Health At Every Size

I remember when I first heard about the philosophy of health at every size.  As a graduate student in exercise physiology and a dietetic intern I was first very skeptical of the philosophy that a person could be healthy at any size.  Coming to believe in the Health at every Size (HAES) philosophy was an evolution for me.  I was familiar with the literature of how obesity impacted health parameters including cardiovascular disease, diabetes, and cancer (to name a few).  I understood as a person lost weight their risk for the disease went down.  However, what I did not fully understand at that time and what many people, including medical professionals, still do not understand is that health and weight are not synonymous.

Let me repeat that, health and weight do not mean the same thing.  Losing weight does not make you automatically healthy; in fact you can be overweight and healthy and you can be normal weight and unhealthy.   You cannot look at someone and judge if they are healthy or unhealthy based solely on their external appearance, and weight alone will not depict this either.

How can this be?  This is because health is more than an overall appearance or a number on a scale.  This sounds simplistic, but if you saw a 250-pound individual would it be possible for you to believe that they were healthy?  What about 300 pounds?  Many people would say No, that this individual is unhealthy without knowing anything else.  What if I told you they exercised regularly ate a balanced diet, had normal blood pressure, normal cholesterol, and normal blood glucose levels?  Let’s consider the opposite for a second too.  What if you saw a normal weight person, would you believe they were healthy?  What if I told you that this person did not exercise, mostly ate “junk” food, had high blood pressure, high cholesterol, and elevated blood glucose levels?  Could this be possible?

This is where we turn briefly to scientific studies for more information.

•  You can increase your health without losing weight.  Usually when someone says they are going to get healthy they mean they are going to lose weight.  However, you can actually increase your health without losing weight.  One study, the Dietary Approaches to Stop Hypertension (DASH), showed that blood pressure could be lowered by changing diet without losing weight.  (1)  Another study found that individuals with high total cholesterol improved their cholesterol levels by consuming a low fat diet while their weight remained relatively the same (they lost an average of two pounds).  Interestingly, in this same study when the subjects returned to a high fat diet their total cholesterol levels increased to their original level, yet their weight remained the same.  (2)

•  Being physically active, or “fit”, is more important than being thin.  One major study, including 32,000 men and women, found that the fittest men and women had the lowest death rates regardless of weight.  Basically, an overweight individual that is physically fit has a better chance of living a longer life than a thin couch potato.  Another study found that obese fit men had death rates as low as lean fit men and interestingly, that obese fit men had death rates one-half that of lean un-fit men. (3, 4)

•  Extreme weight cycling, or yoyo dieting, may in fact have negative effects including: increasing blood pressure, reducing HDL (good) cholesterol levels, increasing risk for gall bladder disease, kidney cancer, breast cancer, and risk for premature death. (5-10)

• Separate studies show that a HAES model can work resulting in metabolic improvements, reduced health risk, reduced anxiety, normalized eating behaviors, and improved self-esteem in chronic dieters.  (11,12)

So, what is HAES?  Health at Every Size (HAES) is a relatively new perspective on health and weight that challenges the old adage that to be healthy you must be thin.  HAES focuses on a holistic view of health that includes self-acceptance, eating in response to internal cues, joyful movement, and the contribution of social, emotional, and spiritual well-being.   HAES is based on the idea that the best way to improve your health is to honor yourself and your body.  It also promotes healthy habits for the sake of health and well-being, versus the sake of the weight loss.  There are many different sources that describe the principles of HAES to varying degrees, however the end philosophy and emphasis are very similar.  Overall Health at every size encourages:

• The acceptance and respect of size diversity for everyone, including yourself.

• Eating in a manner that is balanced and flexible that is based on your own internal hunger and fullness cues, nutritional needs, and personal preferences rather than an externally regulated system, such as a meal plan or diet.

• Discovering the Joy of Movement through physical activity for the pure sake of enjoyment and the health benefits rather than regimented exercise for weight loss or calorie manipulation.

• Healthy behaviors for the sake of overall Health Enhancement including emotional, physical, social, and spiritual well-being without the focus on weight loss.

• An end to discrimination against weight.  (13)

Just to be clear, many people will read this or learn about HAES and interpret it as an excuse for people to be overweight, sit on the couch, and eat whatever they want.  This interpretation could not be farther from the truth.  HAES encourages everyone, not just overweight or obese people, to make choices that are health enhancing.  Many people believe because someone is thin, they are healthy and because someone is fat, they are not healthy.  As previously stated, this is not true.   This belief though is exactly why HAES is so important.  It promotes healthy behaviors in everyone regardless or size, weight, or perceived level of health.

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1. Appel LJ, Moore TJ, Obarzanek E, et al.  A clinical trial on the effects of dietary patterns on blood pressure.  N Engl J Med.  1997; 336: 1117-1124.
2. Ehnhol, C, Huttunen JK, Pietinen P, et al.  Effect of diet on serum lipoproteins in a population with a high risk of coronary arteries.  J Am Med Assoc.  1995; 273: 1093-1098.
3. Lee CD, Blair SN, Jackson AS.  Cardiorespiratory fitness, body composition, and all cause and cardiovascular disease mortality in men.  Am J Clin Nutr.  1999; 69: 373-380.
4. Blair SN, Kohl HW III, Barlow CE, et al.  Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men.  J Am Med Assoc. 1995; 273: 1093-1098.
5. Guagnano M, Balone E, Pace-Palitti V, et al.  Risk fators for hypertension in obese women.  The role of weight cycling.  Clin Sci.  1999; 96: 677-680.
6. Olson M, Kelsey S, Bittner V, et al.  Weight cycling and high-density lipoprotein cholesterol in women: Evidence of an adverse effect.  J Amer Coll Coardiol. 2000; 36: 1565-1571.
7. Syngal S, Coakley E, Willett W, et al.  Long-term weight patterns and risk for cholecystectomy in women.  Ann Int Med.  1999; 130: 471-477.
8. Linblad P, Wolk A, Bergstrom R, et al.  The role of obesity and weight fluctiations in the etiology of renal cell cancer: a population-based case-control study.  Cancer Epidemiol Biomarkers Prev.  1994; 3: 631-639.
9. Guagnano M, Pace-Palitti V, Carrabs C, et al.  Weight fluctuations could increase blood pressure in android obese women.  Clin Sci.  199; 96: 677-680.
10. Lissner L, Odell P, D’Agostino R, et al.  Variability of body weight and health outcomes in the Framingham population.  N Engl J Med.  1991; 324: 1839-1844.
11. Carrier K, Steinhardt M, Bowman M.  Rethinking traditional weight management programs: A three-year follow-up evaluation of a new approach.  J Psychol. 1993; 128: 517-535.
12. Bacon L, Keim N, Van Loan M, Derricote M, Gale B, Kazaks A, Stern J.  Evaluating a “non-diet” wellness intervention for improvement of metabolic fitness, psychologocial well-being, and eating and activity behaviors.  Int J Obes.  2002; 26: 854-65.
13. Kratina K, King N, Hayes D.  Moving Away from Diets.  Lake Dallas: Helm Publishing; 2003.