Health at Every Size
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).". 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[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. HAES proponents believe that obese people who are unhealthy may in part 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. Today there are over 8,000 pledges to HAES.
HAES proponents believe that:
- In many cases, fad diets do not lead to sustained weight loss.
- 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.
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.
This study of around 3000 Finns over an 18-year period showed that "Weight loss in overweight and obese individuals leads to rapid improvement of the cardiovascular risk factor profile and reduced risk of developing type 2 diabetes." while seeing a slightly increased morbidity in individuals who intentionally lost weight or unintentionally gained weight.  The study acknowledges the increased morbidity to be very slight, and partially attributes it to loss of FFMI (fat free mass index) due to weight loss through diet alone, weight loss due to onset of disease, and negative changes in lifestyle such as smoking.  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 saw no increase in mortality from weight loss. 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.
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'", which while it does not explicitly name HAES as the topic of the piece, it could easily interpreted as such. While he applauds the principles of anti-obesity bias, his opinion is that a continued focus on being 'okay at any size' (which may be an allusion to HAES) may normalise ill-health and prevent action being taken to reduce the burden of disease that is caused by obesity.
Studies have linked obesity to a wide variety of health problems, and some studies indicate that it increases the risk of some serious health conditions. 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 erectile dysfunction. Additionally, obesity complicates any operation and can cause significant postoperative wound care problems. 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%.
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