Health at Every Size and Eating Disorders

How Health at Every Size Can Help With Eating Disorder Recovery

Health at Every Size and Eating Disorders
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Eating disorders are not only about body image. Nor have they only recently arisen in response to societal pressures to be thin. In fact, eating disorders date back to at least the 13th and 14th century, when it was documented that women were fasting to demonstrate religious devotion. However, today eating disorders occur in the context of a society obsessed with thinness, afraid of fatness, and permeated with diet culture. This makes recovery more difficult.

Diet Culture Impacts Eating Disorders

There are few mental disorders whose behaviors the culture admires and values as greatly as the eating disorder. People commonly praise people with restrictive eating disorders for their self-control and success at dieting or commitment to exercise. Imagine being praised for the symptoms of other disorders, such as excessive worry or the inability to get out of bed due to depression? When it becomes normal for everyday discussions to revolve around diet suggestions or the shame of eating tasty food, recovery becomes even harder.

Research on Weight Stigma

The focus on eradicating obesity leads to discrimination and stigmatization of people living in larger bodies. In turn, this stigma encourages numerous negative psychological and health consequences. Studies have shown that weight stigma increases unhealthy eating behaviors— including binge eating—and decreases participation in physical activity. Weight stigma also has been shown to lead to depression, stress, low self-esteem, and negative body image. In fact, many of the negative health consequences commonly attributed to greater weight are now believed to be exacerbated by weight stigma itself.

Weight Loss Research

Most individuals are unable to maintain weight loss long-term. Estimates indicate that no more than 20 percent of participants who complete weight-based lifestyle interventions maintain this weight loss one year later. By the second year, this percentage drops even further. Research shows that after five years participants regained, on average, 77 percent of their initial weight loss. Dieters often also gain back more than they initially lost—a phenomenon called “dieting up the scale.”

Diet failure can also lead to weight cycling: alternating periods of weight loss and weight gain. Weight cycling has been shown to lead to psychological and health problems. In addition, it can lead to reduced metabolic energy expenditure, which makes regain more likely.

What Is Health at Every Size?

Health at Every Size (HAES) is an approach to health that shifts the focus from weight to health. It is a new philosophy that has emerged primarily since the late 1990s. It is promoted by the Association for Size Diversity and Health (ASDAH), who owns the phrase as a registered trademark.

The primary goal of HAES is to promote healthy behaviors for people of all sizes. HAES is grounded in five principles:

  • Weight Inclusivity: acceptance that bodies naturally come in a variety of shapes and sizes, and no size of body is inherently better than any other size of body
  • Health Enhancement: the focus on health rather than weight and attendance to additional disparities that contribute to health including economic, social, spiritual, emotional, and physical factors.
  • Respectful Care: acknowledgment of weight bias and weight-based discrimination, and the commitment to work towards its end. This involves the adoption of an intersectional lens to understand different identities such as race, body size, gender, sexual identity, etc.
  • Eating for Well-Being: flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure—not external eating guidelines focused on weight control.
  • Life-Enhancing Movement: encouragement of enjoyable physical activities for people in a range of bodies with a range of abilities, to the extent that they wish to participate.

Does Research Support HAES?

Several clinical trials comparing HAES to conventional obesity treatment have been conducted. Evidence from these six studies indicates that a HAES approach led to improvements in physiological, behavioral, and psychological measures. Subjects exhibited statistically and clinically-relevant improvements in blood pressure and blood cholesterol levels. They also displayed increased physical activity and decreased eating disorder symptoms and had increased self-esteem.

No studies found any negative consequences associated with the HAES interventions. Subjects who received HAES interventions seemed to stay in the program longer. This is promising, considering that patients in weight loss programs often drop out

How a HAES Approach Helps With Recovery

Weight recovery is a prerequisite for recovery from anorexia nervosa. Aside from the necessity of restoring lost weight for patients with restrictive eating disorders, the treatment of eating disorders should not aim to address weight issues.

Weight loss has not proven effective for patients with binge eating disorder. There is growing evidence that individuals who try to lose weight and maintain a suppressed weight—that is, a weight lower than a previous higher weight—are at increased risk for binge eating disorder and bulimia nervosa. Individuals with bulimia nervosa who maintain a suppressed weight are less likely to fully recover. A persistent focus on limiting weight gain or losing weight can drive and maintain eating disorder behaviors. Research shows that continued focus on weight loss as a goal can lead to food and body preoccupation, eating disorders, weight stigma, and reduced self-esteem.

Conventional thinking suggests that feeling bad about one’s body would motivate behavioral changes that promote weight loss; in fact, the opposite is true. Feeling bad about one’s body drives more destructive behaviors. By contrast, body acceptance can help promote healthier behaviors.

Renouncing the dieting mindset and returning forbidden foods back into their diet can be a formidable challenge for patients surrounded by friends and family who talk about losing weight or avoiding certain foods. Adopting a HAES mindset can challenge the veneration of thinner bodies and promote body acceptance.

The HAES approach shifts the focus from the resolution of weight issues to resolution of body discontent. It encourages you to accept the body’s setpoint: the weight to which your body tends to return when you don’t fixate on weight loss and instead respond to your body’s natural cues for hunger and fullness; the weight you to which you return between diets; and the weight you maintain without a lot of effort. This is the weight your body wants to be.

While a HAES approach acknowledges a correlation between higher weight and certain medical conditions, it questions whether this relationship is purely causal. The data suggest that the behavior change may play a greater role in health improvement than weight loss itself.  We know that weight loss rarely works, and when it does, people lose only a modest amount of weight and maintain even less of it. Is weight loss, rather than an important end in itself, just an occasional and incidental result of the health improvements driven by these behaviors?

Each body is different. Humans naturally come in all varieties of shapes and sizes. It can be hard to remember this in a world where dolls our children play with are all white and svelte. The shape and size of our bodies are largely determined by genetics, just as is the color of our eyes and skin. A HAES approach allows you to trust your body to maintain the body size and shape that is right for you.

The HAES approach advocates for intuitive eating—listening to and acting on internal hunger and satiety cues and preferences. Those in recovery who have previously allowed proscriptive external diet rules to drive their food decisions may be especially helped by the HAES approach. HAES also recommends pleasurable movement—exercising for the goal of pleasure rather than weight loss. Decoupling exercise from weight loss is challenging for many patients with eating disorders.

How Can I Learn About HAES?

There are many ways to learn more about HAES. Check out the following resources.

Websites:

Video:

  • The Problem With Poodle Science by The Association for Size Diversity and Health is ​an animated video exposing the limitations of current research on weight and health

Books:

There are also many blogs and social media groups and accounts focused on Health at Every Size. Try searching for #HAES online to find connections.

 

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Article Sources
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  • Puhl, Rebecca M., and Chelsea A. Heuer. 2010. “Obesity Stigma: Important Considerations for Public Health.” American Journal of Public Health 100 (6): 1019–28. https://doi.org/10.2105/AJPH.2009.159491.
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