At Green Mountain, we’ve said that diets don’t work since 1973 when Thelma first founded us. We’ve also said that hating your body and yourself because of your size is highly counterproductive. And that eating, not starving, is critical to taking care of yourself (seems common sense, but how many of us have lost sight of that fact at times?). And that moving your body should feel good and be fun – not be something you do at a pace or intensity that will create the most weight loss possible.
That’s why it’s so refreshing to see this philosophy starting to really take hold in the larger world. One piece of evidence for that: Last week, the e-newsletter from Medscape – one of the web’s largest sites for education of health professionals – led with a piece titled “Health at Every Size: Toward a New Paradigm of Weight and Health.”
Take the time to read it, then consider taking a copy to your doctor, nutritionist or other member of your healthcare team. Hopefully, they’ll already be in sync with the philosophy. But if not, you’ll be helping spread the word; coming from Medscape adds credibility that might spur even the most weight- and diet-focused health professional to take a second look.
Promoting weight loss through exercise, dietary restriction, and behavior modification rarely succeeds. It often results in cycles of weight loss and gain, with the potential for serious physical and psychological health risks, and contributes to body hatred, dangerous eating disorders, and exercise addiction.[1,2] Yet we believe that if we continue to use the same approaches, we will somehow obtain different results. Indeed, this is the definition of insanity put forth by Alcoholics Anonymous.
There is, however, an exciting, effective, alternative approach to this problem. It is called Health At Every Size (HAES). The basic conceptual framework of this approach includes acceptance of the:
- Natural diversity in body shape and size
- Ineffectiveness and dangers of dieting for weight loss
- Importance of relaxed eating in response to internal body cues
- Critical contribution of social, emotional, and spiritual as well as physical factors to health and happiness.
The Table contrasts the underlying assumptions of traditional weight management approaches with those of HAES.
What Is a Healthy Weight?
The HAES philosophy promotes the concept that an appropriate, healthy weight for an individual cannot be determined by the numbers on a scale, by a height/weight chart, or by calculating body mass index or body fat percentages. Rather, HAES defines a “healthy weight” as the weight at which a person settles as they move toward a more fulfilling and meaningful lifestyle. This includes, but is not limited to, eating according to internally directed signals of hunger, appetite, and satiety and participating in reasonable and sustainable levels of physical activity.
Although research and experience have clearly demonstrated that focusing on weight loss as a primary goal is most likely to produce weight cycling and, over time, increased weight,[4-9] the HAES approach certainly does not suggest that all people are currently at a weight that is the most healthy for their circumstances. What it strongly purports, however, is that movement toward a healthier lifestyle over time will produce a healthy weight for that person.
It is important to understand that removing the focus on weight does not imply ignoring health risks and medical problems. When heavy persons present with medical problems, HAES suggests that health professionals offer the same approaches that they would for a thin person presenting with similar problems. In the case of a thin person with essential hypertension, for example, conventional wisdom suggests dietary changes, increases in aerobic physical activity, and stress management followed by medication if necessary. Yet a heavy person presenting with the same diagnosis is told to lose weight, regardless of all that is known about the most likely consequences of this recommendation.
Healthier at Every Weight
The HAES approach supports a “holistic” view of health that promotes feeling good about oneself; eating well in a natural, relaxed way; and being comfortably active. The following list outlines the major foci for helping people with eating and weight-related struggles from the HAES perspective:
- Self-acceptance: affirmation and reinforcement of human beauty and worth, regardless of differences in weight, physical size, and shape;
- Physical activity: support for increasing social, pleasure-based movement for enjoyment and enhanced quality of life; and
- Normalized eating: support for discarding externally imposed rules and regimens for eating and attaining a more peaceful relationship with food by relearning to eat in response to physiologic hunger and fullness cues.
The overarching goal for health professionals is to help people live healthier, more fulfilling lives by caring for their bodies they presently have.
Health at Every Size: Major Components
HAES offers an effective, compassionate alternative to the failures of traditional approaches. There is a significant body of literature that clearly demonstrates that most so called weight-related problems can be treated effectively with little if any weight loss.[11-13] Even in type 2 diabetes, blood glucose can be normalized without weight loss even when the patient remains markedly obese by traditional medical standards. This finding is further strengthened by the growing body of research showing that obese individuals who are active and fit have lower mortality rates than normal-weight persons who are inactive and unfit.[14-16] Finally, recent research shows that the HAES approach is clearly superior to state-of-the-art, behavioral weight-loss intervention for improving the long-term health of obese participants.[17,18]
Although HAES may not always help make people thinner, by embracing this new approach we can help people of all sizes to be healthier. By not promoting weight loss as a primary goal, we can prevent future generations of children, women, and men from developing eating problems, loathing their bodies, engaging in risky weight-loss strategies, and dying to be thin.
- Gaesser GA. Big Fat Lies. Carlsbad, Calif: Gurze Books; 2002.
- Campos P. The Obesity Myth: Why America’s Obsession With Weight Is Hazardous to Your Health. New York: Gotham Books; 2004.
- Robison JI. Weight, health & culture: shifting the paradigm for alternative healthcare. Alternative Health Practitioner. 1999;5:1-25.
- Field AE, Austin SB, Taylor CB, et al. Relation between dieting and weight change among preadolescents and adolescents. Pediatrics. 2003;112:900-906. Abstract
- Field AE, Wing RR, Manson JE, Spiegelman DL, Willett WC. Relationship of a large weight loss to long-term weight change among young and middle-aged US women. Int J Obes Relat Metab Disord. 2001;24:1113-1121.
- Stice E, Cameron RP, Killen JD, Hayward C, Taylor CB. Naturalistic weight-reduction efforts prospectively growth in relative weight and onset of obesity among female adolescents. J Consult Clin Psychol. 1999;67:967-974. Abstract
- Bild DE, Sholinsky P, Smith DE, Lewis CE, Hardin JM, Burke GL. Correlates and predictors of weight gain in young adults: the CARDIA study. Int J Obes Relat Disord. 1996;20:47-55.
- Coakley EH, Rimm EB, Colditz G, Kawachi I, Willett W. Predictors of weight change in men: results from The Health Professionals Follow-up Study. Int J Obes Relat Metab Disord. 1998;22:89-96. Abstract
- Korkeila M, Rissanen A, Kaprio J, Sorensen TIA, Koskenvuo M. Weight-loss attempts and risk of major weight gain: a prospective study in Finnish adults. Am J Clin Nutr. 1999;70:965-975. Abstract
- Lyons P, Burgard D. Great Shape: The First Fitness Guide for Large Women. Lincoln, Neb; Universe Press; 2000.
- Tremblay A, Despres JP, Maheux J, et al. Normalization of the metabolic profile in obese women by exercise and a low fat diet. Med Sci Sports Exerc. 1991;23:1326-1331. Abstract
- Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of non insulin dependent diabetes. Diabetes Care. 1994;17:1469-1472. Abstract
- Blankenhorn DH, Johnson RL, Mack WJ, El Zein HA, Vailas LI. The influence of diet on the appearance of new lesions in human coronary arteries. JAMA. 1990;263:1646-1652. Abstract
- Barlow CE, Kohl HW, Gibbons LW, Blair SN. Physical fitness, mortality and obesity. Int J Obes Relat Metab Disord. 1995;19(suppl4):S41-S44.
- Church TS, Cheng YJ, Earnest CP, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004;27:83-88. Abstract
- Katzmarzyk PT, Church TS, Janssen I, Ross R, Blair SN. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care. 2005;28:391-397. Abstract
- Bacon L, Keim NL, Van Loan MD, et al. Evaluating a “non-diet” wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes Relat Metab Disord. 2002;26:854-865. Abstract
- Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improves health for obese female chronic dieters. J Am Diet Assoc. 2005. Accepted for publication.
Jon Robison, PhD, MS, Assistant Professor, Michigan State University, East Lansing, Michigan; Co-Editor, Health at Every Size — the journal. Email: firstname.lastname@example.org
Disclosure: Jon Robison, PhD, MS, has disclosed no relevant financial relationships.
Medscape General Medicine. 2005;7(3) ©2005 Medscape