What is Health at Every Size? Why Weight Inclusive Care Is the Foundation of My Therapy Practice.
The past year and a half has been a weird time for me as an eating disorder therapist. The principles that were so vital to my own healing are being drowned out by GLP-1 ads and Skinny-Tok. A common narrative is that “body acceptance is dead” and that we’ve lost all the progress we made in the late 2010’s body positivity movement. While the body positive movement had its flaws, it felt like a more hopeful time than what we’re dealing with now. As I continue to meet people where they are on their journeys, this time has only solidified my committment to HAES therapy.
Much of our history has been rooted in the idea that health is measured by someone’s weight, and that being in a larger size meant you were unhealthy. The idea of being concerned about one’s health was and still is a way to mask the fatphobia that is simmering underneath. Even in progressive spaces, body shaming and diet culture go unchecked and are even normalized. It’s not a surprise that the rise of anti-trans legislation is correlating with GLP-1s becoming the norm. Fat phobia used to be more covert but now our current administration is making it so that people don’t have to hide it anymore.
What is Health at Every Size?
Health at Every Size is rooted in the core principle that everyone deserves access to holistic, weight inclusive care, no matter what size they are. While it got its name in the 1990s, the conversations around size diversity and oppression go far back in history. HAES is an evidenced-based framework that shows that a person’s health is not defined by their weight and that focusing on intentional weight loss does not work long term. Research shows that intentional weight loss leads to weight cycling, which has negative impacts on phsycial and emotional wellbeing.
HAES focuses more on health-promoting behaviors through building a relationship with food and movement that is sustainable and values-aligned. HAES brings attention to how one’s race, gender, and socioeconomic background can impact their health. Oppressive systems are held accountable, rather than placing the sole responsibility on the individual.
Eating for Wellbeing, Rather Than Weight Loss
Health at Every Size encourages eating in a way that balances nutritional needs, hunger, satisfaction, and pleasure. It recognizes everyone’s relationship with food will be different, and people shouldn’t be forced to conform to a structure that doesn’t work for them. The number on the scale is viewed as only a number, not an actionable behavior or a sign of value. As a Certified Intuitive Eating Counselor, I help people work towards a more flexible approach to food that supports their needs.
Weight Loss Doesn’t Work Long-Term
Decades of research on intentional weight loss has shown that most people gain most or all of the weight they’ve lost within two years. Weight loss and yo-yo dieting can lead to negative health outcomes including heart issues, disordered eating, malnutrition, and slow metabolism.
Food and Exercise Are Not the Only Indicators of Health
HAES draws attention to the systemic issues that contribute to daily stress and chronic health issues, rather than individual health behaviors. It expands the conversation to look at other factors including income level, access to affordable healthcare, educational background, and work environment. BIPOC individuals, transgender folks, and people in larger bodies are at risk of chronic stress due to facing discrimination and social inequality. Research shows that people in larger bodies will avoid going to the doctor because they don’t want to feel judged. Or their doctor recommends weight loss rather than addressing the issue, which leaves it untreated.
You Don’t Owe Anyone Health
While Health at Every Size focuses on improving healthcare for all sizes, it also means that someone’s health doesn’t determine whether they are worthy of respect. Every single person deserves compassionate care regardless of their size and health status.
Fat Phobia is a Systemic Issue
Anti-fat bias has played a major role in the medical recommendations and research that are used in our healthcare systems. People in larger bodies and other marginalized identities are often excluded from research studies, leading to treatment approaches that are not just unhelpful, but harmful. HAES asks us to look at every institution with a critical eye. Who is represented in these research studies and how are these studies being funded? Many of the studies for GLP-1s are being funded, designed, and analyzed by Novo-Nordisk, the company that created Ozempic. Many of the researchers are paid consultants, employees, or have received grant money by Novo-Nordisk.
Many Spaces Exclude People in Larger bodies.
Airplane seats, hospital gowns, and medical equipment are not designed for larger bodies in mind. Individuals continue to be blamed for this systemic issue, rather than being offered inclusive equipment and care from providers trained weight inclusivity. Clothing shopping has only gotten harder as plus-size clothing is disappearing off the racks. Target has significantly scaled back their plus-size clothing section in their brick-and-mortar stores.
Weight Stigma Needs to be a Part of the Conversation for Healthcare Providers
While I’m grateful for my education as an art therapist, I had never heard of Health at Every Size until I discovered intuitive eating through my own personal therapy. I was not aware of my own fat phobia and had to do so much work to address it (and still do.) I read books, attend trainings, and participate in peer consultations to continue unpacking my own biases. HAES is a life-long comittment to my therapy practice and my own personal growth.
Lack of education around weight stigma is one of the many reasons why therapists can feel out of their element when body issues come up in the therapy room. Therapists may have their own anti-fat biases and project them onto their clients. They may change the subject or avoid certain topics due to their own discomfort. Some therapists will recommend weight loss as an intervention. They may have their own body image stuff they haven’t worked through. While it’s not meant to be harmful, these issues come out in unconscious ways and clients will sense it.
I truly believe that weight stigma and weight inclusive care need to be part of education and training for all healthcare providers. Providing respectful, weight inclusive care requires owning our own biases and doing intentional work.
Health at Every Size in My Therapy Practice
HAES is part of the foundation of the work I do for my clients. That means I won’t recommend weight loss as a solution to problems that are beyond your control. I’ll listen closely to what you want for yourself, and we’ll create goals that reflect that. Every intervention will be discussed in depth with the option for you to decline if it’s not the right fit for you. Instead of just focusing on individual coping skills, we’ll talk about what it feels like for you to move through the world. We’ll talk about the ways that diet culture and other systems have harmed you, and how it’s shaped how you feel about yourself. I won’t make assumptions about your relationship with your body and remain open to your unique experiences.
HAES for Queer and Transgender Individuals
Health at Every Size aligns with anti-oppressive and liberatory frameworks by viewing social determinants of health has equally, if not more important than individual health markers. As a HAES therapist, I maintain awareness of how my identities show up in the therapy room and impact our work together. I engage people in conversations about how discrimination impacts their health and sense of self. Your struggles will not be pathologized, but viewed as normal, necessary responses to living in a world that hostile and unsafe. Together we’ll look at the messages you’ve absorbed from diet culture, racism and transphobia and help you get space from them. By viewing these messages as separate, you can seem them as parts of you that came from somewhere else. This creates an opportunity to gain more compassion towards every part of you and connect with your core self.
Looking for HAES Therapy?
My therapy approach is fat positive, HAES aligned, and body liberation focused. If you’re looking to have a more grounded relationship with your body or struggling with disordered eating, then I’d love to hear from you.
Frequently Asked Questions
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Yes, Health at Every Size is research-backed and supported by clinical studies. HAES promotes weight neutral interventions which has been known to have a positive impact on blood pressure, cholesterol, and metabolic health. It emphasizes sustainable health behaviors rather than intentional weight loss.
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The primary benefit is helping people focus on their overall wellbeing rather than intentional weight loss. It increases self-compassion and reduces shame caused by dieting. It’s helpful for anyone who is looking to break free from dieting or is struggling with an eating disorder. HAES can be a more sustainable approach to food because it emphasizes care that is tailored to your unique goals. HAES is aligned with intuitive eating principles, which help prevent weight cycling and yo-yo dieting. People who eat for their wellbeing rather than weight loss experience better health outcomes.
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The core of HAES is that everyone along the size spectrum deserves comprehensive care without exception.
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HAES encourages flexible eating that meets your unique nutritional needs, hunger, satiety and tastes. It is rooted in trusting yourself rather than conforming to a pre-determined diet plan. While HAES doesn’t advertise as an anti-diet framework, it does share a lot of the same values. Both emphasize trusting your body’s needs over relying on a rigid diet.
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Yes, you absolutely can. A HAES approach will have you focusing on behaviors such as nutrition, movement, and sleep to manage blood sugar or blood pressure. It shifts the focus from weight control to sustainable, flexible changes in your lifestyle.
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A Health at Every Size (HAES) therapist provides weight inclusive, trauma-informed care that focuses on holistic well-being rather than weight loss. A HAES therapist can help people address disordered eating and body image issues by promoting self-compassion and intuitive eating.
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HAES is based on four principles: Health is a Human Right, Wellbeing and Healing are Resources that are Personal, Health is a sociopolitical Construct, and Care is Fully Provided When Free from Anti-Fat Bias.
