If you have a child who has an eating disorder then you might have heard of the HAES approach to health and recovery. So what is HAES, and why is it so important to eating disorder recovery? I’ve done my best to distill this significant and nuanced concept to its most important points.
What is the HAES approach?
HAES, or Health at Every Size, promotes a weight-neutral approach to health. This is a critical departure from the dominant approach of our cultural, public health, and medical interventions when it comes to weight.
The dominant culture says that weight gain is bad and weight loss is good and healthy.
But HAES says that weight should not be the main diagnostic tool for health and that health behaviors can be pursued at any size.
Healthy behaviors supported by the HAES approach include:
- Acknowledge weight stigma and work to overcome it, including internalized forms of judgment against your own weight and externalized forms in which you are judging others based on their weight.
- Eat in a way that is flexible and based on natural hunger and appetite cues and recognizes the inherent pleasure that goes along with eating.
- Move your body in a way that feels good and promotes mental health and enjoyment.
- Avoid intentional weight loss, which is almost always temporary and has negative health consequences.
- Care for and respect the body you have, not the body you wish you had.
HAES is a social justice movement that was first documented in the 1960s. The Association for Size Diversity and Health (ASDAH) trademarked both Health at Every Size® and HAES® in 2003. Lindo Bacon wrote the book Health at Every Size: The Surprising Truth About Your Weight in 2010.
Many, many activists have promoted and expanded upon HAES. In the past decade (at least) it took hold in the eating disorder community, and today it is considered by some to be a required philosophy in eating disorder treatment and recovery. However, there are still many treatment providers who do not follow a HAES approach, and many activists accuse the eating disorder treatment community of being fat-phobic.
Why is HAES helpful in eating disorder recovery?
There are many reasons why HAES can be helpful in eating disorder recovery. First, people who have eating disorders typically have internalized weight stigma. This means they are judging themselves based on their weight.
It’s common when you have an eating disorder to believe that weighing less is better. Thus, anti-fat bias lies at the heart of most eating disorder behaviors. These include restricting, purging, binge eating caused by restriction, over-exercise, etc. Therefore, taking a HAES approach in recovery can be very helpful.
HAES is about accepting the body as it is and not pursuing intentional weight loss. This approach can help a person with an eating disorder, which includes both physical behaviors intended to support weight loss, consequences including weight loss and weight cycling, and cognitive (mental) distortions about weight, eating, exercise, and health.
Recovering with HAES
A HAES approach to eating disorder recovery might include the following tenets:
- Accept what you cannot control: release the expectation that bad things can be anticipated and therefore avoided. Not everything, including weight to other things that happen to us, can be controlled. Let it go.
- Meet yourself where you are: weight bias pushes us towards an imagined future. You imagine your behaviors will make you thinner and happier than you are now. Release the idea that eating disorder behaviors will bring happiness. Meet yourself where you are. Live in the moment.
- Drop the prejudice that weight loss is healthy: believing that losing weight is healthy is a core driver behind most eating disorders. But the true danger to your health is weight stigma, under-nourishing your body, and weight cycling. Claim your right to live in your body as it is meant to be.
- Mental health is physical health: there is no separation between the mind and the body. Your attempts to control your body have backfired and impacted your mental health. Invest in your mental health and trust that physical health will follow.
Who benefits from HAES?
A HAES approach to health benefits all people. Our cultural fixation on weight loss has spurned a massive $72 billion weight loss industry in the U.S. Maybe that would be OK if we saw a correlative drop in average weight (since that’s what they say they’re “curing”).
But the opposite is happening. Average U.S. weights have actually increased alongside the diet industry, likely caused by the weight cycling that is a known side effect of intentional weight loss.
Additionally, as the weight loss industry grows, rates of disordered eating and eating disorders have grown, too.
Everyone can benefit from a HAES approach to health, including:
People who have eating disorders
… or have disordered eating
… and all people who eat!
People who are in larger bodies
… and people who are in medium and smaller bodies
… in fact, anyone who lives in a body!
HAES demands respect and dignity for the body and mind of each individual. Rather than dominating bodies with rules and rigid beauty standards, HAES says we can pursue health in any body.
What is the scientific data behind HAES?
HAES is first and foremost a social justice issue. All bodies of all sizes deserve dignity. But it is also a powerful health intervention. HAES has been clinically proven as a better way to approach health. Here are two key pieces of research:
1. Nutrition Journal 2011
In the article Weight Science: Evaluating the Evidence for a Paradigm Shift, Lindo Bacon and associates found the following:
- A HAES approach to health achieved clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids); health behaviors (e.g., eating and activity habits, dietary quality); and psychosocial outcomes (such as self-esteem and body image). The HAES health outcomes were more successful than weight-loss treatment and without the contraindications associated with a weight focus.
- Intentional weight loss efforts may induce short-term weight loss for some people. But the majority of individuals end up weight cycling and do not achieve improved morbidity and mortality.
- Weight focus is ineffective at producing thinner, healthier bodies, and may also have unintended consequences, including:
- Food and body preoccupation
- Repeated cycles of weight loss and regain
- Distraction from other personal health goals and wider health determinants
- Reduced self-esteem
- Eating disorders
2. Journal of Obesity
In the article The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss, Tracy Tylka and associates found the following:
- The weight-normative approach is not improving health for the majority of individuals across the entire weight continuum.
- Weight is overemphasized for higher-weight individuals (i.e., assumptions are made that they are unhealthy) and underemphasized for lower- or “average-” weight individuals (i.e., assumptions are made that they are healthy).
- Weight loss through dieting is not sustainable over time for the vast majority of higher-weight individuals and is linked to harmful consequences.
- It is unethical to continue to prescribe weight loss to patients and communities as a pathway to health, knowing the associated outcomes—weight regain (if weight is even lost) and weight cycling—are connected to further stigmatization, poor health, and well-being. The data suggest that a different approach is needed to foster physical health and well-being within our patients and communities.
It is very hard to recover from an eating disorder if your family is immersed in weight stigma and diet behaviors. I recommend that families adopt a HAES approach to health in order to create a pro-recovery environment. The good news is that this approach is healthier for everyone!
If you’d like to hear more about this, please contact me.