HAES: Health at Every Size

The War on Obesity

The cultural zeitgeist of our nation in the current century has been one of declaring ‘War’ on conditions, behaviors and things;  the war on drugs, the war against poverty, and the war on obesity.  As we have observed, these culture wars are often as effective as War (in its traditional martial sense) in that they spread misery, fear, and death, regardless of any victories they may achieve.  The war on obesity continues, however we are approaching a transition point, we are beginning to get tire of fad diets, pills with side effects that are worse then a little weight, or a lot.  Most of all we are weary from seeing the suffering of living with shame over ones own body on the faces of their children, loved ones, and in the mirror.

Fighting fat has not made the fat go away. However, extensive “collateral damage” has resulted: Food and body preoccupation, self-hatred, eating disorders, weight cycling, weight discrimination, poor health… Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat. It’s time to withdraw the troops.
– Linda Bacon, The HAES Manifesto 

Body Image Obsession –

We are all more obsessed with our appearance than we like to admit.

Women young and old live today constantly confronted by images in magazines, media and advertising that proclaim what should be seen as the ‘perfect’ Women, 99.9% of which are airbrushed and manipulated, mental health providers see the negative implications of this in the epidemics of eating disorders, starvation dieting, body image obsession and body dysmorphia.  The body of research on body image issues and related emotional and physical distress dates back to the origin of psychotherapy.

Body image isn’t just a women’s problem, the Males ego is also at stake, as we sail the ocean of gentlemen’s magazines,fitness magazines and sports media, in a similar boat—a smaller and less publicly observed boat, with a similar and often unattainable destination.  A number studies in the last decade reveal that a surprisingly high proportion of men are dissatisfied with, preoccupied with, and even impaired by concerns about their appearance, evidence that we men are also a species that suffers.  Body dysmorphia is reported by non-psychiatric medical practitioners as being as common in men as women, and far more concerning is a new obsession with appearance, known as the Adonis Complex.

Concern with appearance is not the aberration of Modern Western culture, in fact concern about appearance is quite normal and understandable. Every period of history has had its own standards of what is and is not beautiful, and every contemporary society has its own distinctive concept of the ideal physical attributes.  And going back to ancient cultures some of these standards were achievable only by potentially harmful means:

  • For six centuries in Imperial China women practiced foot binding, a symbol of beauty that caused lifelong pain and disability.
  • At various times in european, asian, meso-american and african cultures (some continued in the present day) male childrens heads were strapped to boards to shape a comely head, this practice often resulted in traumatic brain injury.
  • In the 19th Century being beautiful meant wearing a corset – causing breathing and digestive problems, while men in the same age would wear a cylindrical corset and brace to have a dignified, stiff bearing.

Regrettably although we resemble our ancestors and other cultures in our concern about appearance.  Advances in technology and in particular the rise of the mass media has caused normal concerns about how we look to become obsessions for many.  At face value one might conclude that body image obsession and body dysmorphic disorder might sound trivial, however high proportions of patients require admission to hospital, become housebound, and attempt suicide.  With the advent of cosmetic surgery many sufferers of both genders are turning to procedures, often with serious health repercussions, often to discover that in their distorted self image, they  are so disappointed with the outcome that they become severely depressed, suicidal, litigious, or even violent towards the treating physician.

Imagine if underwear and bathing suit advertisements represented body diversity.

real men underwear realwomanbathingsuits

What is H.A.E.S.

We are all raised with assumptions, deeply ingrained cultural ‘truths’ that settle into our subconscious, regardless of how factual these truths are.  One of the assumptions that we grow up with (and so do our health providers) is that seeking to lose weight is healthy.  Another is that self responsibility and self control are how one becomes thin and athletic, and thereby attractive.  Despite evidence that our bodies are shaped by factors as evident as our genes, and as unalterable as our parents social class, we continue to think that health and the perfect body are as easy as self control and that THIN = HEALTHY.

HAES, the Health at Every Size research and philosophy comes from the research and work of Dr. Linda Bacon, a professor, researcher, and the author.  It draws its name from her groundbreaking book Health at Every Size: The Surprising Truth About your Weight.  Dr. Bacon applies scientifically validated research that stands counter to the thin-centric view of our medical establishment and culture, and shifts the focus from WEIGHT to WELL-BEING, giving doctors, dietitians, therapists, and people of all shapes the tools for achieving better fitness, health and even happiness – all without dieting.

The framing for a Health At Every Size approaches reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice.  HAES grounds itself in a social justice framework, and the progressive feminist movement with the premise that pursuing cultural definitions of health are neither a moral imperative nor an individual obligation, and health status, body composition, and appearance, should never be used to judge, oppress, or determine the value of an individual.  Dr. Bacon and other researchers continue to expand on the HAES approach, body diversity and body respect, in the upcoming book Body Respect,  Dr. Bacon and her colleague Dr. Lucy Aphramor, PhD, RD delve more into the politics and social justice issues while remaining true to the health lense.

Body insecurity is rampant, and it doesn’t have to be. It’s time to show every body respect. Let’s toss out the discredited nostrums and false assumptions that drive our culture’s shame and distress about weight. – Aphramor & Bacon

The HAES Pledge

The Health at Every Size  movement helps professionals, such as myself, you develop a framework for conceptualizing weight and working with weight concerns in an affirming and supportive way.  I have joined over 7500 (and counting) healthcare professionals in signing The HAES Pledge to provide sensitive and meaningful care to people, respecting the HAES Principles.

The Health At Every Size Principles are:

Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.