Health at Every Size is not a new diet.

I would like to state that I am firmly in favour of Health at Every Size. I am a healthcare practitioner and student of nutrition, so that I find HAES an interesting and attractive concept should come as no surprise. That is my bias, as a healthcare nerd.

But I would also like to make it clear that I believe fat acceptance and the rights of fat people are in NO WAY contigent on believing in, agreeing with, or practicing Health at Every Size.

IN NO WAY.

Quick fat history moment:

I think it is very important that as a movement we do NOT adopt elitist attitudes which tend to weed out the very people most in need of what we claim to support. It is one thing to have as our goal the right of every person, regardless of size, to have access to the resources to become more physically fit. It is quite another to base the acquisition of our civil rights, individually or as a community, on being or becoming “fit”. To do this would be healthist.”

-Karen Stimson, 1983

Fat acceptance has been wrangling with this issue for a while now. However. I do think that, commonly, people who are uncomfortable with the idea of Health at Every Size, are likely uncomfortable due to a misunderstanding of one sort or another.

The misunderstandings are various, but include:

1) the definition of “health” itself — there actually isn’t an official, universally agreed-upon one, and I believe a fundamental aspect of HAES philosophy is to try to create a newer, more inclusive, more compassionate definition of health

2) the fear that HAES must be classist in its practical requirements (it doesn’t; I am dreadfully poor and would never be able to claim a HAES badge if I had to do certain things like join a gym or buy special foods)

3) the assumption that a certain eating style (most often classical ‘demand feeding’ or the newer concept of ‘intuitive eating’) is absolutely required

4) the assumption that a certain type or amount of exercise is absolutely required

5) the assumption that, if you have a limiting or pre-existing health condition of some sort, you are excluded from practicing HAES (most people I know who are HAES-boosters actually have fairly limiting health issues, myself included, in that I have a history of disordered eating which precludes me from practicing demand-feeding, and including my very good friend, aerobics enthusiast, and extreme heroine of all situations, Dee, who has a serious physical injury.)

In my opinion, the behaviours of HAES are much less important than the intentions and beliefs behind those behaviours. The behaviours are simply tools, and there are a plethora from which to choose. Many of those tools have been totally co-opted by the weight-loss establishment, and so have taken on a pungent flavour of negativity and neuroticism — but, if sincerely divorced from the context of weight control, I really believe some or all of them could be adapted and put to good use.

So, in rough format, the essential beliefs of HAES are as follows:

1) You are fat accepting — both of yourself and others. You may not be perfect at it, but you make an effort to be aware of your own biases and to challenge them, both in regard to yourself and other people. You value size diversity.

2) In view of item 1, you are therefore not making any intentional attempts to lose weight. There are situations in which a person might need to purposely try to gain weight (cancer, recovery from an eating disorder, post-surgery, etc.), and I do think this can be done within a HAES framework. But weight loss cannot be intentionally pursued within HAES. If weight loss happens (and it might), it only happens incidentally — NOT intentionally.

3) You are interested, within whatever physical or mental limitations you may have, in pursuing “health” — using a definition of health that means something like “the ability to live a meaningful life, balancing optimal physical functioning with optimal mental and emotional functioning, within whatever inevitable health challenges I will, at some point, have to face.” (I believe Jon Robison has a similar philosophy — “Health can be redefined as the manner in which we live well despite our inescapable illnesses, disabilities, and trauma.”)

It should go without saying that, if #3 does not apply to you, and if you are not at all interested in considering health, no matter what definition is used, then that is your entirely legitimate choice, and you are still eligible to have human rights, and to be involved in fat acceptance, and everything else. For many people, health is simply not something they are interested in thinking about, period. I was that way myself for many years, before I was clotheslined by a love of nutrition, and I can entirely understand and respect that choice.

But, if you sincerely believe in the above, and are not fooling yourself (and this can get tricky) about being on some kind of “HAES lifestyle plan” in order to lose weight — then I don’t really care what tools you use to help you eat and move in ways that work best for you, and that give you the best quality of life, whatever your limitations may be.

If you are diabetic, you may count carbohydrates. Even though this smacks of some kind of Atkins-style ridiculousness to the average fat activist, it is a legitimate tool for some people. If you never end up finding your hunger and satiety signals (and it can happen! It is hard to find them, especially if you’ve dieted for years!) and feel most comfortable using some method to estimate an intake that allows you to function physically without driving you crazy, mentally — then I don’t care. Only YOU can know what your true intentions are. Only you can decide whether you are interested in HAES, and whether or not you “qualify,” based on your sincere beliefs and intentions. Behaviours are, largely, irrelevant.

Everyone is limited, physically or mentally, to a certain extent. HAES must work within those limitations. And because humans come in all shades of disease — from Crohn’s, to diabetes, to cancer and chemotherapy, to eating disorders, to fibromyalgia — there is no tool that can be definitively excluded from being used within HAES.

But ANY tool, no matter how innocuous and HAES-friendly it seems, if used to flagellate yourself, becomes instantly outré. Even intuitive eating. Even yoga. Even anything, if done with the slightest shade of self-hatred.

I would rather someone count calories while truly believing in fat acceptance and HAES, than practice intuitive eating in the secret hope that they will lose weight, or in competition with someone they look up to as a perfect disciple of HAES, and beat themselves up when they ‘fail.’

HAES is a paradigm shift, not simply a new diet. Without the underlying beliefs, the behaviours alone are meaningless.

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18 Comments

  1. Posted June 6, 2009 at 6:03 pm | Permalink

    I love love love this. I struggle with diet think vs healthy think + fat acceptance on a daily basis. No way of thinking happens immediately, and I think this should be required reading for anyone just starting in the fat acceptance movement, like myself. Last year I did exactly that – start ‘intuitive eating’ in the hope of losing weight, and I completely set myself up for failure.

    I’m still investigating what I eat, how I eat and things, and I hope I don’t fall into a similar mistake again.

    Thank you

    • Posted June 6, 2009 at 8:43 pm | Permalink

      It can be really, difficult, Sarah. I totally know what you mean. I was actually just reading a book called “Punished by Rewards” by Alfie Kohn, which is actually a book about how behaviourism is applied to school and work settings, and about how intrinsic motivation works, but he makes points that really strike home when it comes to intuitive eating and HAES.

      One of those points is, when intrinsic motivation efforts (like “learning for the joy of it” or intuitive eating) are applied for the purpose of achieving extrinsic goals (like “getting good grades” or weight loss), it pretty much undermines the whole thing. Becase the intrinsic motivators are supposed to be ends in themselves — you know?

      Anyway, thank you, and good luck with your efforts!

  2. Synj
    Posted June 6, 2009 at 6:31 pm | Permalink

    the best definition of “health” i’ve heard thrown around is it is being in a form that is capable of doing the things you want to do. I have no need nor want to run a marathon, but for work i must be able to hike several miles a day in rough terrain carrying a load; one of my hobbies is bellydance. If I can do these things and still sleep without pain, I am healthy, “for me.” I also get migraines with several food triggers, so I avoid those foods for my health.
    Now, my brother has a degenerative muscle disorder, which prevents him from doing some things he may want to do, but he exercises and eats such that he can get as close to doing those things as he can; this is healthy, “for him.”

  3. Posted June 6, 2009 at 9:16 pm | Permalink

    One of those points is, when intrinsic motivation efforts (like “learning for the joy of it” or intuitive eating) are applied for the purpose of achieving extrinsic goals (like “getting good grades” or weight loss), it pretty much undermines the whole thing. Becase the intrinsic motivators are supposed to be ends in themselves — you know?

    That makes so much sense, I’m amazed it never occured to me before. It is a topic I think about a lot – why do people do what they do? I believe that we should only force ourselves to do things we don’t enjoy if it’s absolutely necessary, like swallowing bitter pills, and there must be a way to restructure the rest of life in a way that enables us to enjoy everything else.

    • Posted June 7, 2009 at 2:13 am | Permalink

      “there must be a way to restructure the rest of life in a way that enables us to enjoy everything else.”

      Quoted for truth, Tiana. I’m with you. I think there’s too much of an underlying belief in our culture that pain or discomfort is inherently valuable. And, well, I just kind of don’t think it is, for its own sake. For things that are totally necessary — yes, of course. But for the rest of life? Forcing yourself through every single thing you do just doesn’t seem like a wonderful way to enhance quality of life.

      I really think self-respect means giving up on self-abuse and self-bullying. There are kinder, more compassionate ways to get the same things done, to get the same results.

  4. Godless Heathen
    Posted June 7, 2009 at 9:24 am | Permalink

    2) the fear that HAES must be classist in its practical requirements (it doesn’t; I am dreadfully poor and would never be able to claim a HAES badge if I had to do certain things like join a gym or buy special foods)

    Except that, you’re missing the fact that may people live places where it’s not safe to walk outside without being shot at, mugged, raped, or killed. If enjoyable movement is a part of HAES, and there’s no place at all for one to move, then HAES doesn’t embrace every social class. If HAES is about eating what your body needs, and you cannot get access to a grocery store, or even the money/food stamps to purchase food, HAES doesn’t include you. Health is primarily a matter of economic access, and HAES proponents are falling down by not acknowledging this, loudly, publicly, and legislatively.

    HAES proponents make mealy mouthed statements about poverty, and then brush real poor people under the rug. It isn’t enough to personally practice HAES, it means a lot more when you make it possible for more people to be able to practice HAES.

    I say this as someone who has had to steal food in order to feed my household. I say this as someone who has to wait until her husband has a day off of work to get a two hour walk in once a week. HAES proponents haven’t done one thing to bring a grocery store to my neighborhood, they haven’t done one thing to bring safe (and free) exercise space to my town. They’ve done a lot of talking about their “personal journey”, some of them have even wrote nice books, but it’s all middle class smoke and mirrors as far as I’m concerned. Good on you if you’re healthy, but please don’t pretend that it’s not because you don’t have class advantages.

    • Posted June 7, 2009 at 10:12 am | Permalink

      Hey, Godless Heathen — I’m really sorry about your situation. Truly, seriously. I also live in a bad neighbourhood — I think it’s been described as the poorest one in my country. Though I’ve never had to steal food, we do live technically below the poverty line. I often avoid going outside, because I encounter harassment and threats out there. Sometimes the best I can do, exercise-wise, is calisthenics or yoga poses on the floor of my apartment.

      And I absolutely don’t think people in similar situations need to feel guilty about not being able to take that “personal journey” toward HAES. It’s BS that any of us have to live like this, and it is something I would like to help change.

      You’re right that health is primarily a matter of economic access. It is the most important social determinant of health.

      Systemic changes need to take place to get food to people in poor neighbourhoods, and to make it safe for people to do basic stuff outside. Absolutely.

      Something you might find interesting: Ellyn Satter, the dietitian to whom much of HAES is conceptually indebted, has recently created a hierarchy of food needs based on Maslow’s hierachy of needs. The very foundational part of that hierarchy is access to food. Without that, nothing else can happen.

      I’m really glad you took me to task, and I hope you’ll stick around and talk about this in the future. We need your perspective.

  5. meerkat
    Posted June 7, 2009 at 12:32 pm | Permalink

    Great post. It’s important not only for people who reject HAES based on these misunderstandings to read this, but for people who write about HAES to be careful not to further these misunderstandings. I am constantly feeling uncomfortable reading about HAES because of the phrase “move your body because it feels good” which is often used as one of the main tenets (the other being intuitive eating). I’m not sick or disabled or anything, it just doesn’t actually feel good to get exercise. Mostly it feels humiliating and sweaty and unpleasant. So I don’t go out of my way to get exercise very often (although I do walk a lot out of necessity, and there are some physical activities I enjoy, but it is hard to find the time and energy to do them) and this makes me Fail at HAES (as expressed by “move your body because it feels good”).

    • Posted June 7, 2009 at 4:56 pm | Permalink

      You know, I’m really torn on the issue of exercise. On the one hand, I did kind of learn to love being athletic when I was dieting. On the other hand — I associate a lot of exercise with that diet mentality, which is a compete turn-off. And on YET ANOTHER hand, I was born with a more bookish, sedentary personality, though there are a few active pursuits I always enjoyed (like biking and swimming.) And, like you, I dislike the feeling of being out of breath and sweating — unless I’m doing some SO FUN that I don’t even realize that’s happening.

      What I need to do is get my hands on a copy of “Great Shape” and some other size-friendly exercise materials and really give it some good thought.

      At any rate, I want to make it explicitly clear that “you fail at HAES” is never a good answer to anything. Because, really, that kind of superior, top-down, judgmental mentality is exactly what HAES isn’t about. At all. And I feel really frustrated when people insinuate that anyone who is making an effort can “fail” at HAES. Because I really don’t think you can, if you’re making an effort in good faith. At the risk of sounding cheesy, it’s a process. It’s not something that’s ever a done deal that you can then get a failing or passing mark at. And just because other people might be at different points of the process doesn’t mean anyone’s doing “better” or “worse.” I have absolutely no use for those kinds of judgments. Because they don’t help people — they actively discourage people from even trying.

      Also, if HAES simply isn’t your thing, you’re not a health conscious person, you don’t have health concerns, or it just isn’t (or can’t be) a priority in your life, then that is totally legit. No one should ever feel obligated to be a part of something they simply have no use for.

      • meerkat
        Posted November 24, 2009 at 2:53 am | Permalink

        But wouldn’t “making a good faith effort” be more like actually trying different things to find this mythical exercise that I actually enjoy, and less like trying to imagine that there is any possibility I would actually enjoy said things and not feel badgered into doing them by the HAES ideal and being unable to imagine that happening? I just inherently hate anything that makes me sweat, particularly if I have to do it more than once. It’s probably partly because I consider sweat to be disgusting and partly because changing out of sweaty clothes and taking an extra shower is annoying and time-consuming.

        • Posted November 24, 2009 at 4:36 pm | Permalink

          I don’t know. That’s a good question.

          According to the old, musty “stages of change” theory thingy, some people are at a point where just *thinking* about exercise is basically a huge effort. Other people are at different points.

          I was so disordered in my exercise habits while dieting that I have had to *really* back off from doing any kind of intentional exercise (meaning, yes, I still live a life where I walk as my primary mode of transport, but that’s not because I’m trying to get “exercise.”) Because, frankly, it scares me. I’m scared that I could go down that path again, and hurt myself by doing too much, just like I did before.

          At this point, thinking about it, and maybe trying a few things here and there, is where I’m at. Where you’re at, and where everyone else is at, is a totally individual thing.

          I still don’t think it’s helpful at all to think of oneself as “failing” at HAES, if you believe in the ideas behind it.

          Not everyone likes exercise. Not everyone likes vegetables, either. That doesn’t mean you can’t be doing good things for yourself and your health, anyway.

  6. meerkat
    Posted June 7, 2009 at 12:46 pm | Permalink

    “the best definition of “health” i’ve heard thrown around is it is being in a form that is capable of doing the things you want to do.”

    This doesn’t work if you have aspirations to be really, really good at a particular sport. I would like to be as good as some people at some activities, but this is not a realistic goal. Even if I decided to make a dedicated attempt at it, it would take months and months if not years, and that wouldn’t mean I was unhealthy until I achieved it but healthy afterward. My friend who played soccer in high school says that training for soccer destroyed her knees, and no one can maintain peak athletic condition all the time, so I don’t think athletic goals are a good measuring stick.

    While I’m contradicting people, I think that if weight gain to recover from an eating disorder can be part of HAES, weight loss to recover from a different eating disorder should fall under the same category. I would say both weight changes are incidental to recovery from the eating disorder, but I’m just theorizing in my head.

    • Posted June 7, 2009 at 4:16 pm | Permalink

      Well, it’s an interesting quandary, meerkat, and I was thinking about it myself while I was readying these old posts to be put up on this site.

      The thing is, for someone profoundly anorexic, who is at a severely low weight, the low weight itself (from starvation) can actually cause the brain to not function properly, which precludes recovery. And I don’t mean it precludes *full* recovery — a dangerously low weight precludes even the beginnings of recovery, because the person simply is not functioning at a capacity that can full benefit from therapy, or that can even make simple decisions about their food.

      As far as I know, the same brain changes don’t occur for someone who has gained lots of weight from, say, BED. It seems intuitively like it should work both ways, but as far as I know, it does not. People who gain extreme amounts of weight might have their mobility impacted, which, of course, can interfere with recovery, but that’s different from having a cognitive impairment that disallows you from even being able to consent fully to participate in recovery.

      But I agree that weight changes in either direction are, essentially, incidental to recovery (except in cases of extreme self-starvation, for the reason I’ve mentioned) and that weight is more a symptom of the eating disorder than the problem itself.

      Because even people recovering from anorexia nervosa who gain enough weight back to be considered medically stable, and to have their cognitive function restored, are still in need of full recovery.

      Weight stabilization alone doesn’t confer healing, in either case.

    • Posted June 7, 2009 at 5:21 pm | Permalink

      So, while we’re geeking out about definitions of health (one of my favourite pet topics), I just want to interject and say that, after giving this some thought, I’ve decided that, to me, the definition of health is the ability to live a meaningful life. Meaning, if you have physical or mental issues to deal with, you have the ability to cope with them such that your life is still worth living. And, really, only the individual can decide whether this is the case.

      Anyway, let the geeking continue. Don’t mind me :)

  7. Posted June 7, 2009 at 5:41 pm | Permalink

    Oh, how do I hate the “move your body because it feels good” thing. Umm, no. Actually, it hurts. I hope that exercise will eventually move from the “swallowing bitter pills” category to the “can be made enjoyable” category for me, but right now I am not even capable of doing it at all, no matter how many people tell me it’s supposed to help.

    There’s something that’s been bugging me about the whole HAES debate. People don’t seem to understand that HAES is not a new set of rules that we all have to follow, but rather a belief (people can be healthy at any size) and a set of guidelines that are supposed to help those who want to pursue health. If circumstances prevent you from following those guidelines, that obviously sucks, but nobody’s going to berate you for being unable to do something. I can’t exercise, I can’t afford good food, in fact I can’t do anything to get better at all at the moment – so what?! That doesn’t mean I’m excluded from HAES, all it means is that right now, circumstances are preventing me from pursuing health. I still want to, I just can’t. That’s not the fault of those who are giving advice on how to pursue health! I will appreciate it once I can do so again.

    Besides, all of the beliefs stated above still apply to me. I believe in size diversity, I’m not trying to lose weight and I am interested in pursuing health. So instead of getting angry with those who are writing about things I can’t do, I’m angry at the fact that I can’t.

    I cannot actively follow HAES at the moment and it freaking SUCKS BALLS. So there. I don’t think anyone is going to call me a bad person for it or exclude me from the community!

    (Why can’t we all just get along.)

  8. Posted June 7, 2009 at 6:58 pm | Permalink

    You know what, Tiana, I’d be really interested in working on figuring out a way to help people in your situation (and mine, and godless heathen’s) incorporate HAES into their lives in the ways they want when it doesn’t seem possible.

    It is true, though, that, at a certain point of poverty or lack of access, all the tricks and strategies in the world won’t help a person to practice HAES. There has to be a basic subsistence level of access/finances going on. And I don’t want to minimize how shitty it is to be truly impoverished.

    But I think that, if smart people like us put our heads together, maybe we could come up with, like, a guerilla guide to HAES for poor people. Or something.

  9. Posted February 1, 2010 at 2:30 pm | Permalink

    I know this is an older post, but I just have to say, I’m coming back to it again. Such a great explanation of HAES. And great comments, too. Thought-provoking. (I really like your statement in #3 about living a meaningful life.)

    • Posted February 1, 2010 at 2:57 pm | Permalink

      Thank you! The definition of health is one of my favourite topics. Which makes me a huge nerd.

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