Tuesday, March 20, 2012

Why HAES May Never go Mainstream

It's not the concept that's for sure.

For those of you who aren't familiar with the acronym HAES, it stands for "Health at Every Size", and it's a principle with which I strongly agree.

According to the official HAES community page HAES,
"acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors."
And truly, I could not agree more in that the words "healthy", and "weight", are not mutually inclusive or exclusive terms.

According to HAES' founder Linda Bacon, one of HAES' tenets is, "Show me the data", and in her recent Huffington Post piece, she says that we should all be demanding the data too and adopting HAES' "more skeptical" mantra.

Again, I could not agree more.

Yet despite readily agreeing that fat has been regularly and unfairly vilified by society and the medical community for decades if not centuries, and despite regularly telling my otherwise healthy overweight and moderately obese patients that their weights aren't likely contributing much if anything to them in the way of medical risk, I struggle with HAES as it would seem to me that they are fighting misinformation with misinformation, and in so doing, weakening and cheapening their incredibly important and valuable message.

Looking at Linda's debut Huffington Post piece here are the 3 things she wants readers to understand are, "known (even if everyone can't accept it yet)",
"-  Stable fat is blown out of proportion as a health risk (even dreaded "tummy fat"), but yo-yoing weights common to dieters do harm health.

-  The "ironclad" notion that obesity leads to early death is wrong: Mortality data show "overweight" people, on average, live longest, and moderately "obese" people have similar longevity to those at weights deemed "normal" and advisable.

-  Life spans have lengthened almost in lockstep with waistlines over the last few decades, which should make you wonder about the supposed deadliness of fat.
If we're talking, "show me the data", then lets talk data.  First, the data on yo-yo diets, otherwise known as weight cycling. Looking at the most recent and robust data, one set from than Cancer Prevention Study II Nutrition Cohort which followed 55,983 men and 66,655 women from 1992-2008, and the other set from the Nurses Health Study which followed 44,882 women from 1972-1994, neither demonstrated any relationship between weight cycling and mortality. Other studies have exonerated weight cycling from increasing the risk of hypertension, and type 2 diabetes, and there's a mixed bag of studies suggesting both protective and causal effects of weight cycling on various forms of cancer. But if we're really talking "show me the data", the only thing very conclusively linked to weight cycling are increased body fat percentages, and while I definitely agree weight cycling is symptomatic of a broken societal approach to weight management, and may well carry with it some harm, the data simply do not currently support a blanket, "harm health" statement.

Next the "ironclad" comment. While it's true that "overweight" has been shown to be protective in the over 65 population, and that "Class I", or "moderate", obesity carries the same risks as "normal" weight in that same population, what Linda omits here, other than the age qualifiers, is the ironclad fact that as weights rise more dramatically than simply "moderate" obesity, so too does risk. And it's not just as weights rise, but also as weight responsive conditions accumulate as is clearly shown by Dr. Sharma's Edmonton Obesity Staging System work which demonstrates that as EOSS stage rises, where EOSS evaluates weight in the context of having or not having weight related co-morbidities or quality of life impacts, so too does mortality.

Lastly we get to the lockstep comment about the last few decades. Here I'm nearly at a loss for words. Is Dr. Bacon honestly suggesting that the very simple fact that our life spans are continuing to lengthen, while at the same time as a society we're gaining weight, is in turn an argument that weight can't possibly be deadly? Isn't the whole point of HAES' existence to combat what HAES sees as correlations not being causal? Couldn't there be dozens, if not hundreds of other explanations for why our life spans are increasing despite our weight gains even if those gains did carry risk? Like for instance the very dramatic improvements in medicine that have occurred over the course of the past few decades?

Fighting misinformation with misinformation, relevant omissions with relevant omissions, and logical fallacies with logical fallacies, is not the way to accredit your movement, and if HAES has any hope of actually penetrating mainstream medicine, something I would dearly love to see happen, they're going to need to hold themselves up to at least the same, if not a higher level of scrutiny to which they hold others. If they don't do so, then their detractors will have an easy time dismissing them as champions of a self-serving, non-evidence based, over-hyped agenda, which ironically is the very same thing of which HAES is accusing mainstream medicine.