Health at Every Size
Health at Every Size (HAES) is a theory advanced by certain sectors of the fat acceptance movement. It is promoted by the Association for Size Diversity and Health, a tax-exempt nonprofit organization that owns the phrase as a registered trademark. Its main tenet involves rejection of the scientific consensus regarding the link between excessive calorie intake, a sedentary lifestyle and lack of physical exercise, improper nutrition, and greater body weight - and its effects on a person's health.
HAES advocates argue that traditional interventions focused on weight loss, such as dieting, do not reliably produce positive health outcomes. The benefits of lifestyle interventions such as nutritious eating and exercise are presumed to be real, but independent of any weight loss they may cause. At the same time, HAES advocates espouse that sustained, large-scale weight loss is difficult to the point of effective impossibility for the majority of obese people. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited, and often false, as studies have shown that obese individuals incorrectly self-report calories consumed; on average, obese people have a greater energy expenditure than their healthy-weight counterparts due to the energy required to maintain an increased body mass. HAES proponents believe that health is a result of behaviors that are independent of body weight and that favouring being thin discriminates against the overweight and the obese. Efforts towards such weight loss are instead held to cause rapid swings in size that inflict far worse physical and psychological damage than would obesity itself.
As part of the wider fat acceptance movement, HAES includes also a significant social and psychological dimension. Proponents view the common wisdom that obesity is unhealthy as part of a general stigmatization of the obese, and especially of obese women; thus, the movement has strong connections with feminism.
Health At Every Size first appeared in the 1960s, advocating that the changing culture toward aesthetics and beauty standards had negative repercussions to fat people. They believed that because the slim and fit body type had become the acceptable standard of attractiveness, fat people were going to great pains to lose weight, and that this was not, in fact, always healthy for the individual. They contend that some people are naturally a larger body type, and that in some cases losing a large amount of weight could in fact be extremely unhealthy for some. 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. In the opinion piece, Louderback argued that:
- "Thin fat people" 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 without dieting allowed Louderback and his wife to relax, feel better while maintaining the same 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 said people who ate unrestricted diets were not worried about food and weight, and advocated "intuitive eating". Molly Groger wrote a book about her training program, Eating Awareness Training, which also advocated intuitive eating. Both Groger and Schwartz however, suggested that by following this program 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 claimed 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 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.
Proponents claim that evidence from certain scientific studies 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.
Obesity has been correlated with a wide variety of health problems. These problems range from congestive heart failure, high blood pressure, deep vein thrombosis and pulmonary embolism, type 2 diabetes, infertility, birth defects, stroke, dementia, cancer, asthma and chronic obstructive pulmonary disease and erectile dysfunction. Having a BMI greater than 30 doubles one's risk of congestive heart failure. Obesity is associated with cardiovascular diseases including angina and myocardial infarction. A 2002 report concluded that 21% of ischemic heart disease is due to obesity while a 2008 European consensus puts the number at 35%. Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year (including increased morbidity in car accidents).
In one observational study, weight loss was associated with increased mortality, although the number of deaths was very small. They recommended prevention of obesity as the best course of action. In another observational study, intentional weight loss had a small positive benefit for those classified as unhealthy obese (or those with overweight risk factors) with a slight increase in mortality. While those who are obese but healthy saw no increase in mortality from weight loss. Controlled interventions are required to distinguish the "influence of physical activity, diet strategy and body composition". In another study with a middle-aged to elderly sample, personal recollection of maximum weight in their lifetime was recorded and an association with mortality was seen with 15% weight loss for the overweight. Moderate weight loss was associated with reduced cardiovascular risk amongst obese men. Intentional weight loss was not directly measured, but it was assumed that those that died within 3 years, due to disease etc., had not intended to lose weight. 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.
Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average, obese people have a greater energy expenditure than their healthy-weight counterparts due to the energy required to maintain an increased body mass.
Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept, 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'". He does not explicitly name HAES as its topic, but discusses similar concepts. While he applauds the confrontation and combating of anti-obesity bias, his opinion is that a continued focus on being 'okay at any size' may normalize ill-health and prevent people from taking steps to reduce obesity.
In May 2017, scientists at the European Congress on Obesity expressed scepticism about the possibility of being "fat but fit". A twenty-year observational study of 3.5 million participants showed that "fat but fit" people are still at higher risk of a number of diseases and adverse health effects than the general population.
- ""Health At Every Size®" is now a Registered Trademark".
- "Trademark Guidelines". Association for Size Diversity and Health (ASDAH).
- "Association for Size Diversity and Health". Tax Exempt Organization Search. Internal Revenue Service. Retrieved May 29, 2018.
- "www.who.int" (PDF). WHO. Retrieved February 22, 2009.
- Ed Cara (22 April 2016). "Health At Every Size Movement: What Proponents Say vs. What Science Says". Newsweek Media Group.
HAES has directly attacked commonly held ideas about obesity and weight...
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- 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.
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- "Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults".
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- Kendall Powell (May 31, 2007). "The Two Faces of Fat". Nature. 447 (7144): 525–7. doi:10.1038/447525a. PMID 17538594.
- 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. PMC . PMID 24764532.
- Katz, David. "Why I Can't Quite Be Okay With 'Okay at Any Size'". Huffington Post. Retrieved 29 April 2015.