Health at Every Size and eating disorders

We believe that eating disorder recovery must include education about Health At Every SizeⓇ (HAESⓇ).

HAES is first and foremost a social justice movement created and led by fat activists. It is based on the primary assumption that all bodies deserve respect and dignity, and no body deserves to be discriminated against on the basis of weight. HAES is also a philosophy that the current practice of linking weight to health using BMI standards is biased and unhealthy. 

The belief that to be healthy one must have a so-called “healthy” BMI is based on false premises and inaccurate. The BMI scale itself has been shown to be racist and sexist, and wholly inappropriate for use as an individual health measure. It was developed based on the weight of white males in Northern Europe.

The scale was developed to look at a specific population. It was never designed to be applied to individual health.

And yet today it is broadly assumed that BMI is an essential and accurate health measurement. This incorrect assumption has led to an explosion of weight stigma, which is a bias against people who are larger. It has also directly contributed to diet culture, which is the practice of attempting to control body weight through restriction and exercise. Finally, the belief that weight = health is directly correlated with increasing rates of eating disorders.

Is it possible to be healthy at every size? 

This question demands a firm definition of “health.” However, we don’t have one. What, exactly, are you measuring as “health?” Is it the function of the cardiovascular system? Perhaps it’s a strong immune system. Or maybe a highly effective endocrine system? Excellent joint function? Or maybe the absence of mental illnesses?

The point is that health is multifaceted. It cannot be boiled down to just one measurement. 

And it certainly can’t be boiled down to weight. Except at the very extremes of weight, people can be healthy in various aspects at any weight. Additionally, all the diseases commonly assigned to weight also occur in thin people. In short, yes it is possible to be healthy at almost every size.

But more importantly, the HAES movement is not actually about being “healthy” at every size. It’s about pursuing “health at every size.” There’s a big difference. In other words, low weight is not a prerequisite for pursuing healthy behaviors.

Health-promoting behaviors have no side effects and can be practiced by almost anyone in any type or size of body. They can be adapted based on a person’s body type and size, they are not something you need to wait to be thin to do. 

Health-promoting behaviors include:

  • Getting enough sleep
  • Moving your body
  • Eating a varied diet
  • Not drinking or smoking
  • Getting regular medical care and vaccines
  • Caring for your mental health
  • Engaging in meaningful social connection with other people 
  • Living in an environment that is not polluted
  • Wearing a seat belt when driving and driving the speed limit 

Anyone, in any body, can pursue these behaviors in different ways. There is no weight limit on whether a person can engage in healthy behaviors.

Can you be big and have an eating disorder? 

Eating disorders occur in all body types and sizes. It is a fallacy that eating disorders only result in visible emaciation. Even anorexia, which is a highly restrictive eating disorder, can occur in larger individuals. It’s important to remember that eating disorders are mental illnesses, not weight-based conditions. Using weight as a measurement of an eating disorder is dangerous and reductive. It leads to missed diagnosis and under treatment of a very serious illness.

Can you look healthy with an eating disorder? 

Yes, you can look healthy and have an eating disorder at the same time. In fact, most people who have eating disorders look what most people would consider to be “normal.” Eating disorders are mental illnesses, and thus do not have a specific appearance. They cannot be diagnosed based on how a person looks or what they weigh. And in fact many health measurements such as heart function and blood work fail to diagnose eating disorder status. This is because eating disorders are mental disorders and therefore must be diagnosed based on their mental symptoms, not a simple weight or blood measurement.

Eating disorders are more complex than a simple obsession with body size and weight. However, an obsession with body weight is a critical symptom of an eating disorder, and until a person fully accepts their body at any size it will be difficult to be fully recovered from eating disorder behaviors and thought patterns.

We support a HAES approach to eating disorder treatment for all types of eating disorders. HAES has been a critical path to healing for many people who have eating disorders. It challenges the commonly-held beliefs about health and wellness that uphold and strengthen eating disorders. HAES can help people with eating disorders lose their fear of weight gain and reassure them that they can achieve health, wellness, and goodness at any size.

Is HAES just an excuse to get/stay fat?

Criticism of HAES usually comes down to the idea that people should not be fat. HAES simply encourages people to remember that all bodies deserve respect and dignity, and bodies don’t deserve to be discriminated against due to weight. HAES promotes accepting weight and pursuing health-promoting behaviors regardless of weight. But critics suggest that this is an “excuse” and that all people, especially fat people, should strive to lose weight. The problem with this critique is that there is no method to permanently and effectively intentionally lose weight. So even if it is “dangerous” to be fat, there is no safe and effective cure. Dieting is not healthy.

Diets result in weight regain almost all the time, and the greatest predictor of weight gain is intentional weight loss. In fact, if your goal is to not gain weight, then your best strategy is to not try to lose weight. I realize this is counter-culture. I realize that this goes against everything the $70 billion diet industry preaches. But it’s true. There is no safe and effective way to lose weight. 

This science means that most fat people are likely going to remain fat. Now what? HAES promotes taking care of the body you already have rather than trying to transform it into something it’s not. This means taking good care of it by giving it plenty of sleep, movement, food, and water. Connect with others in joy, happiness, and acceptance. These behaviors are all health-promoting. Whether they impact weight is irrelevant. They are healthy, and they can be pursued at almost any weight. 

What are the principles of health at every size?

The principles of HAES include:

1. Bodies are diverse

The human body is complex and comes in diverse sizes, shapes, abilities, and colors. When we promote a single view of “health,” we limit the opportunity for people in all bodies to feel good about themselves. Bodies don ot need to fit a narrow mold in order to be healthy. Promoting the idea that one size fits all applies to bodies perpetuates discrimination and unhealthy behavior.

2. Weight is a poor measurement of health

Weight is not the best measurement of health. Healthcare providers must stop focusing on weight as an indication of health. Instead, they should understand the physical and emotional elements involved in true health. Providers, educators, and parents must understand that the dangers of fat have been vastly overstated. This has damaged the health of many people. And weight stigma, even when perpetrated with the best intentions, is far more dangerous than weight itself.

3. Bodies should not be weight-controlled

A body does not need to be weight-controlled to be healthy. In fact, it appears that the very thought of weight control leads to food preoccupation and disordered eating habits. In 95% of cases, when a person intentionally loses weight, they regain lost weight and decrease their health. Weight loss practices are promoted as health-promoting, but they are actually bad for our health.

4. Health includes body and mind

Respect and kindness are the pathways to true health. This includes eating food that tastes good, is nourishing, and in quantities that meet our body’s needs. It also includes joyful movement without the intention of weight loss.  Finally, connection and belonging are so vital to human health that a person can die without them.

Learn more about HAES:

The Association for Size Diversity and Health (ASDAH) Health At Every Size® Approach

Review the HAES guidelines from the Association for Size Diversity and Health (ASDAH)

Check out this book: The Body is Not An Apology