Health at Every Size
HAES stands for "Health At Every Size," an approach to health that does not pursue the goal of a particular body weight, but rather concentrates on what health benefits and improvements can practically be achieved for individuals. Typically, practicing HAES includes listening to internal body signals and taking care of the body with nutritious varied eating and enjoyable exercise. Scientific studies show a clear link between obesity and increased morbidity; however, HAES proponents seek to highlight that links do not imply causation. HAES proponents also deem that:
- That, in most individuals, dieting results in short-term weight loss, long-term weight gain, and ultimately does more damage to the body than weight maintenance
- That social, pleasure-based movement for enjoyment and enhanced quality of life is more important than vigorous intensity exercise
- That eating in response to physiological hunger and fullness cues will lead to a healthier body
- That self-acceptance promotes a healthier attitude and happier life than self-hatred does
HAES has gained popularity over the years within the fat acceptance movement.
Health at Every Size also acknowledges the social, emotional, spiritual, and physical factors that affect health and happiness.
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. It is one of the earliest, if not the first, critical writings in American media. In the article, Louderback discussed a variety of issues, including:
- There are “thin fat people” who suffer physically and emotionally from having dieted to below their natural body weight.
- Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
- Dieting seems to unleash destructive emotional forces.
- 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. 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.
Recent evidence from scientific studies have provided rationales for a shift in focus in health management from a weight loss to a weight-neutral outcome. In 2005, a study of around 3000 Finns over an 18-year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best. Similar conclusion is drawn by other studies where intentional weight loss is found to be associated with slightly increased mortality for healthy individuals and the slightly overweight but not obese, while for those who are obese but otherwise healthy the effect of weight loss is neutral. 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. Intentional weight loss appears to be of benefit only to those classified as unhealthy.
Long-term studies of dieting also indicate that the majority of individuals who dieted regain virtually all of the weight that was lost after dieting.
Despite these claims, HAES remains controversial in the medical community.
HAES and the fat acceptance movement
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