I had the opportunity to spend the past 5 days at a Health At Every Size® (HAES) Facilitators’ Training presented by Linda Bacon, PhD and Lucy Aphramor, PhD, RD. HAES is an evidence-based approach that counters the conventional, weight centered/weight-loss approach to achieving health. It focuses on helping empower us to reclaim our bodies by letting go of the constructs of dieting. This wonderful model can be implemented by dietitians and healthcare professionals, grounded in self-discovery and built on self-nurturing as the basis for how to approach eating and exercise.
Linda and Lucy spread their powerful message through trainings, talks and writings, including peer-reviewed articles, the best-selling Health at Every Size book, and the soon-to-be released Body Respect book (on shelves September 1st). They co-authored a ground-breaking study published in the Nutrition Journal in 2011 reviewing 6 randomized controlled trials that have compared the HAES approach to the traditional weight-loss approach. Evidence from these trials indicates that the HAES approach is associated with statistically and clinically relevant improvements physiological measures (blood pressure & blood lipids), health behaviors (physical activity & eating patterns) and psychological outcomes (mood, self-esteem & body image). Evidence reported significant improvements in psychological and behavioral outcomes, particularly with improvements in self-esteem and and eating behaviors in the HAES group versus the group of conventional dieters. Four studies also measured metabolic risk factors, three of which indicated significant improvement in at least some of these parameters (blood pressure & blood lipids) in HAES participants. The most noteworthy aspect of these results is that they are independent of weight loss.
The article compiles evidence to challenge and refute the following assumptions:
- adiposity poses a significant morbidity/mortality risk
- weight loss will prolong life
- anyone who is determined can lose weight and keep it off through appropriate diet and exercise
- the pursuit of weight loss is a practical and positive goal
- the only way for overweight and obese people to improve health is to lose weight
In contrast, the evidence supports a shift in healthcare:
- interventions should meet ethical standards, focusing on health not weight
- interventions should promote self-esteem, body satisfaction and respect for body size diversity
- interventions should only focus on modifiable behaviors when there is evidence to support that the modification will improve health – weight is not a behavior and therefore not an appropriate target for behavior modification
- interventions should be embrace a holistic perspective and consider the physical, emotional, social, occupational, intellectual, spiritual and ecological aspects of health
The authors concludes with the statement, “From the perspective of efficacy as well as ethics, body weight is a poor target for public health intervention. There is sufficient evidence to recommend a paradigm shift from conventional weight management to Health at Every Size.” A radically different approach to health is possible when we embrace the idea that bodies can be healthy at a wide range of sizes.
In addition to reviewing the evidence supporting the HAES model, I heard life stories of the individuals attending the training with me. These women and men represented a diverse mixture of cultural backgrounds, ages and body sizes. Insightful, intelligent words were spoken by people who fearlessly shared personal struggles and triumphs relating to food, body image and self-acceptance. I am inspired, not only by Linda and Lucy, but by the commitment of these individuals to cultivate a sense of wellness in their bodies and lives. I encourage anyone who resonates with the HAES message to read the Health at Every Size book and explore a new paradigm of health.