By Zoe Nicholson
‘Health at every size’ (HAES) aims to promote self-care through addressing health behaviours, acknowledging and tackling weight stigma, and being inclusive of human diversity in terms of body size, ethnicity, sexual orientation, gender identification and social status.
When people feel better within themselves, they are more likely to engage in healthy behaviours and feel motivated to take care of their bodies. Current public obesity interventions may be having the opposite effect through perpetuation of ‘weight stigma’.
Weight stigma is a form of social prejudice toward people of higher body weight, one that elicits deep personal shame and can prevent people from engaging in healthier behaviours.
An article in the American Journal of Public Health reviewed the literature and outlined the research underpinning the proposition that weight stigma threatens the psychological and physical health of people with larger bodies.
HAES has received bad press with regard to not focusing on weight; it has even been suggested that HAES actually promotes obesity. This is where the paradigm is misunderstood.
HAES is not anti-weight loss. Rather, it does not promote weight loss as a health strategy. Key reasons for this are that weight is not a behaviour, and HAES focuses on addressing behaviours, and a focus on weight perpetuates weight stigma.
With HAES, if a person loses weight through changing their health behaviours and better self-care, weight loss is a beneficial side effect, not the primary goal.
A key problem with making weight loss the focus is that a person can actively take steps to improve their eating and exercise habits, but they may not lose the desired amount of weight, or any weight at all. Despite the person’s health improving, they feel disheartened about their weight and may be less motivated to maintain changes.
This is particularly pertinent if people are restricting food or engaging in exercise they do not truly enjoy. As humans, we must eat for survival, but eating is also a key part of pleasure in life, it is a vital aspect of social connection.
When these factors are impinged upon with no clear ‘benefit’ (ie weight loss), why would a person continue with the restriction? If exercise is not enjoyable or feels like a chore, and there is no apparent benefit, can we really be surprised when people throw in the towel?
Of course, some people do lose weight with dietary changes and exercise, but how many of these people are satisfied with the results, and how many are truly happy with their bodies? How many keep the weight off long term? A studylooking at exactly this area showed most people not only regain lost weight, but up to two thirds end up heavier.
I will ask GPs to reflect on their own patients: How many struggle with their weight?
Do a significant number keep weight off long term or do most end up yo-yoing, either getting heavier over time or staying much the same?
Weight cycling is problematic in itself, independent of body weight, and more research is needed in this area. What is clear, however, having talked to people who have spent years, often a lifetime, weight cycling, is that the focus on weight can erode self-worth and adversely affect psychological health.
Not using weight loss as a primary goal requires practitioners who promote eating well or physical activity to find ways to motivate people in a different fashion. This is precisely what HAES does.
Another issue with a weight focus is people often push themselves too hard to get the ‘results’. Rather than making gentle, sustainable changes to eating habits, dietary changes can end up being overly restrictive or unsustainable. A person who enjoys walking for exercise can feel this doesn’t burn enough calories, so they try something more intense, which they may not enjoy, or they experience pain or injury, often putting them off exercising altogether. These negative experiences do little to foster long-term behaviour change or self-care.
Can a HEAS approach be used for chronic diseases such as diabetes? Yes, the principle is still applicable as it is about fostering long-term behaviour change and self-care.
So is there evidence? Here are some studies that show health improvements using a HAES approach:
- A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial
- Healthy lifestyle habits and mortality in overweight and obese individuals
But I also suggest healthcare professionals to consider, while the traditional diet approach has been in vogue for more 20 years, how effective has it been?
Zoe Nicholson is an accredited practicing dietitian and accredited nutritionist, Dietitians Association of Australia
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