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] In particular, HAES claims that being obese is not a problem, contrary to the consensus of the medical community.[4] HAES has recently gained popularity among proponents of the fat acceptance movement as an alternative to weight-loss.[5][6]

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.[7] HAES proponents 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.[8] Today there are over 8,000 pledges to HAES.

HAES proponents believe that:

  1. In many cases, attempts to diet to lose weight do not lead to sustained weight loss in the long term.[9]
  2. Self-acceptance promotes improved mental health and happiness.[10]

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.[11] 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.[12] 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. Linda Bacon is also an important role in this movement today. Linda Bacon is the leader of many HAES workshops and has written four books based on the HAES principles.

Scientific evidence[edit]

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, but will, develop obesity related co-morbidities such as type 2 diabetes and/or symptoms of cardiovascular disease.[13] 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"[14] 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.[14][15] 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."[14] 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."[14]

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.[13][16][17] 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.[15]

Scientific criticism[edit]

Many studies show clear links between mortality and obesity.[18][19][20] In recent years, medical studies have continued to promote healthy living and recently have focussed on the so-called '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.[21][22] 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).[23] Another review found that metabolically-healthy obesity "is an important, emerging phenotype with risks somewhere intermediate between healthy, normal weight and unhealthy, obese individuals."[24] One complicating factor is that definitions of metabolically-healthy obesity are not currently standardized across studies.[25]

Studies show that obesity causes a wide variety of health problems.[26] These problems range from congestive heart failure,[27] high blood pressure,[28] deep vein thrombosis and pulmonary embolism,[29] type two diabetes, infertility,[30] birth defects,[31] stroke,[32] dementia,[33] cancer,[34] asthma and chronic obstructive pulmonary disease[35] and erectile dysfunction.[36] Additionally, obesity complicates any operation and can cause significant postoperative wound care problems.[37]

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[38][39] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[26] while a 2008 European consensus puts the number at 35%.[40]

Having a BMI greater than 30 doubles one's risk of congestive heart failure.[41][42]

More than 85% of those with hypertension have a BMI greater than 25.[42] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin-aldosterone system.[43] The association between hypertension and obesity has been also well described in children.[44]

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[45][46]

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it “diabesity”.[42] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[47]

Due to its association with insulin resistance, the risk of PCOS increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI greater than 30.[48]

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[42] and altering spermatogenesis in men.[49] It is believed to cause 6% of primary infertility.[42][50] A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3.[51] Being morbidly obese increases the odds ratio to 2.0.[51]

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[52] Obese women have more than twice the rate of C-sections compared to women of normal weight.[53] Obese women also have increased risk of preterm births and low birth weight infants.[54]

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[55]

Ischemic stroke is increased in both men and women who are obese.[42] For women with a BMI greater than 30, the risk of ischemic stroke increases by 1.7 fold,[56] while men with a BMI greater than 30 had a risk of stroke 2.0 times greater.[57]

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[58]

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[59] These cancers include: [60]

Al high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.[61]

Compared to men with a BMI of 21–23, men with a BMI of 30–35 have 2.3 times more gout, and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.[62]

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints.[42] Those with a BMI greater than 26.4 had rate of osteoarthritis of the knees 6 times greater than those with a BMI of less than 23.4, well rates of osteoarthritis in the hand was about 1.5 times greater.[63]

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[64]

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[65] The rates are about double that found in the normal weight population.[66] Urinary incontinence improves with weight loss.[67]

Obesity increases one's risk of renal failure by three to four times.[68]

References[edit]

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Further reading[edit]