Health At Every Size (HAES) Criticisms - from a HAES Dietitian

Updated 1/24/23. Take a deep dive into the follow up thoughts, clarifications, and corrections that I have about my article "Health At Every Size (HAES) Criticisms - from a HAES Dietitian".

TOPICS COVERED 👇 

• The context of these criticisms [1:00]
• What no HAES provider seems to be saying [3:22]
• The generalized mistake I made in my original post [5:17]
• Social justice and HAES [6:35]
• My proposed action point to this conversation [11:39]
• HAES dietitians and objective thoughts [12:52]
• Recap [15:51]

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Transcript

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This post was adapted from episode 16: "Health At Every Size (HAES) Criticisms - from a HAES Dietitian" of the Nourished & Free podcast. 

Listen to the full episode all about Health At Every Size Criticisms

A note from the author: Before you judge the contents of this article based on the title alone, I challenge you to read this post in it's entirety before coming to conclusions.

Some will not dare to listen to my words by the fact that I’m a “thin” white cis-gender woman. Some will say that I’m not examining my “weight bias”  or “privilege” closely enough. Some will discount me based solely on the body I was born in. That's a red flag.

If you’re a health and wellness provider, you probably noticed this interesting divide among the community. This divides states that you are either for:

1.             Diet Culture, or for

2.             Health At Every Size (HAES)

While I 100% do not align with diet culture and think it is one of the most harmful things that has ever come into our society, I used to think that in order to be anti-diet culture, I had to be HAES-aligned. 

So I was. But I’m not thrilled to be saying that anymore. 

Today, I want to provide some Health At Every Size criticism from the viewpoint of a HAES(ish) dietitian.

If you are a HAES professional - you're probably not going to like this. That's okay. I'm not writing this to make anyone feel warm and fuzzy. I'm writing because I feel that we are missing some really huge red flags regarding the HAES bubble.

This post is not to change anyone's minds about HAES who are passionate about it. This post is for those who have blindly followed suit because they were too afraid to do otherwise. This is for those who feared being called out by HAES providers. This is for all of us to start asking some questions (and subsequently seek those answers) that perhaps had not been asked before about HAES.

Ready for some Health At Every Size criticisms?

Calories in, Calories out

Let's backtrack. In school, I was taught that weight gain/weight loss is a simple math equation of calories in vs calories out. Obesity is correlated with chronic disease (or heck, it is a chronic disease), and weight loss is the cure. The end.

Out of school, I dove more into the Health At Every Size (HAES) approach to healthcare. In the HAES approach, all have potential to be healthy regardless of shape and size. All bodies should be valued equally. The end.

What I found is that each side was so incredibly opposed to each other that it felt like I had to pick sides. So, I chose the HAES side. It was more inclusive and caring for the whole person. And quite frankly, the arguments were really damn compelling.

Let’s review HAES really quick and shed light onto the benefits of Health At Every Size healthcare, before I get into the Health At Every Size Criticisms:

What is Health At Every Size® (HAES)?

The principles of Health At Every Size are as follows:

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.

What Health At Every Size® Does Well

In general, I think HAES is a massively needed shift in the way we think about health and the way that we treat others (especially as healthcare professionals. A 2013 study showed that 98.6% of students who were to be doctors, nurses, dietitians or nutritionists had a negative attitude about fat people - that is not okay. I absolutely detest when people say this… but honestly: do better).

There are a few things that I think HAES really gets right:

Weight Stigma is Harmful

Weight stigma is harmful. It keeps people away from the doctors, it exacerbates disordered eating and body image issues, and it’s downright discriminatory. If we think long enough about it, fat people may actually be “unhealthy” simply because they feel too judged to get help for their health, not necessarily just because they are fat.

A note on the word “fat”: I use this word as a neutral descriptor… as it should be. I do not think that the word fat is “mean”, because that implies that being fat is something undesirable. I don’t think this is fair. If we are okay with using the word thin, we should also be okay with using the word fat. I don’t say this to peoples faces because our society hasn’t caught up to the fact that saying ‘fat’ is not a bad thing (remember when it actually was a good thing?) But, when describing fat people in writing or in my work, I will say the word fat and that’s okay.

We should not judge health based on weight

Judging someone's life and wellness routines based on their weight is preposterous. Genetics play such a large factor in our size, but so does their mental health, environment, socioeconomic status, underlying health conditions, etc.

We need to have more accessibility for larger-bodied individuals to simply live their life

Imagine being afraid that you won’t be able to sit in a chair at the doctor’s office? Or that a massage table won’t be able to hold your weight? Picture having to buy 2 airplane tickets even though you are one person. These people can't go anywhere! 

This is not “a consequence to someone’s actions for being unhealthy” (which is a hateful way to think), that’s just manufactures f*cking up.

So HAES has some things right, most definitely. 

Let’s look at the things that I think HAES does wrong:

What Health At Every Size® Does Wrong

The truth is, I’ve grown weary of the supremest opinions that have come along with HAES. I even hesitate to say I’m anti-diet now because even though I am anti-diet culture, using the label of “Anti-Diet” has become so closely woven with HAES. HAES has become too extreme for me. And, if I’ve learned anything in my life, it’s to be cautious of things that are extremely one-sided and supremest. Honestly, I've had some Health At Every Size Criticisms brewing in my mind for a long time now... and I need to get them. So here goes.

If you talk about weight loss, you are immediately pro-diet culture.

In an effort to eradicate weight stigma, professionals are frowned upon for talking about weight loss at all (other than allowing one to “grieve” over their weight… which to be fair, I do think is an important part of body image healing). What this turns in to is that any whisper of intentional weight loss is immediately shut down and deemed ‘diet culture’.  I will get to the topic of intentional weight loss soon. But ultimately, what this has led me to is this panic of ‘can I say this? can I say that? I feel like we need to be talking about this but if I do I’ll be allegedly perpetuating racism and I’m fatphobic and a part of “the problem”.

In the HAES space, we don’t seem to have an issue with objectively realizing “yes that person is at too low of a body weight and needs nutritional rehabilitation” when dealing with anorexia nervosa. However, we cannot apply that same logic to opposite side of the spectrum out of fear for hurting feelings.

Do I agree with automatically assuming someone’s health based no their body size? Of course not, we need to investigate more before making judgement calls. I don’t agree with commenting on someone’s weight, what they are eating, or assuming anything about them. However, if you are a professional and that person is your patient – you do have a responsibility to see how their weight may be telling a bigger story, and that YES weight loss may be something their body would benefit from (*gasp*!).

HAES discriminates despite their mission not to

Health At Every Size providers and advocates let their social justice agendas get in the way of critical thinking and conversation among others who do not think exactly like them, which is a vital skill scientists need to exercise. To have a conversation with HAES practitioners, you have to qualify yourself by your race, body size, sexual orientation and gender preference. If you are white, thin, or cis-gender, you have no valid opinion, facts, career, or education. What this means is that my entire life is now null just because of my genetics and skin color. Is that not perpetrating the same bias that HAES is fighting against?

Some HAES advocates will not dare to listen to my words by the fact that I’m a “thin” white female. Some will say that I’m not examining my “weight bias" or “privilege” closely enough. Some will discount me based solely on the body I was born in. That's a red flag.

HAES tends to be primarily about social justice, not healthcare

If I haven’t lost you let and you’re a HAES fan, I’m definitely about to lose you now. 

Social justice is important. I’m not denying that. Racism and discrimination is pure evil. But I don’t know why we started letting our political agendas overwhelm our ability to be scientists first and foremost. 

I found this quote very thought-provoking from a former HAES advocate who has now walked away from supporting the movement (quote paraphrased for reader ease):

‘If your nutrition approach / eating disorder treatment isn’t HAES aligned, it is not social justice. HAES naysayers are misguided.’ Saying these things is an unjustifiable way to impose “one right way”. This stance also entrenches binary logic of right vs wrong, which may actually be reproducing racism in itself by cementing the oppositional hierarchy of black/white. – Lucy Aphramor

HAES provideres may be close-minded

I recently posted in a Facebook group exclusively for dietitians and posed the question, “Is there anyone who has researched well into the HAES approach, and not adopted it? If so, why?”

Naturally, I heard from not only RDs who had researched it and not adopted it’s philosophy into their practice, but also those who were HAES RDs and wanted to give their two cents on why someone might *incorrectly* not come over to “the HAES side”.

What I found in that conversation (and other conversations I’ve engaged in) is that die hard, Health At Every Size providers have a hard time with open-minded conversation and healthy debates, even though that is the very thing they ask of others when introducing their philosophies. They let words like ‘weight’ emotionally hijack them into a lens of “this is racism, fatphobia, and thin privilege” and cloud their ability to critically think. Letting your emotions cloud your ability to reason simply doesn’t make sense in a field rooted in science. 

I think it’s unfair for HAES practitioners to ask others to be open-minded to what they are saying and then shut down anyone who wants to debate otherwise because they are being ‘fatphobic’ and ‘racist’ (especially if you are white or thin, good heavens just shut your mouth now!).

Debate, for me, is the pursuit truth. This is important in science. Believe me, I hate confrontation and clam up when someone challenges me because I’m afraid I’ll say the wrong thing. Nevertheless, I think pursuing truth (which sometimes involves a healthy debate) is one the most important thing we can do for the wellbeing of our clients. They need us to stay up to date on the latest health sciences and be challenged by our colleagues so we can translate that into their wellbeing and to them living their best lives.

HAES causes rifts rather than unity 

Interestingly, in the Facebook post I mentioned, I got a response of over 220 comments. The responders fell into 1 of 3 categories: HAES RDs, non-HAES RDs, and RDs who fell somewhere in the middle and said, “I’m a little bit of both”. 

What I found is that the HAES RDs and non-HAES RDs were in this interesting online battle of “who can talk the loudest”. Interestingly, the non-HAES RD’s were anticipatorily doing this because they expected the HAES RD’s to backlash against their opinions (which you better believe they did).

HAES is all about promoting inclusivity, eliminating racism, privilege, and elitist health advice (all good things). But in the process, they become supremest in their own bubble and aggressive against those who disagree. The advocates for fat liberation, body positivity, and HAES are aggressive because they are mad at diet culture. Which I get! And honestly, we should be. But they automatically assume that anyone who is not 100% aligned with them must be 100% against them. 

It seems like what started out as them having a novel, open-mind approach to healthcare resulted in a “my approach is better than yours and always will be” mentality. This is understandably infuriating for non-like minded professionals and is turning them away from potentially adopting some of the important sentiments of HAES.

HAES research isn’t perfect.

At a certain point, I broke down and had to start listening to my own advice. I say all the time (often in criticism against fad diets) that there will almost always be research to support any ideas. 1 or 2 studies proves nothing. Research is complex – the quality matters, the factors matter, the study count matters, and the length of time lapsed matters. This is why I hate when a Tiktok goes viral for 1 study that says something different than the 1,000 studies before it that had said the opposite. It causes fear-mongering for no reason. But I digress…

I realized that I was either taking my own advice or ignoring it when it was convenient for me. I had to look in the mirror and realize, maybe it’s time I explore that the HAES approach doesn’t have that amazing of research, either. While it is promising, yes, I cannot necessarily ignore the decades of research that does seem to point to the fact that large amounts of adipose tissue are greatly linked to a higher risk for disease. 

“Intentional Weight Loss is Always Harmful”

What has happened is that we’ve shifted from making someone feel guilty overeating carbs (diet culture) to now making someone feel guilty for wanting and/or trying to lose weight (HAES). 

Intentional weight loss has been known to cause harm. But I want to stop saying that it always causes harm which according to HAES, it does (and dating back to a post I wrote back in Feb, I agreed). What I’m proposing today is a simple (but powerful) change in the language: Intentional weight loss may be harmful.

Instead of condemning my clients for wanting to lose weight, I want to validate them. I once said to a client, “I’m about to blow your mind with what I say next: It’s okay that you want to lose weight”. Sure enough, she said I did blow her mind. I think it’s because she’s so used to the HAES and anti-diet narrative which is that you shouldn’t want to lose weight.

What we need to be encouraging rather than rejecting weight loss vs. intentionally trying to lose weight is informed decisions. 

If someone wants to lose fat, they need to know the risks behind it. There is a risk for disordered eating and eating disorders. There is a risk for rebound weight gain. There is a risk that losing weight and/or weight cycling will decrease their lifespan. There is a risk that their life will suck. There is a risk that their metabolic health markers won’t change at all, or they may even worsen. There’s a risk their weight won’t change at all. There’s a risk that it won’t help their body image. 

But we also need to be real. A large amount of adipose tissue can lead to a greater risk for disease, and it might help their state of health and might reduce their risk of chronic disease to lose that. So it’s up to them: what does fat loss look like for them?

If someone wants to lose fat, it’s not inherently wrong to do that (just like there are inherently wrong or right foods). Where we run into trouble is when we focus on the wrong things.

For more on intuitive eating and weight loss, read my most recent blog post: What if I want to lose weight with intuitive eating? 

Concluding my Health At Every Size Criticisms

The difference that I want to teach my clients moving forward (and that I already have been) is just the focus of our behaviors. The roots of our behaviors. The why behind our behaviors.

I think we need to find a middle ground to health, wellness, and discussions of weight. Fat isn’t good or bad, just as food isn’t good or bad. We don’t need to be body positive and say that losing weight is evil, but we also don’t need to be obsessed with the thin ideal and cutting carbs, calorie tracking, or weighing ourselves for the rest of our lives. 

The focus behind our behaviors is what needs to be addressed. 

So yeah, I’m turned off by HAES and I don’t say I’m a HAES dietitian anymore, but I’m not totally against everything it stands for either. Some of the sentiments are important and have greatly impacted my practice for the better... but so are the nuances and other science that is not necessarily HAES-aligned is important as well.

If you're ready to work with a dietitian who will meet you where you are at and make sure you are well informed before making any decisions regarding your health, apply to work with me today.

Listen to the Nourished & Free Intuitive Eating Podcast below! ⬇️

Episode 16: Health At Every Size (HAES) Criticisms - from a HAES Dietitian