Using the “Health at Every Size Approach” (HAES) in a Diet Focused World (March 2016)

As a nutrition therapist who specializes in the non-diet approach, in my private practice I have embraced a movement which is known as the Health at Every Size Approach or the HAES approach.  It is common in health care to hear our physicians speak to us about our weight, family history of hypertension, hypercholesterolemia or adult onset diabetes mellitus in addition to other medical concerns.  When people are overweight, we have been told that they are at a significant risk of developing these medical issues and that reduction in size can reduce the chances of developing these health problems. Of course, genetics plays a part in our health status as well.

What exactly is the HAES approach? Linda Bacon, Ph.D. is a San Francisco based psychologist who is a researcher and leading force within the HAES movement. She has explained that when people lose weight they are not always healthier. Her first book, Health at Every Size, reveals some evidence-based truths about weight. One myth that her book overturns is that “fat kills,” but the reality is that up to a point, overweight people live longer than “normal” weight people. Another myth she endeavors to dispel is the “lose weight, live longer” notion.  The truth is that no study has ever shown that weight loss prolongs life. As the cover of her book indicates, another myth is “anyone can lose weight if he or she tries.” The reality that Dr. Bacon has uncovered is that human biology dictates that most people regain the weight they lose, even if they continue the same fitness and diet program.

Many people tend to perceive that the HAES approach is a “free for all” meaning they can eat whatever they want.  Since following that thought can certainly be detrimental to health, it is important to work with a clinician that is trained in the HAES approach because someone who is not a HAES, non-diet approach clinician may have undesirable results.

The research has shown that many fad diets do not lead to sustained weight loss.  It is important to note, therefore, that self-acceptance promotes improved mental health and happiness which can lead to overall good health and well-being. Positive behavioral change is the goal of the HAES approach; the emphasis is not on weight loss.

HAES proponents also believe that obese people who are unhealthy may, in part, be unhealthy not because body fat in and of itself is unhealthy, but because years of repeated attempts to lose weight only to gain it back each time (a process referred to as “yo-yo dieting”) purportedly causes health issues. There could be various reasons why the individual is the size s/he is. Research has shown that having a BMI greater than 35 is associated with a higher death rate, compared with normal-weight individuals.  Having a BMI from 30 to 35, inclusively, had no greater risk of death, and being overweight with a BMI from 25 to 30, inclusively, was associated with a lower death rate compared with that of normal weight people.  It is also important to note that the degree of health risk may depend on where the body fat is located. Abdominal fat is associated with a greater health risk than fat on the hips and thighs.

This HAES approach has now been recognized and endorsed by The Academy of Nutrition for Eating Disorders, Binge Eating Disorder Association (BEDA), Eating Disorders Coalition for Research, Policy & Action, International Association of Eating of Eating Disorder Professional (IAEDP), and the National Eating Disorder Association (NEDA).

As a clinician, the challenging aspect that I am confronted with is how to satisfy my clients relative to the food choices they crave. The fundamental philosophy of the HAES approach overlaps to a great degree with the Intuitive Eating approach. Not all of my clients intuitively crave lentils, which would be an excellent choice in any approach.  Instead, many of them crave chips and cupcakes, choices that can be closely monitored. They also tell me they will intuitively eat their “fun foods” meaning that they are mindful of what they are eating.  Many clients may require some handholding during this journey such as checking in with a clinician who is knowledgeable in the HAES approach.  This process is about removing the judgement, guilt and shame from food so we can have Doritos and cupcakes with our lentils. To make achieving good health a successful venture, I always like to understand where my clients are in their respective journeys, meet them on that road, and walk along with them toward health and well-being.

References:
1. Bacon, Linda. Health at Every Size, Dallas, TX: Benbella Books, 2008.
2. Bacon, Linda, and Lucy Aphramor.  Body Respect: What Conventional Health Books, Leave Out, Get Wrong, or Just Plain Fail to Understand about Weight.  Dallas, TX: Benbella Books, 2014.