What is Health at Every Size (HAES)? HAES is a registered trade mark for the Association for Size Diversity and Health. Anyone who uses the term has a responsibility to follow these principles:
- Accept & respect diversity of body shapes & sizes.
- Recognise that health and well-being are multi- dimensional and includes physical, social, spiritual, occupational, emotional, and intellectual aspects.
- Promote all aspects of health and well-being for people of all sizes.
- Promote eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.
- Promote individually appropriate, enjoyable, life- enhancing physical activity, rather than exercise that is focused on a goal of weight loss.
For health practitioners, this means encouraging healthy behaviours and wellbeing regardless of size. HAES is a weight-neutral paradigm that sees weight status as a consequence of disease, environment, society, and genetics, rather than a cause of disease.
Why HAES? HAES provides the framework to see your clients for the complex beings they are, and encourages treating the root cause, rather than a band-aid solution.
- The vast majority of people who lose weight regain it within 5 years, frequently in excess of their loss.
- Weight loss and subsequent weight regain cycles lead to significant physical harm including increased risk of: type 2 diabetes, hypertension, cancer, bone fracture, and all cause mortality.
- Engaging in a weight loss diet is the #1 risk factor for developing an eating disorder.
- People who lose weight intentionally tend to have poorer body image and self-esteem regardless of current weight.
- Undue focus on weight may cause you to overlook how you can treat a person’s condition right now.
- HAES approaches described in academic literature so far result in weight stability, and improved biochemistry and psychological outcomes. The bottom line is that a focus on weight loss causes harm and there is more we can be doing.
Speaking to your clients about weight: It is normal for clients to bring up their size during treatment. They may be concerned that their size will affect their prognosis, or they may wish to reduce their size and are hopeful you can help with that.
- Talk about what you can do to assist in managing their condition that doesn’t rely on weight loss (e.g. strengthening exercises). If you’re unsure of how to do this, do what you would do if a person with a BMI of 22 came in with the same ailment.
- If a client has been told that if they lose x amounts of kilos their condition will disappear (which despite being commonly said is rarely ever true) and therefore that is their goal for the future, redirect their attention to what they could be doing right now to improve their condition.
- If a client brings up wanting to try a weight loss diet explain to them that there is a dietitian on staff who takes a holistic approach to nutrition which includes nourishing your social and emotional health alongside your dietary health.
What to expect from a non-diet dietitian: Initial appointments tend to be very detailed covering a wide range of topics from biochemistry, medical conditions, and family history to physical sensations such as GI upset and one’s ability to identify their hunger and fullness, diet history, and dieting history, engagement with physical activity and client goals. Subsequent appointments can follow numerous trajectories based on issues identified and prioritised but generally follow the same pattern: Accepting and embracing body cues:
- Build awareness of hunger/fullness cues
- Teach how to eat mindfully and encourage pleasurable eating experiences Accepting and embracing all foods:
- Debunking diets
- Normalising Eating
- Dealing with nagging foods Accepting and embracing body shape:
- Acknowledging size diversity
- Move away from body weight goals
- Encourage dressing for comfort now Finding Enjoyable Movement Increasing food variety/gentle nutrition education
From our dietitian, Ebony McCorkell