What is HAES? A dietitian's perspective.
(~1300 words, 5 minute read)
It is a widely accepted phenomenon that no two snowflakes are exactly alike. Some are symmetrical, some asymmetrical, some are larger, some are smaller, some fall quickly and some more slowly. This uniqueness is universally accepted and celebrated. The perceived inherent worth of a snowflake that you catch on your mitten does not change if it is small or large. We do not scrutinize or question why they look different - rather the individuality is broadly accepted and admired.
Why is it that the same logic is not widely applied to the diversity of human bodies?
As a dietitian, I am very familiar with the research that identifies that people living in larger bodies are at a higher risk of developing chronic diseases (1,2). In an effort to optimize health and prevent chronic disease as a society, diet culture was born.
Diet culture is a system of beliefs that values thinness over health and well-being, celebrates a certain way of eating, demonizes specific types of foods, normalizes negative self-talk and discriminates people who do not fit within its perceived definition of “health”. Some of those impacted include women, people in larger bodies, people of colour, people in the LGBTQ2S community and people with disabilities.
Christy Harrison has an excellent summary of diet culture - here (3). In North America, diet culture is all around us, both overtly and subtlely dispersed (hidden) in our everyday lives.
Since dieting first entered the scene in the 1970’s, modern science has discovered overwhelming evidence that dieting is an ineffective method to manage weight, may promote weight gain and fail to improve long-term health (4,5,6,7). The human body’s biological survival adaptations, such as slowing down metabolism, muscle breakdown and hormonal changes, make sustained weight loss extremely difficult for most people (4,5,6,7). In addition to being ineffective, traditional dieting and restriction may also cause physical, emotional and spiritual distress and can also increase your risk for developing an eating disorder.
As a side note: an individual’s weight is a multifaceted variable and is influenced by factors such as genetics, the gut microbiome, activity level, dietary intake, stress, illness, chronic disease, ethnicity and socioeconomic status. It is not realistic to think that we can significantly manipulate our bodies’ biological set point weight by addressing only one or two pieces of the puzzle.
So, what is a human to do in the pursuit of optimizing their health status if dieting might not be the answer?
Introducing…..the Health At Every Size (HAES) approach. HAES is based on peer-reviewed studies that show being at a lower weight does not necessarily mean better health outcomes (8,9,10). This approach argues that lifestyle habits are key determinants of health and can be optimized regardless of body weight status (8,9,10).
The key principles of HAES, from the Association for Size Diversity and Health (11) are:
● Weight Inclusivity
● Health Enhancement
● Respectful Care
● Eating for Well-being
● Life-Enhancing Movement
Observational and controlled studies have demonstrated that HAES interventions improve the physiological and psychological functioning of its participants (12,13,14). Randomized controlled studies have reported significant improvement in physiological measures of health such as blood pressure and blood lipids (15,16,17).
Common Misunderstandings about HAES
Those new to the concept of HAES may have some misunderstanding of what HAES really entails. I broke down some key points of what HAES is vs. what HAES is not to help with this!
A key point to understand is that HAES is an anti-diet approach but it is not an anti-health approach. It is simply a refreshed and non-discriminatory way of supporting the health and well-being of individuals that removes a microscopic focus from the size or appearance of one’s body.
So why doesn’t everyone adapt to HAES?
Unfortunately, there are prominent societal barriers that make adapting to this approach challenging. Societal messages link weight to age, beauty, worth and health status. Women of various ages report experiencing appearance related pressures (18). People are faced with constant messaging surrounding what your body “should” look like and what foods you “should” be eating which makes stepping away from the scale a difficult step to take.
..And where does nutrition come in?
When it comes to the HAES principle of “eating for well-being”, an approach to eating called intuitive eating is an excellent evidence-based approach that is complimentary with HAES.
If you are interested in learning more about intuitive eating – stay tuned, a blog post on this is coming soon!
What is our approach at Happy Bellies?
Our approach at Happy Bellies is very much in line with the HAES approach and intuitive eating is a fundamental tool we use as practitioners to support many of our clients.
That being said, we always meet clients where they are at. We would never judge someone for wanting to change their body weight. We hope to work together to explore how you can achieve your health and nutrition goals (without focusing solely on a number on the scale), and support you in fostering a positive relationship with food and your body.
Sincerely,
Sarah & Julia
Author: Sarah Hunt, M.AN, BASc, RD
Reviewed by: Julia Celestini, BSc, RD
Additional Resources
References
World Health Organisation. Obesity and overweight—Fact sheet. 2017; http://www.who.int/mediacentre/factsheets/fs311/en/. Updated October 18, 2017. Accessed June 22, 2018.
Field AE, Barnoya J, Colditz GA. Epidemiology and health and economic consequences of obesity. In: Wadden TA, Stunkard AJ, eds. Handbook of Obesity Treatment. New York, NY: Guilford Press; 2002:3-18.
Mann, T., Tomiyama, A. J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare's search for effective obesity treatments: diets are not the answer. American Psychologist, 62(3), 220.
Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?. Journal of the American Dietetic Association, 106(4), 559-568.
Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R., ... & Colditz, G. A. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112(4), 900-906.
Pietiläinen, K.H. et al. (2011). Does dieting make you fat? A twin study. International Journal of Obesity, | doi:10.1038/ijo.2011.160
https://www.penguinrandomhouse.ca/books/315212/the-obesity-paradox-by-carl-j-lavie/9780698148512
Tomiyama, A. J. (2019). Stress and obesity. Annual review of psychology, 70, 703-718.
Køster-Rasmussen, R., Simonsen, M. K., Siersma, V., Henriksen, J. E., Heitmann, B. L., & de Fine Olivarius, N. (2016). Intentional weight loss and longevity in overweight patients with type 2 diabetes: a population-based cohort study. PLoS One, 11(1), e0146889.
Bégin, C., Carbonneau, E., Gagnon-Girouard, M. P., Mongeau, L., Paquette, M. C., Turcotte, M., & Provencher, V. (2019). Eating-related and psychological outcomes of health at every size intervention in health and social services centers across the Province of Quebec. American Journal of Health Promotion, 33(2), 248-258.
Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011;10:9. 21.
Schaefer JT, Magnuson AB. A review of interventions that promote eating by internal cues. J Acad Nutr Diet. 2014;114(5): 734-760.
Bacon L, Keim NL, Van Loan MD, et al. Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes Relat Metab Disord. 2002;26(6):854-865.
Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105(6):929-936.
Rapoport L, Clark M, Wardle J. Evaluation of a modified cognitive-behavioural programme for weight management. Int J Obes Relat Metab Disord. 2000;24(12):1726-1737.
Augustus-Horvath, C. and T. Tylka. 2011. The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood. Journal of Counseling Psychology. 58:110-125.
https://www.intuitiveeating.org/
