Health At Every Size (HAES): Social Justice and Redefining Healthy Weight

Medically reviewed by Alida Iacobellis, Registered Dietitian (RD), MHSc

Writing and research contributions by Alana Freitag, Olivia Kuhlmann, and Ann Le

In Part 2 of this series, Health At Every Size (HAES): The Surprising Truth About Your Weight and the Health Impacts of Weight Bias, we looked at the research on HAES and how the non-diet approach is supportive of improved physical and mental health, along with the detrimental health effects of weight bias and stigma. In Part 3 we’ll be shining a light on the concept of a healthy weight, uncovering some of the many shortcomings of the Body Mass Index (BMI), and providing you with some actionable steps to reducing weight bias. Let’s dive in… 

Expanding the Concept of a Healthy Weight: Beyond the BMI

Unlike traditional weight management approaches that aim to help overweight and obese individuals lower their weight for the sake of fitting into a lower BMI category, the HAES approach prioritizes finding your biologically appropriate weight (BAW) – a weight that is easily maintained without the practice of dieting or other inappropriate food and exercise behaviours (1). A person’s BAW also takes into consideration normal physical and psychological functioning, ethnicity, gender, and family history, all important factors the BMI fails to take into consideration (1).

BAW is a much more holistic and individualized way of determining a healthy weight, especially compared to the BMI which is only a measurement of the relationship between your height and weight and was never intended to be a metric of health when it was first developed. By taking the focus off BMI, HAES works to normalize size diversity and in doing so, promote whole person health.

The Racist Roots of the BMI

Did you know the BMI was developed based on the size and measurements of mainly White Western European males (2)? Studies have shown that the BMI is not an accurate measure for people of colour, and disproportionately labels back bodies as being ‘overweight’ (3, 4). Research also shows that the BMI more often under diagnoses for Asian communities (5). Due to its focus on acceptance of all body shapes and sizes, HAES is an approach that lends itself well to the work of diversity, inclusion, and anti-racism.

Tips to Reduce Weight Bias

It’s important to recognize that weight bias and discrimination are embedded within the very fibres of the fabric of society. Doing your part to recognize and respond to weight shaming, stigma, and discrimination can make a positive and lasting change in the lives of others. To make a real change, it’s important to understand how we might be (without intention or knowing) contributing to and/or perpetuating weight bias and fatphobia. 

Here’s where you can start:

1. Become aware of your own attitudes and assumptions about body weight by taking a weight bias self-assessment. https://implicit.harvard.edu/implicit/ Note: if you are surprised or uncomfortable by the results of the assessment, that does not make you a bad person. It just goes to show the power of diet culture and societal ideals in impacting our beliefs (6).
2. Stop complimenting weight loss and expressing concern over weight gain (6).
3. Use person-first language rather than describe or define others by their weight or disease. ie., “person living with obesity” is person first language, saying “an obese person” is not (6).
4. Speak up when you hear or see inappropriate comments or jokes (6).

To Diet or Not to Diet: The Pros and Cons of HAES

With a HAES approach, it’s possible to improve many markers of physical and mental health and in some cases, these improvements are more long standing than with traditional weight loss methods such as restrictive diets and increased exercise (7-10). Encouraging size acceptance, reducing dieting behaviour, increasing awareness of body signals, and prioritizing health rather than weight is proving to be an effective and sustainable way to improve health outcomes while also combating weight stigma (7-10).

When considering any new approach, it’s always important to critically evaluate all sides to ensure you are making the best decision for you. So how does HAES stack up to traditional “eat less move more” approaches? Here’s a summary of the current research to help you decide.

Risks of a Traditional Weight Loss Approach to Health

• Lack of evidence to support long-term and sustainable results – often leads to weight regain (11)
• May lead to poor mental health outcomes including negative self-image and body dissatisfaction, low self-esteem, binge eating behaviour, disordered eating or eating disorders (11)
• Contributes to weight bias and stigma and perpetuates the thin ideal leading to weight-based discrimination (12)

Benefits of a Traditional Weight Loss Approach to Health

• Generally results in short term weight loss (12)
• May lead to improved physical health improvements in blood pressure, cholesterol, and cardiovascular fitness (11, 12)
• May reduce depression in the short term (11, 13)

Risks of a Non-Diet HAES Approach to Health

• Weight neutral – weight loss is not the focus, therefore it is not guaranteed as an outcome

Benefits of a Non-Diet HAES Approach to Health

• Can improves heart health and increase physical activity that is sustainable long term (11)
• Can improve self-esteem and body acceptance and reduce depression longer-term (11)
• Reduces disordered eating and intake of processed foods (11)
• Increases conscious eating behaviour (11)
• Helps to reduce weight stigma and bias by promoting body positivity and body acceptance (11, 14)

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Alida Iacobellis is a Registered Dietitian with her Master’s in Health Science based in Toronto, Ontario, Canada. She is the creator of The MORE Method – the framework she uses to help her clients take their eating from disordered to intuitive and through Moderation, Optimization, Restoration and Elevation of their diet and mindset. Her coaching philosophy and approach is informed by Intuitive Eating, Health At Every Size, Cognitive Behaviour Therapy, Dialectical behaviour Therapy, and Motivational Interviewing.    

References

[1] Herrin, M., Larkin, M. Nutrition Counseling in the Treatment of Eating Disorders. 2013. p 169-170

[2]Eknoyan, G. (2008). Adolphe Quetelet (1796–1874)—The average man and indices of obesity. Nephrology Dialysis Transplantation, 23(1), 47–51. https://doi.org/10.1093/ndt/gfm517

[3] Gilbert, S. C. (2003). Eating Disorders in Women of Color. Clinical Psychology: Science and Practice, 10(4), 444–455. https://doi.org/10.1093/clipsy/bpg045  

[4] The Endocrine Society. (2009, June 22). Widely Used Body Fat Measurements Overestimate Fatness In African-Americans, Study Finds. ScienceDaily. Retrieved May 16, 2021 from www.sciencedaily.com/releases/2009/06/090611142407.htm 

[5] Racette, S. B., Deusinger, S. S., & Deusinger, R. H. (2003). Obesity: Overview of Prevalence, Etiology, and Treatment. Physical Therapy, 83(3), 276–288. https://doi.org/10.1093/ptj/83.3.276

[6] 3 Tips to Overcoming Weight Bias. Nutrition for Non-Nutritionists. (2017, November 30) https://nutritionfornonnutritionists.com/2017/11/3-tips-to-overcoming-weight-bias/.

[7] Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1), 9. https://doi.org/10.1186/1475-2891-10-9

[8]  Bacon, L., Keim, N. L., Van Loan, M. D., Derricote, M., Gale, B., Kazaks, A., & Stern, J. S. (2002). Evaluating a “non-diet” wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. International Journal of Obesity and Related Disorders, 26(6), 854–865. http://dx.doi.org.ezproxy.lib.ryerson.ca/10.1038/sj.ijo.0802012

[9] Darragh, M. (2020). The ‘health at every size’ approach to health: A critical review. Journal of HEIA,  Vol. 6, No. 1. Retrieved from https://heia.com.au/wp-content/uploads/2020/09/Darragh_from-HEIA_Vol26No1.pdf 

[10] Penney, T. L., & Kirk, S. F. (2015). The health at every Size paradigm and obesity: Missing empirical evidence may help push the reframing Obesity debate forward. American Journal of Public Health, 105(5). doi:10.2105/ajph.2015.302552 

[11] Ulian, M. D., Aburad, L., Oliveira, M. S. da S., Poppe, A. C. M., Sabatini, F., Perez, I., Gualano, B., Benatti, F. B., Pinto, A. J., Roble, O. J., Vessoni, A., Sato, P. de M., Unsain, R. F., & Scagliusi, F. B. (2018). Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: A systematic review. Obesity Reviews, 19(12), 1659–1666. https://doi.org/10.1111/obr.12749

[12] Dugmore, J. A., Winten, C. G., Niven, H. E., & Bauer, J. (2020). Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: A systematic review and meta-analysis. Nutrition Reviews, 78(1), 39–55. https://doi.org/10.1093/nutrit/nuz020

[13] Bacon, L., Stern, J.S., Van Loan, M.D. & Nancy L. Keim, N.L. (2005). Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters. Journal of the American Dietetic Association, Volume 105, Issue 6, 2005, Pages 929-936, ISSN 0002-8223, https://doi.org/10.1016/j.jada.2005.03.011.

[14] Association for Size Diversity and Health [ASDAH]. ( 2020, October 16). The health at Every Size® (HAES®) APPROACH. Retrieved March 19, 2021, from https://asdah.org/health-at-every-size-haes-approach/