Since people seem to be awfully confused.
What I am saying: “Weight loss interventions have very low permanent success rates for most people.”
What I’m not saying: “No one in history has ever lost weight permanently in a healthy manner.”
Health At Every Size is, fundamentally, a weight-neutral approach, which means it focuses directly on health-supporting behaviours, and allows weight to adjust as it will. Sometimes it will adjust up, sometimes down, and sometimes it will stabilize. It is true that only a small percentage of people seem to lose weight permanently, according to research, but I do not deny that those people exist. Some of them may have even lost weight by using a HAES approach.
What I am saying: “People have the literal, legal right to eat any food they like, because human beings are condemned to be free. Food choices cannot make you a better or worse person, and food choices are only one factor among many that influence health.”
What I’m not saying: “No food choice ever has an impact on health, and you can eat anything you like without having it impact your health in any way.”
Food choices do impact health, but food choices have also been spun up in the media as the only or the most important thing that influences health, which is not accurate. (The largest impact on health actually comes from living conditions and other social determinants of health.) You are allowed, as an autonomous human being, to choose to eat any food that’s available to you – but, as an autonomous human being, you will also be the one to bear the brunt of the consequences of those choices. Health at Every Size includes a focus on intuitive eating and getting good nutrition because we believe a healthy relationship with food, and a good quality diet, can help improve people’s health. Eating well, in the HAES philosophy, is not the same as eating in a restrictive, restrained manner that is the current popular conception of “healthy eating.” Instead, it focuses on understanding internal signals of hunger and fullness, truly getting enough to eat, improving one’s attitudes toward food so that you are not feeling guilty or anxious, and getting balance, variety, and pleasure in the diet.
What I am saying: “Weight is not a behaviour. Weight is a multifactorial trait that is highly heritable. It is not completely within anyone’s control, and no one can simply choose how much to weigh.”
What I’m not saying: “Weight is never, ever influenced by behaviour [see the first point, above.]”
In arguments about fat and health, people often enjoy claiming that fatness (a phenotypic trait) is opposite but equivalent to anorexia nervosa, an eating disorder with a specific set of behavioural and clinical diagnostic criteria. I think they do this because it gives their arguments (often very abusive, stigmatizing arguments) a veneer of respectable concern and clinical authority, but it’s a false equivalence. Fatness is actually the opposite of thinness, which is also a trait. Traits can be associated with diseases, they can even be implicated in diseases, or symptomatic of diseases, but they are not, in and of themselves, diseases. If you believe fatness is an eating disorder, then in order to be logically consistent, you would have to believe that thinness is also an eating disorder. It’s not. Binge eating disorder is a disorder, and it can cause people to gain weight. However, most fat people do not have binge eating disorder. Moreover, the treatment for binge eating disorder is not dieting and weight loss, it’s learning to eat normally and intuitively, without shame.
What I am saying: “Giving fat people the autonomy to make their own choices around food and exercise and weight, instead of abusing, threatening, and coercing them, is not only more ethical, but also more likely to result in people prioritizing their health in a way that makes sense for them.”
What I’m not saying: “Encouragement to eat well, exercise, or value one’s health is inherently oppressive to fat people.”
Health at Every Size actively encourages people to eat well and find activities that suit them, while not hating themselves. Random strangers on the street shouting abuse at fat people “for their own good”? No. Not acceptable. Doctors withholding effective treatment for certain health issues on the condition that fat people engage in a risky, non-evidence-based treatment (dieting)? No. Not acceptable, and not health-promoting. Well-meaning but ignorant, or even frankly abusive, family members or friends tossing off health advice to adults who have not solicited it? No. Not acceptable.
Black-and-white thinking is the order of the day when it comes to discussions about weight and health. It’s tempting, but don’t get sucked in. A fun trick I like to use, when I encounter two statements that seem to be totally at odds, is to ask myself, “Is there any way both of these things can be true at the same time?” (e.g. Is it possible to believe both that fat people may have a higher risk of disease, and that they can take steps to gain health without losing weight? I think so!) Reality is usually complex enough to sustain seeming paradoxes. Sniff them out. They are good medicine for dichotomous thinking.