Health at Every Size
Health at Every Size (HAES) is a movement that "supports people in adopting health habits for the sake of health and well-being (rather than weight control)." 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, 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. HAES has recently gained popularity among proponents of the fat acceptance movement as an alternative to weight-loss.
HAES 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 link between obesity and increased morbidity; however, HAES proponents seek to highlight that correlation does not imply causation. For instance, they believe that obese people who are unhealthy may 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.
HAES proponents believe that:
- In many cases, attempts to diet to lose weight do not lead to sustained weight loss in the long term.
- Self-acceptance promotes improved mental 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.
Evidence from certain scientific studies has provided no rationale for a shift in focus in health management from weight loss to a weight-neutral approach in obese individuals who have not yet developed obesity related co-morbidities such as 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" there is a small amount of evidence that weight loss from dieting can result in slightly increased mortality, while those who maintained their weight (but did not gain any additional weight) fared the best. 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." 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."
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. 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.
Many studies show links between mortality and obesity. In recent years, medical studies have challenged the 'healthy obesity' concept. A notable study which was published in the Journal of the American College of Cardiology in 2014 shows that obesity is correlated to higher artery plaque, which means higher risk for heart disease and stroke despite the participant's current lipid profile. A recent meta-analysis found elevated risk for all-causes mortality and cardiovascular disease in metabolically-healthy obese patients, estimating the relative risk for these patients vs. metabolically-healthy normal-weight individuals at 1.24. However, this is lower than the relative risks estimated for metabolically-unhealthy obese patients (RR 2.65) and for metabolically-unhealthy non-obese patients (RR 3.14). Another review found that metabolically-healthy obesity "is an important, emerging phenotype with risks somewhere intermediate between healthy, normal weight and unhealthy, obese individuals." One complicating factor is that definitions of metabolically-healthy obesity are not currently standardized across studies.
Studies show that obesity is linked to a wide variety of health problems. These problems range from congestive heart failure, high blood pressure, deep vein thrombosis and pulmonary embolism, type two diabetes, infertility, birth defects, stroke, dementia, cancer, asthma and chronic obstructive pulmonary disease and lifestyle changes are associated with improvement in sexual function in about one third of obese men with erectile dysfunction at baseline.
- 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.
- 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.
- "NAAFA Policy Recommendations". National Association to Advance Fat Acceptance.
- "Activists See Diet Industry as Drain on Money, Self-Esteem". USA Today. Associated Press. August 2, 2004.
- Shields, Margot; Gorber, S. Connor and 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.
- "Does sustained weight loss lead to decreased morbidity and mortality?". International Journal of Obesity 23 (S5): S20. 1993. doi:10.1038/sj.ijo.0800982.
- 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.
- Louderback, Lew (Nov 4, 1967). "More People Should Be Fat". The Saturday Evening Post.
- Bob Schwartz (1996). Diets don't work. Breakthru Pub. ISBN 978-0-942540-16-1.
- 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.
- 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.
- Kendall Powell (May 31, 2007). "The Two Faces of Fat". Nature 447 (7144): 525–7. doi:10.1038/447525a. PMID 17538594.
- 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.
- 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.
- Samaras TT, Storms LH (1992). "Impact of height and weight on life span.". Bull World Health Organ 70 (2): 259–67. PMC 2393304. PMID 1600586.
- "Negative health effects of obesity". Michigan State University. Michigan State University Board of Trustees. 2014.
- Schwimmer JB, Burwinkle TM, Varni JW (2003). "Health-related quality of life of severely obese children and adolescents.". JAMA 289 (14): 1813–9. doi:10.1001/jama.289.14.1813. PMID 12684360.
- "Is Healthy Obesity a Myth?". nlm.nih.gov. 30 April 2014. Retrieved 31 May 2014.
- "Dispelling the myth of 'healthy obesity'". British Heart Foundation. 1 May 2014. Retrieved 31 May 2014.
- Kramer, CK; Zinman, B; Retnakaran, R (Dec 3, 2013). "Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis.". Ann Intern Med 11 (159): 758–69. doi:10.7326/0003-4819-159-11-201312030-00008. PMID 24297192.
- Roberson, Lara L; Aneni, Ehimen C; Maziak, Wasim; Agatston, Arthur; Feldman, Theodore; Rouseff, Maribeth; Tran, Thinh; Blaha, Michael J; Santos, Raul D; Sposito, Andrei; Al-Mallah, Mouaz H; Blankstein, Ron; Budoff, Matthew J; Nasir, Khurram (Jan 8, 2014). "Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review". BMC Public Health 14 (14): 14. doi:10.1186/1471-2458-14-14. PMC 3890499. PMID 24400816. Retrieved 29 July 2014.
- Blüher, S; Schwarz, P (Jun 19, 2014). "Metabolically healthy obesity from childhood to adulthood — Does weight status alone matter?". Metabolism 14. doi:10.1016/j.metabol.2014.06.009. PMID 25038727.
- "www.who.int" (PDF). WHO. Retrieved February 22, 2009.
- "Obesity and the risk of heart failure".
- "Obesity and thrombosis".
- "Impact of male obesity on infertility: a critical review of the current literature".
- "Maternal Overweight and Obesity and the Risk of Congenital Anomalies".
- "Body Mass Index and the Risk of Stroke in Men".
- "Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis".
- "Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults".
- "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies".
- "Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men".
- 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.
- Aphramor, Lucy (2011). "Weight Science: Evaluating the Evidence for a Paradigm Shift". Nutrition Journal (Springer Science+Business Media) 10: 9. doi:10.1186/1475-2891-10-9. PMC 3041737. PMID 21261939.
- 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.
- Glenn A. (2006). "Fatness, Fitness & Health: A Closer Look At The Evidence" (PDF). Absolute Advantage 5 (3): 18–21.
- 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.
- Robison, J (2006). "Health At Every Size" (PDF). Absolute Advantage 5 (3): 8–13.
- 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.