Understanding the Health At Every Size (HAES) paradigm

Accredited Practising Dietitian, Zoe Nicholson discusses why weight cycling is problematic and the shift towards HAES

 

The HAES paradigm

The HAES paradigm is ultimately about promoting self-care. HAES aims to do this through addressing health behaviours, acknowledging and tackling weight stigma and being inclusive of human diversity in terms of body size, ethnicity, sexual orientation, gender identification and social status.

When people feel better within themselves, they are more likely to engage in healthy behaviours and feel motivated to take care of their bodies. Current public obesity interventions may be having the opposite effect through perpetuating weight stigma. Weight stigma is a form of social prejudice toward people of higher body weight that elicits deep personal shame and can prevent people from engaging in healthier behaviours. An article in the American Journal of Public Health [1] reviewed the literature and outlined the research underpinning the proposition that weight stigma threatens the psychological and physical health of people in larger bodies.

 

HAES and Weight Loss

HAES has received bad press with regard to not focusing on weight; some even suggest HAES promotes obesity. This is where the paradigm is misunderstood. HAES is not anti-weight loss; it simply does not promote weight loss as a health strategy. Two key reasons for this are weight is not a behaviour and HAES focuses on addressing behaviours, and a weight focus perpetuates weight stigma. With HAES, if a person loses weight through changing their health behaviours and better self-care, weight loss is a beneficial side effect, not the primary goal.

A key problem with making weight loss the focus, is that a person can actively take steps to improve their eating and exercise habits, but they may not lose the desired amount of weight, or any weight. Despite the person’s health improving, they feel disheartened about their weight and may be less motivated to maintain changes.

This is particularly pertinent if people are restricting food or engaging in exercise they don’t truly enjoy. As humans, we must eat for survival, but eating is also a key part of pleasure in life, it is a key aspect of social connection. When these factors are impinged upon with no clear “benefit” (i.e. weight loss), why would a person continue with the restriction? If exercise is not enjoyable or feels like a chore and there’s no “benefit”, can we really be surprised when people throw in the towel?

Of course some people do lose weight with dietary changes and exercise, but how many of these people are satisfied with the results, how many are truly happy with their bodies? And how many keep the weight off long-term? A study by Mann et al looking at exactly this, showed most people not only regain lost weight, but one third to two thirds end up heavier [2].

 

HAES in Practice

I’ll ask you for a moment to reflect on your own patients; how many struggle with their weight, do a significant number keep weight off long-term or do most end up yo-yoing, either getting heavier over time or staying much the same? Weight cycling is problematic in itself, independent of body weight and more research is needed in this area. What is clear though, if you talk to people who have spent years, often a lifetime, weight cycling, is that the focus on weight erodes their self worth and adversely affects their psychological health.

Not using weight loss as a primary goal requires practitioners who promote eating well or physical activity, to find ways to motivate people to do this in a different fashion. This is precisely what HAES does. Another issue with a weight focus is people often push themselves too hard to get the “results”. Rather than making gentle, sustainable changes to eating habits, dietary changes end up being overly restrictive or unsustainable. A person who enjoys walking for exercise can feel this doesn’t burn enough calories and so they try something more intense, which they may not enjoy, or they experience pain or injury, often putting them off exercising altogether. These negative experiences do little to foster long-term behaviour change or self-care.

 

Can a HEAS approach be used for chronic diseases such as diabetes?

Yes, the principle is still applicable as it is about fostering long-term behaviour change and self-care.

 

So is there evidence to show that HAES works?

I have included some studies below that show health improvements using a HAES approach. But I also urge you to consider that the traditional diet approach has been in vogue for over twenty years, how effective has this been?

 

This article was originally published on RACGP and has been adapted for dietitians

 

About Zoe Nicholson: a member of Dietitian Connection, has over 13 years experience in private practice, she is the owner and senior dietitian at Love What You Eat. Zoe uses a HAES and non-diet approach to assist people with weight and body image concern, disordered eating and chronic lifestyle disease.

 

Add address

Australia