What is Health At Every Size (HAES)?
By: Lindsay Hodgson, MSN
Health At Every Size (HAES) is both a healthcare approach and social justice movement. It centers weight neutral care while also working to end size-based discrimination, stigma, and anti-fatness/anti-fat bias.
HAES brings awareness to the weight bias inherent in our culture. It also aims to challenge ever-present notions that we can judge someone’s health by their appearance or that prescribing weight loss will improve health outcomes. HAES is vastly different from how many of us conceptualize health and healthcare, so it’s very normal for it to feel unsettling and take some time to let it sink in.
HAES is often used in the context of recovering from eating disorders, disordered eating behaviors, and chronic dieting because it removes the focus from weight in order to heal. However, HAES is for everybody and every body. In fact, it is an important shift in how we approach health care because it’s about understanding the humanity in the patient and focusing on behaviors rather than appearance or numbers.
What are the 5 Core Principles of Health At Every Size?
Principle 1: Weight Inclusivity- Weight inclusivity means acknowledging bodies come in all shapes and sizes. A certain weight or body type should not be valued over another just as someone’s weight should never be classified as a disease.
Principle 2: Respectful Care- Respectful care addresses the importance of patient-centered care. All people (regardless of size, race, ethnicity, gender, ability, sexuality, and more), are deserving of support that caters to their unique situation, identities, and health goals. A significant component of respectful care is that all people, especially healthcare professionals, recognize their biases so they can do better and provide inclusive care.
Principle 3: Eating for Well-Being- Eating for well-being promotes eating patterns where you can trust your body and eat the foods that make you feel best. Your food choices are based on your hunger/fullness, preferences, satisfaction, and special dietary needs as opposed to a weight loss diet or plan. Intuitive eating is often used with a HAES approach because it is an anti-diet nutrition framework that helps you reconnect with food and your body.
Principle 4: Life-Enhancing Movement- Life-enhancing movement is the idea that exercise, if you choose to engage in it, should be a gentle and joyful part of self-care instead of rigorous or punishing. It also means redefining fitness and working to address inequities so all people (regardless of age, ability, etc.) have access to enjoyable forms of movement.
Principle 5: Health Enhancement- Enhancing health is widening the lens from the individual to also focusing on systemic change in order to improve community and population holistic health. In this way, HAES also considers social determinants of health, which are the social factors beyond lifestyle behaviors that affect health. Some examples of social determinants of health include the safety of your neighborhood, access to food, racism or discrimination, health insurance, and more. By focusing on public policies that increase access to health-related services and education, the HAES paradigm aims to address inequity as part of your health status.
While the approach is “health” at every size, it also emphasizes that physical health is not a moral obligation. In other words, your health status does not determine your worthiness as a human and should not impact your access to and quality of health care. This view differs greatly from the common belief that health is an individual responsibility and approaches that emphasize healthy food and exercise choices.
Instead, HAES thinks about health in a truly holistic manner, acknowledging that health is not necessarily within our control. It also recognizes that health includes community networks, mental health, economic stability, and spiritual wellness. Widening this definition of health allows people to embrace the aspects that nourish their health and let go of health-related obligations that do not serve them.
Health At Every Size Approach Means:
You as a patient define health for yourself, which helps dictate the health behaviors you and your healthcare provider prioritize
No emphasis on numbers (ie weight, BMI, calories, macros, etc.)
Movement and food patterns that sustain you and make you feel your best
Rejecting the idea of “obesity” as a disease state
An understanding that social factors and identities affect health beyond simply individual lifestyle choices
All people are deserving of quality, compassionate care regardless of health status or lifestyle
Health At Every Size Approach Doesn’t Mean:
Valuing one type of body or weight over another
Using diets or diets disguised as “lifestyles” to guide food choices
Prescribing one treatment for someone in a larger body and a different treatment for someone in a smaller body when both patients have the same medical concern (i.e. weight stigma and discrimination)
Thinking of health as a moral obligation
What are Common misconceptions about Health At Every Size (HAES)?
HAES can be confusing, especially since it represents such a paradigm shift. Some misconceptions are:
Doesn’t HAES encourage “unhealthy” body sizes? HAES does not promote one body type over another, but rather views all bodies as neutral. However, as a social justice movement, HAES does try to center the voices of people who live in marginalized bodies, which includes but is not limited to individuals in larger bodies.
If my healthcare provider uses HAES, they will judge me for wanting to lose weight? HAES providers have compassion that we all live in diet culture where weight loss is celebrated, encouraged and expected, especially from those that live in larger bodies. HAES providors will explore your feelings about your weight with you and ultimately respect your autonomy even if HAES does not resonate with you at this time.
Everyone is deemed healthy no matter their weight. In HAES, health is not just thought of in terms of disease or health status. It recognizes that all people, regardless of size, face health challenges. Further, since health is dynamic and involves a person’s ability to have positive well-being, a HAES approach is about helping you support your well-being using health-promoting behaviors that feel right for you.
Health At Every Size is a crucial part of anti-diet work because it is a movement working to redefine health and make the world a safer place for people of all body sizes. HAES offers a lens that can extend from the doctor’s office to the broader culture to challenge diet culture, weight stigma, and health disparities. So it’s not just about individual weight-neutral health behaviors, but also a collective shift towards inclusivity as part of the definition of health, health-related resources, and healthcare.
References: The Health At Every Size Approach. The Association for Size Diversity and Health. Accessed August 26, 2021.
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