Why I practice Health at Every Size medicine
There are so many reasons to practice Health at Every Size (HAES) medicine, and many brilliant people have described them at length. So this is just a brief overview of some of the main points that inform my own practice.
Weight loss is a (dangerous) myth
Sometimes we hear the statistic that 90% of diets fail. What does this mean? While it is possible to lose weight in the short term, it is almost impossible for people to maintain significant weight loss for a meaningful duration of time. 80-95% of people who lose weight will regain it within 2-5 years, and between one and two thirds of people will regain more weight than they lost. If we had a drug to treat strokes, but it only worked for 5-20% of patients and made up to 66% of patients have more strokes, we would be EXTREMELY judicious about prescribing it (if it even passed safety trials in the first place). And this is only considering success and failure in terms of weight loss. In the scientific literature about weight loss interventions, they almost never consider the other negative impacts of dieting:
The cycle of weight loss and regain (so-called “yo yo dieting”) causes inflammation. Some of the ills attributed to fatness are likely related, instead, to this harmful cycle.
Increased risk of developing eating disorders, and in many cases the diets prescribed (extreme calorie reduction, fixation on good vs. bad foods, obsession with weight) would be classified as eating disorders if the people practicing them were thin.
Physical symptoms such as gallstones, muscle wasting, decreased bone density, lowered immunity, hair loss, fatigue, and cold intolerance
Mood effects like irritability and obsessive preoccupation with food leading to stress, anxiety, and depression
Body size does not determine health.
We have so many very cool and accurate ways to determine a person’s health status: imaging like X-rays, CT scans, MRIs, ultrasounds; hundreds of lab tests of blood and urine to measure organ function and detect diseases; electrical tests like EKGs and EEGs; and old fashioned skills like listening to people’s heart and lung sounds. Looking at a person and making a guess at their well-being based on their weight is simply unnecessary (not to mention biased, inaccurate, ineffective, and leads to worse outcomes for fat patients whose legitimate concerns get ignored and thin patients whose risk factors get overlooked.) It’s like looking at someone’s toenail length to determine if they have back pain. Sure, some people with back pain will struggle to cut their toenails, but there are so many other reasons a person might have long toenails (or maybe they have debilitating back pain but can afford regular pedicures.)
Even if body size did determine health (it does not) and significant weight loss was a realistic possibility (it is not), fat people would still be deserving of care. Performing “health” should not be a prerequisite for receiving compassionate, professional, effective medical care. Period.
There is a very dangerous idea being promoted by some of the most powerful voices in this country’s health spheres that we are all individually responsible for our own well-being, that illness and disability are avoidable, and therefore to be unwell is a personal and moral failing that makes one undeserving of care. There’s so much to unpack here*.
We cannot be expected to take perfect care of ourselves and only perform health-fostering behaviors
Resource extraction and divestment from communities make things like green space and fresh food financially and/or geographically inaccessible to many people.
The demands of capitalism and wage labor (not to mention the lack of affordable childcare) limit the amount of time people have for sleep and basic functioning tasks, let alone inessential activities like exercise and preparing food from scratch.
“Health” is not a monolith. Physical and mental or emotional health needs can be in conflict.
We’re imperfect creatures (see: me forgetting to drink water all day and staying up past my bedtime doomscrolling the news.)
Even if we could take perfect care of ourselves we would still fall ill and become disabled
Because that’s a thing bodies do under the best of circumstances
And it’s especially a thing bodies do when they are subject to air, water, and food polluted with unregulated industrial byproducts; the chronic stress state of coping with poverty and racism; inadequate childhood nutrition and healthcare; environmental catastrophes like wildfires and floods; and other joys of modern living over which we have no individual control.
It feels absurd to have to say this, but access to healthcare should not be reserved for people who are already considered healthy (reiterating here that body size is not a reliable indicator of a person’s health or health-related behaviors. This is just the section where I’m saying “even if it was...”). Regardless of how someone chooses or is able to care for themself, everyone deserves to have a doctor who will listen to and address their concerns, answer health-related questions, and explain the risks, benefits, and likelihood of success of proposed interventions.
I’m so grateful to all the amazing fat people and fat allies that I’ve learned from over the years. I encourage everyone and especially healthcare providers to dig deeper into this, work to unlearn anti-fatness, and build a world that celebrates and honors human bodies of all sizes.
If you want to read more:
Association for Size Diversity and Health
Aubrey Gordon - You just need to lose weight and 19 other myths about fat people
Sabringa Strings - Fearing the black body: the racial origins of fatphobia
If you like podcasts:
Maintenance Phase with Aubrey Gordon and Michael Hobbes
*this piece by Janet Kent does a great job explaining the relationship between the history of this moral failing narrative and our current political situation.
