When health is not on your side.

This post is part of the crowdfunding campaign for my dietetic internship. It is not intended to replace advice from a doctor or other health care practitioner. It represents my opinion alone and not any organization of which I am a member.


Dear Michelle,

How can one achieve Health at Every Size if they don’t have health on their side?


Hi D.,

This question has a lot to do with how we define health, and also how we define Health at Every Size.

In our culture, we tend to look at health as a state or a place we can get to, a finish line to be crossed, and once you’re there, you’re finished. As you say, we look at it like an achievement.

By this definition, if you have good cholesterol, blood pressure, blood sugar, a BMI between 18.5 and 24.9, and no notable illnesses or conditions, then you’ve achieved health. Congratulations. Pick up your trophy.

And we tend to speak of Health at Every Size with similar rigidity — as using a particular approach (intuitive eating and exercise) to achieve a very similar trophy, minus the BMI requirement.

This definition of health excludes anyone with a health condition. There are lots of people in the world dealing with chronic conditions or disabilities, probably more than aren’t. Effectively sending the message that they’ve already “failed” at health, and no matter what effort they put in, they can never be healthy, is deeply discouraging.

I’ve heard people argue that defining health in exclusionary terms is the only way we can motivate people to care for their health. I disagree. I think that casting health in such a meritocratic, neoliberal way is deeply destructive and invokes healthism as well as ableism. I believe that people can be more effectively, and more ethically, motivated through compassion and acceptance, combined with the desire for positive change.

An exclusionary definition of health discourages the most vulnerable people — the people who actually stand to benefit the most from getting help or making positive changes — from caring for themselves at all. They may think, “Why bother? I’ll never be healthy anyway, so what’s the point?” Such a definition of health is oppressive. It’s also incorrect.

The reality is that health is not an achievement. It’s something you already have, and it looks a bit different for every person. Health is a dynamic resource that each person carries with them, in some form, through their entire life.

Here’s how Dietitians of Canada defines health:

“Health is a basic resource for everyday living. It is the extent to which one can realize aspirations, satisfy needs, and change or cope with the environment.”

The definition of Health at Every Size is also quite flexible and allows for individual needs and different health conditions, while also taking into account social and political barriers to health. Even people with diseases or health conditions — and that is likely to be all of us, at some point — can live with good health, provided we cope well, care for ourselves, and find meaning in our lives.

If you’re caring for yourself without using weight loss as a proxy for health, the bottleneck through which you funnel all your efforts, or the primary source of meaning in your life, then you are using the Health at Every Size approach.

By coping well and caring for yourself, in whatever way works best for your unique habitus and challenges, and by living a life that matters to you, you are also cultivating the health that is already yours.

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