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The Rethinking of Weight: Exploring the Evidence for Healthy At Every Size (HAES)

Article reviewed: Bacon, L. & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal. 10(9). 

Written by Madelyn Trefzger, MS

healthy at every size, HAES

Do you associate health with weight? Or risk of disease with percent body fat? Have you been caught in the cycle of “dieting or losing weight will get you to optimal health”? Research has shown that weight and disease risk may not be as closely related as we are meant to believe. 

This article reviews research suggesting healthcare providers and the people they care for would benefit from adopting a Health at Every Size (HAES) approach to improve health outcomes while limiting damaging thoughts and behaviors surrounding food and dieting. 

Weight-neutral outcomes are those that are not directly related to weight. Randomized clinical trials have shown statistically and clinically relevant improvements in both physiological and psychological health measures while also improving health behaviors when implementing approaches not related to weight.  

Many assume that increased body weight, specifically increased body fat, is a cause of diseases. Studies, however, regularly fail to include factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status which all play significant roles in disease. Studies that control for these variables note less significant risk associations between weight and disease. 

Another assumption of the conventional weight paradigm states anyone who is determined to lose weight can and should be able to keep it off through diet and exercise. Evidence shows that individuals who have lost weight through dieting gain back virtually all weight that was lost regardless of methods to maintain weight loss. 

Others assume weight loss is always a practical and positive goal. It is known, however, that weight cycling increases morbidity and mortality risk. Dieting has also been shown to increase risk of osteoporosis, chronic psychological stress, and cortisol production all of which have negative health consequences. Additionally, adopting this idea of “weight loss = positive” leads to increased stigmatization and discrimination against people in larger bodies which is actually demotivating. 

The conventional weight paradigm also assumes that the only way for people with “overweight” or “obesity” to improve health is to lose weight. Most health indicators (blood pressure, blood lipids, blood glucose), however, can be improved through changing health behaviors whether weight is lost or not. 

All this to say - health is not determined by the number on a scale. Shifting to a Healthy at Every Size (HAES) approach includes: 

  • Encouraging body acceptance as opposed to weight loss or weight maintenance 

  • Reliance on internal regulatory processes like hunger and satiety as opposed to encouraging cognitively-imposed dietary restriction 

  • Supporting active embodiment as opposed to encouraging structured exercise

Adopting these approaches is likely to improve health outcomes more successfully than solely focusing on weight loss for health improvement.

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