‘Health At Every Size (HAES)’ is an approach to improving health which shifts the focus from weight-loss, placing it instead on healthy behaviours.
Whilst HAES is often linked with and supports ‘the non-diet approach’, these approaches are separate. The focus of HAES differs from the non-diet approach, which as discussed by Stacey in When Dieting is Not the Answer: Rick Kausman and The Non-Diet Approach, is on mindful eating to avoid detrimental dieting cycles. These two approaches share the common principles of respecting all body sizes, healthy relationships with food and self-care, however they also differ on the point of weight; the non-diet approach discusses a comfortable weight and HAES does not directly address weight at all.
HAES has emerged as an alternative to dieting, in response to the size stigma of society and the focus on weight for health improvement. Essentially HAES is an anti-diet movement based on the premise that a focus on weight-loss increases weight stigma, creates negative psychological outcomes and interferes with long term health. HAES has varying interpretations and can be controversial; the assertion that health is independent of body weight challenges many long held opinions regarding the relationship between body weight and health. There is certainly also the potential for people to hear the name HAES and misconstrue it as everyone is healthy at every size, when it really means that physical health and quality of life can be improved without weight-centred interventions.
The approach is based on the increasing evidence that diets for weight-loss do not work, nor do they achieve significant health improvements and may even result in more weight regained than was lost.Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-33. Concerningly, some evidence suggests that significant weight-loss may actually increase all-cause mortality.Ingram DD, Mussolino ME. Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. Int J Obes (Lond). 2010;34(6):1044-50. Furthermore, fitness in overweight and obese individuals may result in a mortality risk equivalent to fit normal weight individuals, and even a lower mortality risk than un-fit normal weight individuals.McAuley PA, Blair SN. Obesity paradoxes. Journal of Sports Sciences. 2011;29(8):773-82. There is also evidence that HAES may be superior to some weight-loss focused approaches, with a review of HAES randomised control trials finding more successfully improved physiological measures and better psychosocial outcomes.Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011;10:9.
It is well established that weight-loss can decrease the risk of diet-related diseases, however achieving weight-loss is far from simple, and for some people a focus on weight may not necessarily achieve weight-loss or improve physical health. This preoccupation with weight-loss can potentially come at the cost of psychological health, self-esteem and a positive relationship with food. Thus, an approach such as HAES, focussed not on weight-loss, but on overall physical and psychosocial wellbeing may be beneficial for some individuals and health professionals. The HAES approach does not deny the clear link between overweight and obesity and an increased risk of numerous chronic diseases. It simply re-orients the focus from outcomes, such as weight-loss, to healthy behaviours with the potential to result in reduced modifiable risk factors, such as overweight and obesity.
References [ + ]
|1.||⇪||Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-33.|
|2.||⇪||Ingram DD, Mussolino ME. Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. Int J Obes (Lond). 2010;34(6):1044-50.|
|3.||⇪||McAuley PA, Blair SN. Obesity paradoxes. Journal of Sports Sciences. 2011;29(8):773-82.|
|4.||⇪||Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011;10:9.|