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The Health at Every Size Movement

Doctorpedia Editorial Team Doctorpedia Editorial Team March 24, 2020
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Weight. BMI. Fat. Obesity. These are loaded words in 2020.

 

People associate thinness with being attractive and healthy. And that the opposite is true, too. That’s what most of us have been taught from early childhood. “Don’t eat too much cake or you will get fat.” “Fat is unhealthy.” “Fat is bad.” Calling someone “fat” is a grave insult. 

 

What often follows from learning and believing this is that people who are bigger try desperately to lose weight. This in turn can lead to restrictive diets, binge eating, anorexia, bulimia, and other dangerous disordered eating patterns.

 

According to NationalEatingDisorders.org, 81% of ten year olds are afraid of being fat, and 9% of nine year olds have vomited to lose weight. The rate of death for women with eating disorders is 12 times higher than other women of similar ages, and about 1,000 women die each year from eating disorders due to malnutrition, heart attack, and suicide.

 

Even for those who don’t classify as having an “eating disorder,” a larger person is often left feeling “less than” others who maintain a “normal” weight. There is associated shame and guilt for being in a different body–a body that society seemingly looks down on.

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Rebecca Puhl, the deputy director of the University of Connecticut’s Rudd Center for Food Policy and Obesity, and her colleagues find that weight is the most common reason children are bullied in school. In one study, nearly 85 percent of adolescents reported seeing overweight classmates teased in gym class.

 

But what if not all people were meant to be the same size? BMI is a person’s weight in kilograms divided by the square of height in meters. It was developed in the 1830s by an astronomer as a statistical exercise. The scale categorizes people as underweight, normal or healthy weight, overweight, or obese. But what if the BMI is all wrong? What if different people are born with a slower metabolism? What if you can be both technically overweight AND healthy at the exact same time?!

 

Well, 2020 looks like the year when diet culture is finally going out of fashion. The HAES (Health At Every Size) movement, which first appeared in the 1960s and is having a major comeback, believes just this: that not every person was made to be the same size. 

 

Linda Bacon’s book Health At Every Size: The Surprising Truth About Your Weight explains that HAES is “an inclusive movement, recognizing that our social characteristics, such as our size … are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.” Bacon presents an alternative approach to hunger and a way to eat without guilt while listening to our body’s hunger cues and being satisfied. She posits that by following this approach, a person’s body will naturally start to shed excess weight–without dieting.

 

Her approach is often considered revolutionary because it challenges the classic paradigm of dieting, the one that often simply does not work or that may work for a while before the weight that has been shed is put back on.

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The underlying thesis for people like Linda Bacon is that diets are not designed to result in long-term weight loss, but instead trap people in cycles of weight fluctuation. This process is called weight-cycling, and there is evidence that it adversely affects health.

 

Christy Harrison, an anti-diet registered dietitian, nutritionist, and certified intuitive eating counselor, writes: “Weight-cycling is this repeated cycle of weight loss and regain that people undergo when they try to intentionally lose weight, and we see in the research that up to 98% of the time when people embark on weight loss efforts, they end up regaining all the weight they lost within five years, if not more. In fact, up to two-thirds of people who embark on weight loss efforts may regain more weight than they lost.”

 

Of course, as with most emerging movements, there are those who disagree with its general premise. The HAES movement has been criticized by David L. Katz (a professor at Yale) as well as scientists from the Institute of Applied Health Research at the University of Birmingham. Dr. Katz’s perspective is that if you tell people that it is acceptable to be healthy at any size, you are both normalizing being unhealthy and preventing people who medically need to lose weight from doing so. The scientists from the University of Birmingham conducted research into the idea of “fit but fat” and concluded that people who are bigger are actually much more likely to suffer from coronary heart disease, heart failure, and stroke than “average-sized” people. 

 

Nevertheless, the fact remains that society’s obsession with weight loss at any cost has had devastating effects on our bodies and minds for decades. For a person dealing with being overweight, with struggling to stick to impossible diets, with the guilt and shame that society associates with being bigger, this paradigm shift is a fresh breath of air.

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