I recently finished reading Health at Every Size by Linda Bacon, PhD. Bacon agues that promoting weight loss is ineffective in improving health over the long-term. According to the book:
- The vast majority of dieters regain their weight. There is no method proven effective for weight loss maintenance.
- Research is emerging showing that fitness, not fatness, is associated more strongly with health and longevity (1,2,3).
- Preoccupation with weight can be psychologically damaging and may lead to disordered eating (4,5).
- People of any size can improve their health and reduce their risk of chronic disease by eating healthfully and being physically active, regardless of whether or not they lose weight (6,7)
- No study has ever shown that weight loss actually prolongs life.
The Health at Every Size (HAES) approach emphasizes:
- Self-acceptance regardless of weight, size, or shape
- Physical activity for enjoyment and enhanced quality of life
- Normalized eating in response to physiologic hunger and fullness cues rather than external guidelines or rules
- An approach to healthy living that does not necessarily involve weight loss for overweight individuals
With the HAES approach, the fundamental principles of nutrition remain the same. It’s still important to eat a variety of fruits, vegetables, whole grains, lean protein and unsaturated fats from mostly unprocessed sources. It’s still important to eat breakfast and drink water. If you follow these guidelines and lose weight, that’s fine. But if you follow these guidelines and don’t lose weight, that just may be fine too. What are your thoughts on HAES?
For additional information on HAES, check out:
- This Medscape article: Health at Every Size: Toward a New Paradigm of Weight and Health by Jon Robison, PhD, MS
- This USDA article: Health at Every Size: New Hope for Obese Americans?
- Linda Bacon, PhD’s book: Health at Every Size: The Surprising Truth About Your Weight
Also check out this short clip by the Surgeon General, emphasizing a Health at Every Size approach:
References:
- Barlow CE, Kohl HW, Gibbons LW, Blair SN. Physical fitness, mortality and obesity. Int J Obes Relat Metab Disord. 1995;19(suppl4):S41-S44.
- Church TS, Cheng YJ, Earnest CP, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004;27:83-88. Abstract
- Katzmarzyk PT, Church TS, Janssen I, Ross R, Blair SN. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care. 2005;28:391-397. Abstract
- Gaesser GA. Big Fat Lies. Carlsbad, Calif: Gurze Books; 2002.
- Campos P. The Obesity Myth: Why America’s Obsession With Weight Is Hazardous to Your Health. New York: Gotham Books; 2004.
- Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of non insulin dependent diabetes. Diabetes Care. 1994;17:1469-1472. Abstract
- Tremblay A, Despres JP, Maheux J, et al. Normalization of the metabolic profile in obese women by exercise and a low fat diet. Med Sci Sports Exerc. 1991;23:1326-1331. Abstract
Nicole Geurin, MPH, RD 
Great post! I will check back for more 🙂
Wow…powerful message. I couldn’t agree with this post more…it is time we start respecting our bodies and focus on health, not physical appearance. Thanks for posting this!
This has been around for a really long time, and I’ve never really been a fan of Health at Every Size. It’s not because I have a problem with self acceptance, but more that it seemed the biggest reason to promote health at any size had more to do with studies that showed only 5% of people who tried to lose weight could lose 10% of their body weight and keep it off for a year. In other words, docs felt guilty telling people to go home and lose weight because they knew there was only a 5% chance of them succeeding, so Health at Any Size showed up as a type of “plan B.” That’s the way it seemed anyway.
So it always seemed like it was 2nd best. Like we’re only telling them to be healthy at any weight because we don’t think they can actually succeed in losing it, not because it’s ideal.
The thing I DO like about it, is that with physical activity and healthy eating, an overweight person would naturally lose weight anyway, and that is the best way to do it. I’m not a fan of diets at all. So it’s great in that respect. Thinking of weight loss itself as nothing more than a natural side effect of a healthy lifestyle is awesome. I would just hate to think that his might be used as tool to help people make excuses or live in denial.
Derek:
Thank you very much for your comments! I am still determining my position on HAES and would like as much input from professionals as possible. My question to you is: If someone is eating right, exercising and not losing weight… then what? Do you recommend further dietary restriction and increased activity? I think that some people’s bodies are designed to hold on to that weight really well.
Thanks again for your thoughtful comments.
I think that very few people actually take advantage of the expertise of people trained to really help them. They get their diet and exercise advice from television and magazines, the latest diet book, or one of their friends.
So to answer your question, the first thing I would do in that situation is get the person teamed up with some people who do it for a living. I think of personal trainers, dietitians and nutritionist as experts at what they do, and people should be willing to pay for their expertise because health is so valuable. It seems like most people have never seen the inside of a nutritionists office.
This is just my opinion, but I don’t think that anybody should accept the idea that they just can’t lose weight until they have worked directly with a team of professional who are certified, licensed and trained to help people like them reach their health goals. So this, to me, means we’re only talking about 1% of the population.
As someone’s body who loves to hangout in the “overweight” BMI range despite every appropriate dietary restriction and intense exercise, I am a huge supporter of the HAES movement. HOWEVER, this cannot be an excuse to put health risks associated with overweight and obesity aside. We cannot become too complacent with our weight and thus our health. Great post, Nicole 🙂
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