Health at Every Size

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Health at Every Size (HAES) is a public health framework that emphasizes all bodies have the right to seek out health, regardless of size, without bias, and reduce stigma towards people who are in larger bodies. [1] Proponents argue that traditional interventions focused on weight loss, such as dieting, do not reliably produce positive health outcomes, and that health is a result of lifestyle behaviors that can be performed independently of body weight. [2] However, many criticize the approach and argue that weight loss should sometimes be an explicit goal of healthcare interventions, because of the negative health outcomes associated with obesity. [3]

Contents

History

Health at Every Size first appeared in the 1960s, advocating that the changing culture toward physical attractiveness and beauty standards had negative health and psychological repercussions to fat people. They believed that because the slim and fit body type had become the acceptable standard of attractiveness, fat people were going to great pains to lose weight, and that this was not, in fact, always healthy for the individual. They contend that some people are naturally a larger body type, and that in some cases losing a large amount of weight could in fact be extremely unhealthy for some. On November 4, 1967, Lew Louderback wrote an article called "More People Should Be Fat!" that appeared in a major US magazine, The Saturday Evening Post. [4] In the opinion piece, Louderback argued that:

  1. "Thin fat people" suffer physically and emotionally from having dieted to below their natural body weight.
  2. Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
  3. Dieting seems to unleash destructive and emotional tendencies.
  4. Eating without dieting allowed Louderback and his wife to relax and feel better while maintaining the same weight.

Bill Fabrey, a young engineer at the time, read the article and contacted Louderback a few months later in 1968. Fabrey helped Louderback research his subsequent book, Fat Power, and Louderback supported Fabrey in founding the National Association to Aid Fat Americans (NAAFA) in 1969, a nonprofit human rights organization. NAAFA would subsequently change its name by the mid-1980s to the National Association to Advance Fat Acceptance.

In the early 1980s, four books collectively put forward ideas related to Health At Every Size. In Diets Don't Work (1982), Bob Schwartz encouraged "intuitive eating", [5] as did Molly Groger in Eating Awareness Training (1986). Those authors believed this would result in weight loss as a side effect. William Bennett and Joel Gurin's The Dieter's Dilemma (1982), and Janet Polivy and C. Peter Herman's Breaking The Diet Habit (1983) argued that everybody has a natural weight and set-point, and that dieting for weight loss does not work. [6] [ better source needed ]

According to Lindo Bacon, in Health at Every Size (2008), the basic premise of HAES is that "well-being and healthy habits are more important than any number on the scale." [7] Emily Nagoski, in her book Come as You Are (2015), promoted the idea of Health at Every Size for improving women's self-confidence and sexual well-being. [8] [ page needed ]

Evidence

Diagram of the medical complications of obesity, from the US CDC Medical complications of obesity.png
Diagram of the medical complications of obesity, from the US CDC

Proponents claim that evidence from certain scientific studies has provided some rationale for a shift in focus in health management from weight loss to a weight-neutral approach in individuals who have a high risk of type 2 diabetes and/or symptoms of cardiovascular disease, and that a weight-inclusive approach focusing on health biomarkers, instead of weight-normative approaches focusing on weight loss alone, provides greater health improvements. [9] [10]

The HAES principles do not propose that people are automatically healthy at any size, but rather proposes that people should seek to adopt healthy behaviors regardless of their body weight. [11] [12]

Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept, [13] arguing it is not possible to be and remain truly healthy at every size, and suggests that a HAES focus may encourage people to ignore increasing weight, which her research states is easiest to lose soon after gaining. She does, however, note that it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes. Others similarly argue that the HAES focus may encourage people to delay attempts at weight loss indefinitely. [3]

There is some evidence HAES interventions can lead to positive psychological, physical, and behavioral outcomes, including short-term decreased body weight, BMI and body fat mass. [14] There were also some inconsistent findings suggesting an effect on blood pressure, fasting glucose, and triglycerides levels. [14]

See also

Related Research Articles

Dieting is the practice of eating food in a regulated way to decrease, maintain, or increase body weight, or to prevent and treat diseases such as diabetes and obesity. As weight loss depends on calorie intake, different kinds of calorie-reduced diets, such as those emphasising particular macronutrients, have been shown to be no more effective than one another. As weight regain is common, diet success is best predicted by long-term adherence. Regardless, the outcome of a diet can vary widely depending on the individual.

<span class="mw-page-title-main">Fat acceptance movement</span> Social movement seeking to change anti-fat bias in social attitudes

The fat acceptance movement is a social movement which seeks to eliminate the social stigma of obesity. Areas of contention include the aesthetic, legal, and medical approaches to fat people.

<span class="mw-page-title-main">Obesity</span> Medical condition in which excess body fat harms health

Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

<span class="mw-page-title-main">Weight loss</span> Reduction of the total body mass

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat, or lean mass. Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.

<span class="mw-page-title-main">Fad diet</span> Popular diet with claims not supported by science

A fad diet is a diet that is popular, generally only for a short time, similar to fads in fashion, without being a standard scientific dietary recommendation, and often making unreasonable claims for fast weight loss or health improvements; as such it is often considered a type of pseudoscientific diet. Fad diets are usually not supported by clinical research and their health recommendations are not peer-reviewed, thus they often make unsubstantiated statements about health and disease.

<span class="mw-page-title-main">Low-carbohydrate diet</span> Diets restricting carbohydrate consumption

Low-carbohydrate diets restrict carbohydrate consumption relative to the average diet. Foods high in carbohydrates are limited, and replaced with foods containing a higher percentage of fat and protein, as well as low carbohydrate foods.

<span class="mw-page-title-main">Mediterranean diet</span> Diet inspired by the Mediterranean region

The Mediterranean diet is a diet inspired by the eating habits and traditional food typical of southern Spain, southern Italy, and Crete, and formulated in the early 1960s. It is distinct from Mediterranean cuisine, which covers the actual cuisines of the Mediterranean countries, and from the Atlantic diet of northwestern Spain and Portugal. While inspired by a specific time and place, the "Mediterranean diet" was later refined based on the results of multiple scientific studies.

<span class="mw-page-title-main">Diet (nutrition)</span> Sum of food consumed by an organism

In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for health or weight-management reasons. Although humans are omnivores, each culture and each person holds some food preferences or some food taboos. This may be due to personal tastes or ethical reasons. Individual dietary choices may be more or less healthy.

<span class="mw-page-title-main">Weight gain</span> Increase in a persons total body mass

Weight gain is an increase in body weight. This can involve an increase in muscle mass, fat deposits, excess fluids such as water or other factors. Weight gain can be a symptom of a serious medical condition.

Calorie restriction is a dietary regimen that reduces the energy intake from foods and beverages without incurring malnutrition. The possible effect of calorie restriction on body weight management, longevity, and aging-associated diseases has been an active area of research.

<span class="mw-page-title-main">Healthy diet</span> Type of diet

A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.

<span class="mw-page-title-main">Childhood obesity</span> Obesity in children

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term overweight rather than obese is often used when discussing childhood obesity, as it is less stigmatizing, although the term overweight can also refer to a different BMI category. The prevalence of childhood obesity is known to differ by sex and gender.

<span class="mw-page-title-main">Fat feminism</span> Social movement

Fat feminism, often associated with "body-positivity", is a social movement that incorporates feminist themes of equality, social justice, and cultural analysis based on the weight of a woman. This branch of feminism intersects misogyny and sexism with anti-fat bias. Fat feminists advocate body-positive acceptance for all bodies, regardless of their weight, as well as eliminating biases experienced directly or indirectly by fat people. Fat feminists originated during third-wave feminism and is aligned with the fat acceptance movement. A significant portion of body positivity in the third-wave focused on embracing and reclaiming femininity, such as wearing makeup and high heels, even though the second-wave fought against these things. Contemporary western fat feminism works to dismantle oppressive power structures which disproportionately affect working class poor people or poor people generally. It covers a wide range of topics such as diet culture, fat-phobia, representation in media, ableism, and employment discrimination.

<span class="mw-page-title-main">Overweight</span> Above a weight considered healthy

Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.

Intermittent fasting is any of various meal timing schedules that cycle between voluntary fasting and non-fasting over a given period. Methods of intermittent fasting include alternate-day fasting, periodic fasting, such as the 5:2 diet, and daily time-restricted eating.

<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify the ideal body weights for different individuals.

Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.

Nutrition psychology (NP) is the psychological study of the relationship between dietary intake and different aspects of psychological health. It is an applied field that uses an interdisciplinary approach to examine the influence of diet on mental health. Nutrition psychology seeks to understand the relationship between nutritional behavior and mental health/well-being NP is a sub-field of psychology and more specifically of health psychology. It may be applied to numerous different fields including: psychology, dietetics, nutrition, and marketing. NP is a fairly new field with a brief history that has already started to contribute information and knowledge to psychology. There are two main areas of controversy within nutrition psychology. The first area of controversy is that the topic can be viewed in two different ways. It can be viewed as nutrition affecting psychological functions, or psychological choices and behavior influencing nutrition and health. The second controversy is the defining of what is "healthy" or "normal" as related to nutrition.

<span class="mw-page-title-main">Body positivity</span> Movement advocating the mental quality that seeks to accept oneself and ones body

Body positivity is a social movement that promotes a positive view of all bodies, regardless of size, shape, skin tone, gender, and physical abilities. Proponents focus on the appreciation of the functionality and health of the human body, instead of its physiological appearance.

<span class="mw-page-title-main">Intuitive eating</span> Approach to food

Intuitive eating is an approach to eating that focuses on the body's response to cues of hunger and satisfaction. It aims to foster a positive relationship with food as opposed to pursuing "weight control". Additionally, intuitive eating aims to change users' views about dieting, health, and wellness, instilling a more holistic approach. It also helps to create a positive attitude and relationship towards food, physical activity, and the body.

References

  1. ↑ Penney, Tarra L.; Kirk, Sara F. L. (2015). "The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward". American Journal of Public Health. 105 (5): e38–e42. doi:10.2105/AJPH.2015.302552. ISSN   0090-0036. PMC   4386524 . PMID   25790393.
  2. ↑ Brown, Lora Beth (March–April 2009). "Teaching the 'Health at Every Size' Paradigm Benefits Future Fitness and Health Professionals". Journal of Nutrition Education and Behavior. 41 (2): 144–145. doi:10.1016/j.jneb.2008.04.358. PMID   19304261.
  3. 1 2 Sainsbury, Amanda; Hay, Phillipa (March 18, 2014). "Call for an urgent rethink of the 'health at every size' concept". Journal of Eating Disorders. 2 (1): 8. doi: 10.1186/2050-2974-2-8 . ISSN   2050-2974. PMC   3995323 . PMID   24764532.
  4. ↑ Louderback, Lew (November 4, 1967). "More People Should Be Fat". The Saturday Evening Post.
  5. ↑ Bob Schwartz (1996). Diets don't work. Breakthru Pub. ISBN   978-0-942540-16-1. Archived from the original on January 7, 2017. Retrieved September 23, 2016.
  6. ↑ Bruno, Barbara Altman (April 30, 2013) [2009]. "the HAES® files: History of the Health At Every Size® Movement—the 1970s & 80s (Part 2)". Health at Every Size Blog. Archived from the original on March 19, 2016. Retrieved March 7, 2019.
  7. ↑ "Size Diversity & Health at Every Size". National Eating Disorders Association. February 18, 2018. Retrieved August 18, 2020.
  8. ↑ Nagoski, Emily (March 3, 2015). Come as you are : the surprising new science that will transform your sex life. New York. ISBN   978-1-4767-6209-8. OCLC   879642467.{{cite book}}: CS1 maint: location missing publisher (link)
  9. ↑ Tylka, TL; Annunziato, RA; Burgard, D; Daníelsdóttir, S; Shuman, E; Davis, C; Calogero, RM (2014). "The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss". Journal of Obesity. 2014: 983495. doi: 10.1155/2014/983495 . PMC   4132299 . PMID   25147734.
  10. ↑ Bacon L, Aphramor L (2011). "Weight science: evaluating the evidence for a paradigm shift". Nutr J. 10: 9. doi: 10.1186/1475-2891-10-9 . PMC   3041737 . PMID   21261939.
  11. ↑ Ulian; Aburad; da Silva Oliveira; Poppe; Sabatini; Perez; Baeza Scagliusi (2018). "Effects of health at every size® interventions on health‐related outcomes of people with overweight and obesity: a systematic review". Obesity Reviews. `9: 1659–1666.
  12. ↑ "Size Diversity & Health at Every Size". National Eating Disorders Association. February 18, 2018. Retrieved August 18, 2020.
  13. ↑ Sainsbury, Amanda (March 18, 2014). "Call for an urgent rethink of the "health at every size" concept". J Eat Disord. 2 (8): 8. doi: 10.1186/2050-2974-2-8 . PMC   3995323 . PMID   24764532.
  14. 1 2 Ulian MD, Aburad L, da Silva Oliveira MS, Poppe AC, Sabatini F, et al. (December 2018). "Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review". Obes Rev (Systematic review). 19 (12): 1659–1666. doi:10.1111/obr.12749. PMID   30261553. S2CID   52878615.
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