Health at Every Size

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Health at Every Size (HAES) is a hypothesis 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.[1][2][3] Proponents reject the scientific consensus regarding the negative health effects of greater body weight,[4][5] and argue that traditional interventions focused on weight loss, such as dieting, do not reliably produce positive health outcomes.[6] 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 argue that sustained, large-scale weight loss is difficult to the point of effective impossibility for the majority of people, including those who are obese.

HAES proponents believe that health is a result of behaviors that are independent of body weight and that favoring being thin discriminates against the overweight and the obese.[7] Stephan Rössner, an obesity researcher, argues that efforts targeting weight loss may cause rapid swings in size that inflict worse physical and psychological damage than obesity itself.[8]

History

Health at Every Size first appeared in the 1960s, advocating that the changing culture toward aesthetics and beauty standards had negative health and psychological 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.[9] In the opinion piece, Louderback argued that:

  1. "Thin fat people" 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 and emotional tendencies.
  4. Eating without dieting allowed Louderback and his wife to relax and 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 the early 1980s, four books collectively put forward ideas related to Health At Every Size. In Diets Don't Work (1982), Bob Schwartz encouraged "intuitive eating",[10] as did Molly Groger in Eating Awareness Training (1986). Those authors believed this would result in weight loss as a side effect. William Bennett and Joel Gurin's The Dieter's Dilemma (1982), and Janet Polivy and C. Peter Herman's Breaking The Diet Habit (1983) argued that everybody has a natural weight and set-point, and that dieting for weight loss does not work.[11][better source needed]

According to Lindo Bacon, in Health at Every Size (2008), the basic premise of HAES is that "well-being and healthy habits are more important than any number on the scale."[12] Emily Nagoski, in her book Come as You Are (2015), promoted the idea of Health at Every Size for improving women's self-confidence and sexual well-being.[13]

Science

Diagram of the health effects of obesity, from the US CDC

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, and that a weight-inclusive approach focusing on health biomarkers, instead of weight-normative approaches focusing on weight loss alone, provides greater health improvements.[14][15]

There is a considerable amount of evidence that being overweight is associated with increased all-causes mortality, and significant weight loss (>10%), using a variety of diets, improves or reverses metabolic syndromes and other health outcomes associated with overweight and obesity.[16][17][18][19] Obesity has been correlated with a wide variety of health problems.[17][4] These problems range from congestive heart failure,[20] high blood pressure,[21] deep vein thrombosis and pulmonary embolism,[22] type 2 diabetes,[23] infertility,[24] birth defects,[25] stroke,[26] dementia,[27] cancer,[28] asthma and chronic obstructive pulmonary disease[29] and erectile dysfunction.[30] A BMI greater than 30 is associated with twice the average risk of congestive heart failure.[31][32] Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[33][34] A 2002 report concluded that 21% of ischemic heart disease is due to obesity,[35] while a 2008 European consensus puts the number at 35%.[36] Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year[37] (including increased morbidity in car accidents).[38]

In a 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.[39]

There is no evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism; 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.[40][41][42]

Obesity, overweight and specific nutrient excess are recognized as diseases by the World Health Organization,[43] and preventable causes of death worldwide.[44]

Criticism

Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept,[45] 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'".[46] 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".[47] 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.[48]

Using data from 527,662 working adults in Spain, a January 2021 study in the European Journal of Preventive Cardiology found that an active lifestyle cannot cancel the negative effects on cardiovascular health caused by obesity.[49][50] Study author Alejandro Lucia stated:[51]

One cannot be 'fat but healthy,' This was the first nationwide analysis to show that being regularly active is not likely to eliminate the detrimental health effects of excess body fat. Our findings refute the notion that a physically active lifestyle can completely negate the deleterious effects of overweight and obesity.

References

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