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Health At Every Size (HAES)

Health At Every Size (620x930)

Much like judging others based on their skin colour, religious beliefs, gender or sexuality, judging someone on their body size and weight is equally as discriminatory. We sometimes refer to this as “weightist”. In Australia, we’ve progressed significantly toward a less racist, sexist or homophobic society. However, moving away from a weight-centric world is only just starting to get traction. The concept of Health At Every Size (HAES) has been around in our professional (dietitian) circles for at least the past 10 years and we’re hoping to help it gain traction a little quicker. HAES follows the mantra of promoting health outcomes irrespective of body weight.

Being weightiest or applying weight stigma is the discrimination of a person based on their body weight and size. Have you ever assumed, based exclusively on someone’s body size, what someone’s life is like? What they eat? What their lifestyle is like? Their level of happiness? How confident they are in themselves? How healthy they are? Even their level of intelligence? Do you measure your own self-worth based on what that little box in the bathroom tells you each and every morning?

Maybe you’ve seen someone living in a bigger body and assumed they’re lazy, stupid or don’t care about themselves. It works the other way too. Have you seen someone in a smaller body and assumed they have it all together, are super successful or have an easy life? WOW! Crazy when you think about it like that right? Linking someone’s weight as a measure of their happiness or intelligence? Maybe it’s time to rethink your perception.

What Is Weight Bias?

Weight bias is the fundamental belief that:

  1. Our weight is exclusively under our individual control.
    … that if we want to be X kg we can, as long as we just work hard enough.
  2. A high weight is caused by a caloric imbalance of too many calories in and not enough exercise,
    … ignoring the influence of gender, genetics, body composition, disease processes or age.
  3. Lowering our weight will directly improve our health,
    … independent of how we get there. This statement ignores the fact that having a smaller body size than what is considered “natural” can be more harmful to your health.
  4. Weight status can predict health status and health outcomes,
    … which has been completely debunked by scientific evidence. In fact, food choices and regular exercise are much stronger indicators.
  5. Long-term, sustained weight loss is achieved simply by controlling food and exercise.
    … this belief is strongly linked to the presentation of eating disorders.

Let’s be clear, we’re not suggesting food and lifestyle choices (movement) don’t matter; in fact, quite the opposite. We’re suggesting to you that those ARE the focus, independent of any weight change. When you,

– improve your food choices

– ensure nutritional adequacy (enough daily protein, fibre, healthy fats and carbohydrates (yes… enough carbs!)) and

– develop a healthy relationship with exercise (when you do something intentional most days but aren’t obsessed about it),

it will directly improve your health outcomes – including both your physical and mental health.

We frequently have clients coming to us commenting “I don’t know how much more I can do”. Meaning, how much more they can cut out of their diet or how much more time they can dedicate to exercise. We would argue the next thing to do is to change our perspective. That eating well and exercising regularly is, in itself, simply enough!

While this might sound all nice and fuzzy, it’s greatly based on science. Yep! A very large study in 2012 clearly demonstrated that having a healthy lifestyle is a significantly better indicator of health than weight. It’s healthier to have a healthy lifestyle and be in a bigger body than to have an unhealthy lifestyle and be in a “normal” body size. We’ll let you re-read that sentence a few times, it can be confronting.

What’s The Harm? Where’s The Problem?

The level of harm is significant. There’s an enormous level of research that suggests weight stigma and overvaluation of body size are strongly correlated with (all forms of) disordered eating. That the sometimes unachievable goal of weight loss (due to unchangeable factors) correlates with significant body dissatisfaction, dietary restriction, obsession with exercise and/or binge episodes (with or without purging).  

Skipping meals in order to lose weight, cutting out whole food groups because “carbs are fattening” or exercising to the point of discomfort or injury is itself unhealthy. A feeling of a significant sense of shame and inadequacy because, “I can’t get in control of the scales”, completely dismisses the biology that not everyone’s body is supposed to look a certain way or be a certain BMI.

Over-valuation of body weight and size is strongly correlated with anxiety, depression, self-criticism and judgement. We frequently have women in their 70s wanting to “look like I did in my 30s”. They say stuff like, “Before I had kids I was X kg”… “How old are your kids?”, we might ask. To which the reply is, “Ohh… they’re 32 and 28”. Another comment is, “After menopause, I just don’t look the same”. Because your body is biologically changing and there isn’t anything we need to do about that – it’s BIOLOGY!

“BUT MY DOCTOR SAYS…”

We hear this all the time… “My doctor says…”. Here’s a lightbulb moment: Your doctor(s) (be they GP, surgeon or specialist) also live in our weight-centric world. The world with media images of the ‘thin ideal’ and the societal expectation that everyone should fit into a “perfect BMI”. To be fair, it’s not entirely your doctor’s fault. There is a strong weight bias in our medical research, and we agree, this needs to change. The research linking weight to improved health outcomes almost always did not consider lifestyle factors (exercise and food intake) and drew the conclusion that weight = health.

In our opinion, using weight as a measure of health could be classified as lazy medicine. Much better measures are your blood tests, heart, liver or kidney function, and even better than these elements, the adequacy of your dietary intake and weekly exercise regimen, irrelevant of what your weight is.

WHY IS WEIGHT SUCH A FOCUS?

Simply put, it’s very easy to measure. If cardiac output were easy to measure, it might have more credibility. If we could test insulin levels more easily at home, that might be more popular. But those pesky scales in the bathroom are an easy measure aka “torture device”.

Isn’t it better to be smaller? The answer is no, it’s better to be healthier and they aren’t the same thing!

WHAT IS WEIGHT INCLUSIVITY?

Weight inclusivity is the belief that:

  • Everybody can achieve health and well-being, independent of weight
  • Weight is not a behaviour that needs changing
  • Weight is not a focus for treatment or intervention
  • Health and well-being are multi-faceted
  • Everyone, irrelevant of body size, is entitled to compassionate and respectful individualised care
  • Everyone should have equal access to non-stigmatised healthcare

So, we invite you to reframe your thinking. Are you sexist? (Should women get less pay?) Are you racist? (Do you believe because someone wears a hijab they’re a terrorist?) Are you weightist? (Do you believe because someone is of a particular body size their life is a certain way?)

SO, WHAT SHOULD MY WEIGHT BE?

The ideal weight for you is literally whatever your weight is when you’re eating well & exercising regularly. Forcing your weight to be artificially low (because you’re doing extreme things to forcefully lower your weight) is inherently fake and unsustainable. If you can’t maintain these extreme behaviours you’re not a failure, you’re not weak, you’re actually following your body’s natural cues to keep itself alive (and not starve or develop a stress fracture).

We would argue an advanced step forward (and we get this is scary) would be to literally throw out your scales. If you’ve visited SS Diets before and talked with any of our dietitians, you’d know we have an entire folder containing photos and videos of destroyed scales and we welcome you to contribute to our collection (our favourite is using the excavator to run them over). No one’s crying when they’re destroying their own torture devices 🙂

Assess your health based on the things you can control; your food choices, your actual exercise, your diagnoses and your blood pathology. Ask your doctor what their recommendation would be for your health if they were to take your weight off the table. Because your blood tests, ECG, fitness level and nutritional intake are far better indicators of both your physical and mental health than the number on that box you stand on every morning in the bathroom.

If you need help with learning about the concept of Health At Every Size, Alexandra McClelland can help with this. She’s an extremely knowledgeable dietitian who fundamentally believes in ensuring you receive information that is scientifically based, easy to understand, and (most importantly) simple to implement. Click here to book or send an enquiry.