Embracing Health at Every Size
This weight-neutral approach to health encourages positive behavior change.
People who have worked to lose weight may have found that achieving short-term weight loss is relatively easy. But weight loss success all too often ends in weight regain. Soon, dieters embark on a new diet, launching a round of weight cycling that wreaks havoc on the body and causes many problems routinely blamed on obesity.
Dietary authorities have been developing alternatives to dieting for decades, but most alternatives have been founded in the weight-centered paradigm. Lately, many of the efforts have centered around Health at Every Size, a weight-neutral approach to chronic-disease management that encourages healthy behavior change. Kirsten Ackerman, MS, RDN, a non-diet registered dietitian and the founder of The Intuitive RD, explains the concept.
Health at Every Size (HAES)
HAES is based on research suggesting that people who are classified as obese can improve their metabolic fitness and reduce their risk of chronic disease by eating more nutritious meals and increasing their physical activity—independent of changes in weight (Ikeda et al. 2005; Kennedy, Lavie & Blair 2018). This method shifts the conversation away from weight management and toward health promotion.
“[Health at Every Size] rejects a focus on an individual’s weight, or change in weight, as a measurement of health,” says Jennifer McGurk, RDN. It focuses on healthful eating, body acceptance, attention to internal hunger and satiety cues (Bacon & Aphramor 2011). It also promotes active engagement in enjoyable physical activity. HAES does not suggest that everybody is living at a healthy weight. Rather, it maintains that behavior changes can stabilize weight at a healthy level (Robison 2005). This stabilized weight may or may not fall into the arbitrary “ideal body weight” range.
The HAES model does not ignore health risks and medical issues, but it does try to shift the focus away from prescribing weight loss as the solution (Robison 2005).
Research on HAES has been promising, showing substantially higher overall weight loss retention than dieting (Bacon & Aphramor 2011). Since HAES does not encourage weight loss, it also avoids the harmful process of weight cycling.
The Anti-Diet: Intuitive Eating
A natural complement of HAES is intuitive eating. Unlike many traditional diets, intuitive eating encourages people to listen to and honor their internal cues for hunger and fullness. It also discourages the habit of judging some foods as “good” and others as “bad.”
Rather than having people try to override specific food cravings to follow strict diet rules, intuitive eating embraces the body’s natural ability to regulate food intake. The principles of intuitive eating encourage people to observe, without judgment, the way foods make them feel. That includes honoring hunger and satiety cues, noticing energy levels, and identifying when food is used for comfort (Bacon & Aphramor 2011; Tribole & Resch 2012). While diets promote feelings of guilt and shame from failure, intuitive eating embraces the flexibility of the human experience. The goal of intuitive eating is not to eat perfectly, but rather to support a more comfortable relationship with food (Tribole & Resch 2012).
Why Intuitive Eating?
Intuitive eating encourages people to listen to and honor their internal cues for hunger and fullness.
The intuitive eating model is based on studies indicating that children choose foods that meet their nutritional needs without external guidance (Bacon & Aphramor 2011). This body of research suggests that intuitive eating enhances nutrient intake, reduces eating-disorder symptoms and does not cause weight gain (Bacon & Aphramor 2011; Tribole & Resch 2012).
Bacon, L., & Aphramor, L. 2011. Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10 (9).
Ikeda, J., et al. 2005. The National Weight Control Registry: A critique. Journal of Nutrition Education and Behavior, 37 (4), 203–5.
Kennedy, A.B., Lavie, C.J., & Blair, S.N. 2018. Fitness or fatness: Which is more important? Journal of the American Medical Association, 319 (3), 231–32.
Robison, J. 2005. Health at Every Size: Toward a new paradigm of weight and health. Medscape General Medicine, 7 (3), 13.
Tribole, E., & Resch, E. 2012. Intuitive Eating: A Revolu┬¡tionary Program That Works. New York: St. Martin’s Griffin.