Health-at-Every-Size (HAES®) Scientific Evidence
What is Health-at-Every-Size®?
Health-at-Every-Size (HAES®) is an approach that promotes health and well-being without focusing on weight. It emphasizes body diversity, intuitive eating, and joyful movement, advocating for health practices that respect and support people of all sizes.
HAES® emerged as a response to the growing concerns over weight stigma and the harmful effects of dieting and diet culture. Since its inception, the HAES movement has been driven by a commitment to social justice and the evidence that health can be achieved at any size and is a complex interplay of factors beyond weight.
The approach is a transformative paradigm that challenges traditional views on weight and health. It’s an inclusive framework for promoting wellness and regaining trust in your body.
If the concept of “weight not equating to health” seems foreign or against everything you’ve been taught for decades, I get it — I was there, too; in fact, most of us have, since diet culture was ingrained in us in our earliest years. Here’s the thing: Once you’re untethered from diet culture, you can’t unsee its harms and misinformation - nor do you want to. You don’t have to just take my word for it; let’s look at what the science says about Health-at-Every-Size®.
Scientific Evidence Supporting HAES®
I’m a research nerd, so I love that the HAES® approach is backed by a growing body of scientific evidence that challenges traditional views on weight and health. Ready to nerd out with me? Let’s dive in. 🤓
Long-Term Outcomes of Calorie-Restricting Diets
A key study by Mann et al. (2007), critically examined the long-term outcomes of calorie-restricting diets. The study revealed that traditional dieting often leads to weight regain and does not consistently result in long-term health benefits. Maybe read that last line again. Put simply: calorie-restricting diets don’t work long-term.
These findings align with the HAES® principles, which reject dieting in favor of sustainable, healthy behaviors that do not focus on calorie restriction or weight loss as the primary goal. The research suggests that dieting can be counterproductive and emphasizes the importance of a holistic approach to health.
Risks of Significant Weight Loss
Further evidence from Ingram & Mussolino (2011) and Park et al. (2018), suggests that significant weight loss, especially when it involves drastic changes from one's highest body weight, can be associated with increased mortality risk.
Research also shows that weight cycling—the process of losing and regaining weight over time—is associated with higher risks of adverse health effects than staying at a stable weight. Kakinami et al. (2020) and Zou et al. (2020) are two of many studies on this topic.
These studies challenge the notion that weight loss is inherently beneficial and highlight the importance of weight stability, particularly in older adults. The research supports the HAES® perspective that health should be pursued through behaviors that promote overall well-being rather than through weight loss alone.
Impact of Weight Bias on Healthcare
One of the foundational studies by Phelan et al. (2015), highlights the impact of weight stigma on healthcare. This research shows that weight bias can negatively affect the quality of care for higher weight folks. Healthcare providers may hold negative attitudes and stereotypes about people in larger bodies, which can influence their decision-making and the care they provide.
Think about that. We have research showing that people in larger bodies get worse care than their “thin” counterparts because of discriminatory practices based on body size. This is heartbreaking and unacceptable. This study underscores the importance of a weight-neutral approach to health, as advocated by HAES®, to ensure all patients receive equitable and compassionate care.
The Role of Weight Discrimination in Health Outcomes
Weight discrimination - the act of treating people differently based on their weight or body size - has been shown to have serious health consequences, further supporting the need for a HAES® approach. If this sounds similar to racism, you would not be wrong - there is much overlap between racism and anti-fat bias/discrimination - in fact, much of anti-fat bias is rooted in racism.
The following studies highlight the impact of weight discrimination on health.
Physiological Dysregulation Linked to Weight Discrimination
Research by Vadiveloo and Mattei (2017) explores the connection between perceived weight discrimination and physiological dysregulation—essentially, how the body responds to the stressors associated with weight discrimination. The study found that individuals who experience weight discrimination have a higher risk of allostatic load, which is the “wear and tear” on the body due to chronic stress.
Higher-weight folks experience weight discrimination in every aspect of their daily lives — within the medical system, socializing (eating out, grocery shopping), traveling, or simply going for a walk - to name a few. Think about the cumulative effect of feeling discriminated against in everything you do. That’s what this study did, and found that the stress caused by weight stigma can lead to significant health issues, reinforcing the importance of a HAES® approach that minimizes stigma and focuses on supportive, inclusive health practices.
Increased Mortality Risk Due to Weight Discrimination
Another important study by Sutin et al. (2015), examines the relationship between weight discrimination and mortality. The researchers discovered that individuals who experience weight discrimination are at a nearly 60% higher risk of mortality compared to those who do not face such discrimination.
One factor that contributes to this is explained in an article by Lee & Pause (2016), which found that people in larger bodies are less likely to access healthcare from medical providers due to fears of discrimination. They are also less likely to receive evidence-based and bias-free care when they do seek care due to healthcare professionals holding implicit and explicit anti-fat biases and pathologizing them based on their weight alone. Would you seek care if you feared the doctor discriminating against you and holding biased, negative beliefs about you?
These studies underscore that the harm from weight stigma and anti-fat bias can be more detrimental to health than the weight itself, aligning with the HAES® perspective that emphasizes health behaviors over “weight management”.
The Principles of HAES® in Practice
Implementing HAES® principles involves shifting the focus from weight loss to overall well-being. This includes embracing body diversity, eating in a way that honors your hunger and fullness cues (hint: learning to trust your body), and engaging in physical activities that you enjoy.
These concepts are a “practice”, not a “perfect” and take time to embrace. By embracing these practices over time, you can improve your quality of life and health outcomes. Caveat: Only if you choose to - remember, health is not an obligation nor a marker of virtue, morality, or worthiness. The point is it’s your decision to make for yourself - not for others to decide for you or judge you on.
If you choose to improve your health outcomes, HAES® allows you to do so without the pressure to conform to societal standards that put thin bodies on a pedestal and assign higher moral worth to thinness and its achievement. All bodies are worthy and exquisitely imperfect.
Healthcare as a Human Right
HAES® advocates that everyone, regardless of size, deserves equal access to compassionate healthcare without the requirement to conform to specific weight standards. Weight-neutral healthcare should be a fundamental right for all.
Wellbeing, Care, and Healing
HAES® emphasizes that health is a continuum, varying by individual circumstances. It promotes a focus on collective and personal well-being, with an emphasis on community care, mutual aid, and respecting individual autonomy in health decisions.
Anti-Fat Bias and Inclusive Care
HAES® rejects anti-fat bias and advocates for healthcare that is inclusive of all body sizes. It calls for the dismantling of fatphobia within healthcare to ensure that everyone receives fair and supportive care.
Health as a Sociopolitical Construct
HAES® challenges traditional health definitions rooted in oppressive systems. It emphasizes that access to care should never depend on an individual's health status or compliance with societal standards, advocating for a redefinition of health that aligns with collective liberation.
Getting Started with HAES®: A Path to Holistic Wellness
As we’ve explored, the HAES® approach is not only rooted in principles of social justice and body positivity but also supported by a robust body of scientific evidence. As a Licensed Dietitian Nutritionist and Certified Nutrition Specialist, I take an integrative approach to nutrition and wellness, focusing on more than just your symptoms.
As a Health-at-Every-Size Aligned Practitioner, my goal is to help you build a healthy relationship with food and create balance in your life. When designing a customized health plan, I consider the HAES® principles, offering support with Gut Balancing, General Nutrition, and more. Discover how Balanced Gut Nutrition & Health can support your journey to health and well-being.
References
Ingram, D.D., & Mussolino, M.E. (2011, March 1). Weight loss from maximum body weight and mortality: The third national health and nutrition examination survey linked mortality file. International Journal of Obesity (London), 34(6), 1044-1050. doi: 10.1038/ijo.2010.41
Kakinami, L., Knauper, B., & Brunet, J. (2020, August). Weight cycling is associated with adverse cardiometabolic markers in a cross-sectional representative US sample. Journal of Epidemiology and Community Health, 74(8): 662-667. doi: 10.1136/jech-2019-213419
Lee, J.A., & Pause, C.J. (2016, December 29). Obesity stigma in healthcare: Impacts on policy, practice, and patients. Frontiers in Psychology, 7(2063), 1-15. https://doi.org/10.3389/fpsyg.2016.02063
Mann, T., Tomiyama, A.J., Westling, E., Lew, A-M., Samuels, B., & Chatman, J. (2007, April). Medicare’s search for effective obesity treatments: Diets are not the answer. The American Psychologist, 62(3), 220-233. doi: 10.1111.jdi.13380
Park, S-Y., Wilkens, L.R., Maskarinec, G., Haiman, C.A., Kolonel, L.N., & Marchand, L.L. (2018, February). Weight change in older adults and mortality: The multiethnic cohort study. International Journal of Obesity (London), 42(2), 205-212. doi: 10.1038/ijo.2017.188
Phelan, S.M., Burgess, D.J., Yeazel, M.W., Hellerstedt, W.L., Griffin, J.M., & Van Ryn, M. (2015, April). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews: International Association for the Study of Obesity, 16(4), 319-326. doi: 10.1111/obr.12266
Sutin, A.R., Stephan, Y., & Terracciano, A. (2015, September 29). Weight discrimination and risk of mortality. Psychological Science, 26(11), 1803-1811. doi: 10.1177/0956797615601103
Vadiveloo, M., & Mattei, J. (2017, February). Perceived weight discrimination and 10-year risk of allostatic load among US adults. Annals of Behavioral Medicine, 51(1), 94-104. doi: 10.1007/s12160-016-9831-7
Zou, H., Yin, P., Liu, L., Duan, W., Li, P., Yang, Y., Li, W., Zong, Q., & Yu, X. (2020, August 28). Association between weight cycling and risk of developing diabetes in adults: A systematic review and meta-analysis. Journal of Diabetes Investigation, 12(4), 625-632. doi: 10.1111/jdi.13380