramor L. (2011). "Weight science: evaluating the evidence for a paradigm shift". Nutr J 10:9. doi:10.1186/1475-2891-10-9. PMC 3041737. PMID 21261939. 
  13. ^ a b c d Sørensen TI, Rissanen A, Korkeila M, Kaprio J (2005). "Intention to Lose Weight, Weight Changes, and 18-y Mortality in Overweight Individuals without Co-Morbidities". PLoS Medicine 2 (6; e171). doi:10.1371/journal.pmed.0020171. PMC 1160579. PMID 15971946. 
  14. ^ a b Kendall Powell (May 31, 2007). "The Two Faces of Fat". Nature 447 (7144): 525–7. doi:10.1038/447525a. PMID 17538594. 
  15. ^ Harrington M, Gibson S, Cottrell RC (2009). "A review and meta-analysis of the effect of weight loss on all-cause mortality risk". Nutr Res Rev. 22 (1): 93–108. doi:10.1017/S0954422409990035. PMID 19555520. 
  16. ^ Ingram DD, Mussolino ME. (2010). "Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File". Int J Obes 34 (6): 1044–1050. doi:10.1038/ijo.2010.41. PMID 20212495. 
  17. ^ Sainsbury, Amanda (Mar 18, 2014). "Call for an urgent rethink of the ‘health at every size’ concept". J Eat Disord 2 (8). doi:10.1186/2050-2974-2-8. Retrieved 2015-04-29. 
  18. ^ Katz, David. "Why I Can't Quite Be Okay With 'Okay at Any Size'". Huffington Post. Retrieved 29 April 2015. 
  19. ^ a b "www.who.int" (PDF). WHO. Retrieved February 22, 2009. 
  20. ^ "Obesity and the risk of heart failure". 
  21. ^ "Obesity". 
  22. ^ "Obesity and thrombosis". 
  23. ^ Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz (2005). Clinical obesity in adults and children: In Adults and Children. Blackwell. p. 493. ISBN 1-4051-1672-2. 
  24. ^ "Impact of male obesity on infertility: a critical review of the current literature". 
  25. ^ "Maternal Overweight and Obesity and the Risk of Congenital Anomalies". 
  26. ^ "Body Mass Index and the Risk of Stroke in Men". 
  27. ^ "Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis". 
  28. ^ "Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults". 
  29. ^ "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies". 
  30. ^ "Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men". 
  31. ^ http://www.thedailybeast.com/articles/2015/03/21/what-your-doctor-won-t-tell-you-about-surgery.html.  Missing or empty |title= (help)
  32. ^ Kenchaiah S, Evans JC, Levy D et al. (August 2002). "Obesity and the risk of heart failure". N. Engl. J. Med. 347 (5): 305–13. doi:10.1056/NEJMoa020245. PMID 12151467. 
  33. ^ Haslam DW, James WP (October 2005). "Obesity". Lancet 366 (9492): 1197–209. doi:10.1016/S0140-6736(05)67483-1. PMID 16198769. 
  34. ^ Poirier P, Giles TD, Bray GA et al. (May 2006). "Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss". Arterioscler. Thromb. Vasc. Biol. 26 (5): 968–76. doi:10.1161/01.ATV.0000216787.85457.f3. PMID 16627822. 
  35. ^ Yusuf S, Hawken S, Ounpuu S et al. (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". Lancet 364 (9438): 937–52. doi:10.1016/S0140-6736(04)17018-9. PMID 15364185. 
  36. ^ Tsigos C, Hainer V, Basdevant A et al. (2008). "Management of obesity in adults: European clinical practice guidelines". Obes Facts 1 (2): 106–16. doi:10.1159/000126822. PMID 20054170.  as PDF

Further reading[edit]

  • Bruno, Barbara. "The History of the HAES Movement, Part I".  "Part II".  "Part III".  "Part IV". 
  • Bacon, Linda (2010). Health at Every Size: The Surprising Truth About Your Weight. Dallas: BenBella Books. ISBN 978-1-933771-58-8. 
  • Bacon, Linda (2014). Body Respect: What Conventional Health Books Leave Out, Get Wrong or Just Plain Fail to Understand about Weight. Tx: BenBella Books. ISBN 978-1-940363-19-6. 
  • Campos, Paul (2004). The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health. New York: Gotham Books. ISBN 978-1-59240-066-9. 
  • Campos, P.; Saguy, A; Ernsberger, P; Oliver, E; Gaesser, G (2005). "The epidemiology of overweight and obesity: Public health crisis or moral panic?". International Journal of Epidemiology 35 (1): 55–60. doi:10.1093/ije/dyi254. PMID 16339599. 
  • Ernsberger, P; Haskew, P (1987). "Health implications of obesity: An alternative view". Journal of Obesity and Weight Regulation 6 (2): 55–137. ISSN 0731-4361. 
  • Garner, David M.; Wooley, Susan C. (1991). "Confronting the failure of behavioral and dietary treatments for obesity". Clinical Psychology Review 11 (6): 729–80. doi:10.1016/0272-7358(91)90128-H. 
  • Saguy, A. C. (2005). "Weighing Both Sides: Morality, Mortality, and Framing Contests over Obesity". Journal of Health Politics, Policy and Law 30 (5): 869–921. doi:10.1215/03616878-30-5-869. PMID 16477791. 
  • Jonas, Steven; Konner, Linda (1997). Just the Weigh You Are: How to Be Fit and Healthy, Whatever Your Size. Shelburne: Chapters. ISBN 978-1-57630-026-8.