Tuesday, December 10, 2013

Guest Post: Why I am Walking Away from HAES

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A few years ago I wrote a post detailing my concerns regarding the Health at Every Size (HAES) movement. My concerns are simple. While I'm a strong supporter of the notion that scales don't measure the presence or absence of health, it seems to me that HAES proponents often takes this concept further than it ought - both in terms of cherry picking and promoting confirmation bias tweaking data, and in terms of reacting aggressively when anyone suggests weight may be a valid source of concern to an individual or a physician. Yesterday I received an email from someone who has had some struggles with HAES and I asked if I might post their email anonymously so as to see if their experiences were unique and unfortunate for them, or par for the course and unfortunate for HAES.

I wanted to thank you and respond to your HAES article - but had no intention of reviving a nearly 2 year old thread. I recently walked away from the HAES movement, because, as you predicted in 2012, the proponents would use so little credible information that they wind up discrediting their reputation along the way. But not only that, but the localized followers have taken an even more drastic turn, and I feel that it has become somewhat dangerous.

Members of groups are either rabidly defensive, or walk on eggshells. After a recent blow-out it came to my attention that many of the HAES speakers may have some disordered health issues that are unresolved, and are using the program - not to promote health at any size, or to stop shaming people about body size - but to simply cover or hide coping mechanisms. You are not allowed to speak up and say things - things that ordinary people would say - without being accused of "triggering" HAES members - things like, "Some people decide to gain or lose weight for medical reasons".

To me, it became all too frightening that even speaking of someone gaining or reducing weight for a health or medical reason (or just because they want to, honestly) - as decided by patient and doctor - receives such a vehement backlash from the HAES community that you are, essentially, ousted. The "community" has become less about health at any size. It has become "Only healthy at larger sizes". It was noted that people who gained weight for health reasons were OK (that intentional weight change is acceptable). People who benefited from weight loss, however, were villains, lying, or anomalies. (Their intentional weight change is bad, offensive, and "dangerous") Health concerns for people at smaller sizes were/are irrelevant.

It is even more worrisome that unqualified individuals whose disordered habits may be triggered by the personal decisions of others are giving medical advice, and essentially encouraging people to stop listening to their doctors. The HAES people are right, the medical community (and individuals in it) are wrong.

That is downright terrifying.

I just thought I'd drop this note, because, well, people are walking away, and not just because of the lack of credibility. And it's too bad, too - because advocating health for everyone, and reducing stigma is an excellent thing. But alienating people because they have chosen health at a particular size - that does not fit into their overall agenda - is not the way to grow a movement.

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  1. The situation just proves that society has created such a toxic environment for many people. It is really sad. BTW interesting choice of image.

  2. Well said Doc! I do believe there can be health at (almost) every size, but as a pediatric hospitalist, I have treated unhealthy and hospitalized anorexic and obese patients.

    As a physician who has founded a child wellness and pediatric weight management program, I recognize that some people are over or underweight, and this may require treatment. Deciding when this intervention is needed in a child requires a doctor, a patient, a growth chart, and the family history!

    We must all recognize that blanket statements about health just aren't accurate 100% of the time. I agree, many HAES advocates do not recognize this.

    Jennifer A. Gardner, MD, FAAP, Founder, Healthy Kids Company

  3. As distracting as it may be, the personalities of people involved in a movement really have no impact on the validity of the movement. IMO, HAES is about the most effective way to help people achieve health, which weight concerns are supposedly about (emphasis on supposedly).

    There is good evidence that when weight is a problem (and it isn't always because many of us come in larger sizes than is currently "acceptable" and we're perfectly healthy at those sizes), it is a symptom, not the root cause of health problems. Focusing on a symptom runs the risk of not getting to the root cause. Further, in the case of weight, there is so much stigma surrounding it, a focus on weight comes with a high risk of exacerbating the problem (if, indeed, it isn't the root cause itself). Ultimately, root causes are where our focus needs to be because that offers the best chances for long-term resolution of problems.

    HAES is about focusing on health, not weight, so that if health is an issue, the exploration can go there and not get hung up on the size of our clothing (tongue-in-cheek there). It is a weight-neutral approach; some people may lose weight taking the approach, and in our experience, many do because that's an outcome of their bodies getting healthier. It's also a sustainable approach. If weight loss occurs, it's usually permanent, no more yo-yoing up and down the scale. That speaks volumes for both physical and psychological health.

    Thanks for the opportunity for conversation, Yoni. My impression is that you are 99% HAES but maybe don't get the weight neutral part?

    One more point: My impression is also that the negative reactions to weight discussions that your guest author speaks about is really a reaction to the weight stigma people have experienced throughout much of their lives. To give up on a logical approach because the people who support it are still working through their own issues seems a bit defeatist.

    1. Well said Marsha! Completely agree!

    2. Co-signed. The whole point of HAES is that it's YOUR body and YOU know what is best for it. If you change your lifestyle and lose weight, nobody should be haranguing you for it, and if someone who promotes HAES is, then they aren't promoting HAES. Insulin resistance leads to weight gain (which, in turn, makes IR worse), so improving insulin sensitivity may lead to weight loss in those for whom weight is a symptom of IR. Where HAES draws the line is in making weight reduction the primary goal of healthy behaviors because not every fat person is fat because of IR.

      As far as advising people to ignore their doctors, that is irresponsible as well. HAES encourages people to work WITH their doctors to improve their health by emphasizing better metrics than the scale, like blood pressure, blood sugar, blood lipids and inflammation markers. The scale may be useful in showing spikes or drops in weight as a symptom of a problem, but too many doctors treat the scale as a diagnostic tool in and of itself. If you have a doctor who only emphasizes weight loss, then I would encourage the patient to find a more understanding doctor who is willing to focus on those other metrics.

      I've written two posts on our blog (Fierce Fatties) about science denialism within HAES, which I think is a major problem. We cannot blindly say "Fat is never unhealthy!" when there is evidence that in certain instances it can be. But the solution to ALL metabolic health problems is identical: improve your diet and get more exercise. Whether you are thin or fat, the desire to gain or lose weight is secondary to the fact that improving your diet and fitness levels will have a tremendously positive impact on your health. Weight loss or gain as a result of healthier lifestyle is most irrelevant. Anyone who says otherwise is not promoting HAES, period.


    3. I just feel to add that HAES has two faces and both shoudl be considered when evaluating its impact.

      The first is very intimate and personal, and it concerns what each of us believe is best for us as human being, the second is social, meaning that it concerns society as a whole.

      In the first case it comes out of years of dietism, an approach to weight which statistics and reasearch tell us plainly that does not work. Even if it does for some individuals, it does not for the majority. HAES is an answer to the question: what we do next?

      The other face is of the outmost importance. In many years of studying the obesity factor, I never met an approach as powerful as HAES in fighting the weight stigma. Which, as we all know, causes personal and societal breakdowns.

      I believe it would be wise to live HAES for someone who has found something better, a new better path. In that case I'd really be interested in knowing what it would be. But if it means going back to dietism then I'll sign off.

      Let me also add that as Italian in many ways I envy the Size Acceptance movement in the US, 'cos even if some individuals in the movement may not be good examples for Size Acceptance, it has brought the weight stigma at the center of the debate. Here in Italy, instead, the debate still focuses on dietism and introducing a different view is a everyday fight.

      Excuse my raw english ;) Take care

    4. Marsha, thank you for your brilliant response.

  4. Christine Clarahan MS, RD, LDN8:49 am

    I have to agree with Marsha on every point - especially the point that Dr. Freedhoff has always seemed very HAES to me.

    In any movement/different way of thinking from the popular mainstream you will find individuals who are on the more extreme ends - but I believe you need to look at the mission of the movement and see if it rings true with you.

    The HAES principles are:

    1. Accepting and respecting the diversity of body shapes and sizes.

    2. Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.

    3. Promoting all aspects of health and well-being for people of all sizes.

    4. Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.

    5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.

    It sounds like the author in the guest-post lost sight of the message/mission of HAES due to some unfortunate interactions (which I imagine you would have with any movement) - perhaps the author should be walking away from that particular subset of the movement - there are so many amazing individuals and resources with HAES.

  5. If it's truly about health, how come we don't hear more from HAES about not marketing junk food to kids?

    1. Kaija9:58 am

      Because it seems focused on an individual approach to personal health, not a policy movement to enact structural change. Putting it on individuals to solve structural problems is faulty thinking.

    2. I think that individual vs. population misunderstanding is a big part of the problem: "This woman is a prime example of not understanding the basic structure of the HAES philosophy…the first being that 'Health At Every Size' means health at every size for the population, not necessarily the individual."
      This individual approach to not wanting to label foods as good or bad plays into the junk food companies' message that they're all "happy calories" and it is up to the individual parent to say no. Meanwhile, the structural problems are all working against the population (public health) including government subsidies for the ingredients for junk food, billions of dollars spent on marketing junk food to kids, and companies engineering food to be addictive. One of my frustrations with the HAES movement is it should be instrumental in working to improve these things but gets co-opted in the ways described by this guest post.

  6. I have never been a supporter of the HAES movement for the exact reasons listed in the letter above. I have been shamed (attempted) and attacked for "daring" to lose 100 lbs, ridiculed for saying that losing weight made me healthier, accused of being elitist and size-ist for saying that I was more comfortable at a lower weight, etc. The HAES movement, in my personal experience, doesn't promote health. It is just body shaming under another name.

  7. Thank you for this post. There are things about the HAES movement that don't add up to me. Although I don't believe it is intentional, I have noticed the message that weight loss and self acceptance are mutually exclusive: You can either have one or the other, not both. If you are taking actions to lose weight, you must not accept yourself, and if you accepted yourself you wouldn't choose to lose weight. This makes no sense to me, just as if "self acceptance" prevented us from balancing our checkbooks, going to college, or learning to play an instrument because "we should just accept ourselves how we are." In my view, self acceptance and self love can be the catalyst for permanent change in lifestyle and habits that otherwise wouldn't be possible. I see a lot of good intentions and the desire to end fat shaming and stigma, but I fear that in its wake, the movement is developing a new stigma against weight loss.

  8. I'm wondering why so many discussions dissolve into a us versus them argument?

    Why does one person's negative experience define what HAES is or isn't? Is that person who wrote that email any more or less qualified to be dismissing HAES than the people she has come across? Is a person's lived experience and beliefs of no value? They don't agree with HAES and others do, this happens in most arena's. I would suggest about the only thing we can all agree on is that the sun will come up tomorrow. I mean if we applied that same thinking to die-ts we could have all just got on with the business of being health, whatever state of being that is for each of us.

    I think what this post shows Yoni, is that communication and comprehension are the issues not whether HAES is the right or wrong thing. There has been a communication breakdown. Often much of this communication is taking place between individuals who are lay persons and their communication skills will vary. Also most of us have an ego and we like to be right and feel that we've made the right choice for us and will defend that choice tooth and nail. That is human nature.

    HAES has perhaps struggled to engage the broader audience and can appear to those on the outside to be something it in fact isn't and would require further investigation to recognise this as well as to look at information from the expert sources. That point is worth considering.

    Also labelling people as disordered eaters when you've only dealt with them from a distance, with no qualfications to make that call is quite concerning and distracts from what could otherwise be a productive discussion. Personally from discussions I've had with people, many are neither interested in understanding the HAES paradigm or are intent in finding fault with it. Again this is not conducive to the kind of discussion where information and ideas can be shared. No one likes to be told they're wrong and in this instance it appears to me that both sides were reacting to feeling that this was what was being communicated.

    Lastly my intent for responding was to add to the discussion, open up avenues for issues and concerns to be heard, listened to and shared.

    1. Kerry, I too thought the disordered eating label was problematic. One point I also think may be worth discussing is how the overlap between the HAES and fat acceptance communities contributes to possible communication challenges

    2. Anonymous1:36 pm

      If and when people are told that they cannot ask a question, or speak about certain, everyday things outside of the standard mantra within the group because it is offensive and will trigger traumatic or problematic reactions in the group's members or professional leader - then there is an indication of disordered behavior. Open, honest communication that does not include harassing, trolling, or taunting for the sake of it should not be a trigger for anything. (Obviously, people saying inflammatory things to get a rise are creating a problem).

      When you have to walk on eggshells because mentioning a personal choice or varied point of view of a specific ideal of the group - the group is not promoting communication - and when the reason behind that is because you are triggering unwanted or unsafe reactions, there is only one real conclusion.

      If someone is making the circuit, and claiming to be a professional or expert in any given field, but cannot handle hearing some very simple discussion for fear of being offended, hurt, or triggered they have no business putting themselves out there and telling others how they ought to behave, and what they ought to believe.

      It is my impression that HAES groups and spokespeople are not supposed to be using the platform to help them work through whatever disorder they have, but rather it is to promote individual choice with regard to individual health - and they will be met with criticism. So having someone out there that cannot handle that and are telling people, essentially, that they are not allowed to speak - isn't good for the person (they are not ready), isn't good for the movement (they are promoting their own issues) and isn't good for other members who are clearly walking away because of it.

      No, communications aren't breaking down. They're being shut down.

    3. I think the point that Marsha and Kerry are both making is that HAES as described by the ASDAH folks (sizediversityandhealth.org) is fairly explicit. That may be different from your experience with it and that's unfortunate, but it's also seems unfair to paint an entire movement because of your n=1.

    4. Anonymous, seems that your issue is with the individuals having an opinion different to your own and them not wanting to discuss it. Do they have to? Would you go to a political party site and start trying to question them why they aren't discussing the philosophy of another party there? Would you go to a local sporting club and share the merits of supporting another team or being open to exploring both? It is entirely a communication issue and finding the right person to discuss thoughts and concerns with as well as the right situation helps to assist that communication. So if you want to explore HAES or question it or understand it or debate it, then start with choosing the right forum and person/s. So anyone with queries, questions, concerns, feedback might want to start with contacting either a health professional or researcher who works from a HAES perspective. Coming with the attitude of you guys are wrong because this doesn't work for me is also not going to garner the best response. Being curious and open and sharing your experience of it and what doesn't work for you and asking do others having this issue is far more helpful. The questions we ask and the way we ask them will either open or close discussion. If this is done well then the audience is far less likely to be offended. So if we don't get the response we want when talking and communicating with others then take a look at the way and kind of question that we asked. Communication is a 2 part processes and both parties are responsible for the success or failure.

    5. Anonymous7:11 pm

      Who says I don't support the overall theory of HAES? Where in my comment did I state that arguments were being had? It would seem to me that if a member or supporter cannot say anything other than the narrow mantra allowed, even in supportive conversations - communications are being shut down, period. And if the reason for this is because anything other than allowed speech is a "trigger" it's because the people in the group are having some issues that should be dealt with before proceeding forward. And that's not a slam - it's just how recovery works. If you are a recovering alcoholic, it's going to be a long while before you are ready to be near anything alcohol. If you have an eating disorder it's going to be a long while before you can be around people who do not follow your emotional/dietary needs.

      Also, this experience, it would seem, is not uncommon. While the tenents of HAES may be explicitly stated, what was intended and what is actually playing out are two different things. All I had to do was google "HAES criticism" and scores of articles and blog posts showed up regarding people who had been alienated by groups for not falling in lock-step. For daring to not be 100% supportive, or for having intentionally lost weight (regardless of why, or how).

      The main idea of HAES is great - be healthy, weight and size don't indicate condition of health, don't discriminate because of size. But how it's being played out is not great.

  9. II truly appreciate those being able to "speak up" and share their experiences whether for or against HAES. As I graduated from a nutrition program that prepped me to be structured and rigid in my practice using more numbers than listening to the patient in front of me. After many years of seeing the yo-yo effect I questioned my practice and HAES landed in my lap.

    Now many know me as a HAES advocate, but the journey hasn't been easy as many have posed similar questions and thoughts as in the post above. I would like to think I do not respond in a defensive or "blow out" manner, but rather with curiosity to understand the person's reasoning. I am not someone who forces HAES on anyone, but rather offer it as an alternative to a behaviour and/or a focus that has failed them (to help with managing personal guilt of thinking they have failed).

    I have learned weight is a symptom, just as Marsha mentions. It is not the problem, but sure it can exacerbate problems. I am not sure that any HAES advocate would disagree there.

    The HAES program we run on-site is not just for "large" sizes, we promote ALL sizes who want to learn about healthy lifestyle behaviours. We are trying to shift away from judging by "looks" or BMI scorecards and drop the assumptions that this defines health just like Yoni and Dr. Arya Sharma.

    As far as the biased research, I would have to agree many of the weight loss studies I have read or that are available usually have some sort of "obesity" researcher or pharmaceutical company involved, since that is where the money is. Who would make money from lifestyle changes? So I have to question these studies that show a relationship, not a cause and effect, with weight and health.

    When a patient comes to see me my first question is "what do you want to get out of being here" so that my agenda (which I admit is HAES) is not pushed. From there I act as a coach, not so much as a teacher- since many know the difference between "good" and "bad" foods- but this knowledge doesn't bring sustainable changes for many, or as it has been quoted 95% cannot maintain these changes for the long term. Again these thinking patterns are clues and symptoms to what might be really going on. On average although many might come with the initial "goal" of "I want to lose weight"- which really is an outcome, not a goal, the bottom line when asked "what would you hope would be different" the answers are usually related to feeling better, having more energy and loving oneself. Anyone who does work in the eating disorder realm or weight loss world can understand that most eating disorders always start from dieting, the intention to lose weight and the fear of being fat. So when I hear of these outcomes I am curious to learn more about how this person takes care of themselves and all I am there to do is help the person to learn the skill power of overcoming their challenges, learn to take care of themselves in a way that may or may not produce weight loss, but almost always achieves feeling better, having more energy and an appreciation for self love.

  10. con't from above

    It is not my intention to imply that anyone is "right" or "wrong", my intention is to help the individual decide for themselves what works for them rather than only listening to external sources of control, and find their intuitive voice. And it is there choice to choose whether or not to work with me.

    It is a common misconception HAES means "you're just giving up" or as stated " not to promote health at any size, or to stop shaming people about body size - but to simply cover or hide coping mechanisms". I am sorry to hear this is your impression of HAES because I believe it is anything but that. I can speak from a personal and professional experience that HAES gives people permission to become "the captain of their own ship", as we are the ones who have to live our lives daily, it is only us who can decide what fits in our lifestyle and what does not. I spent many years forcing myself to do exercise that I thought I should do because I am a dietitian, and I missed out on the enjoyment of it. Now because of HAES I can pick and choose what activities I want to do and that my body safely allows me to do not because of the weight control, not because I have to, but because I want to. Because what I get out of it is personal time, healing time, stress management and feeling good. I do it for me and I know now that I deserve that. To me that doesn't sound like I am hiding from my eating disorder, which I never had, but overcoming the wonky thoughts that society and my training had lead me to believe were helpful. From my own professional experience there is nothing better than seeing someone overcome their eating disorder not because I am closely monitoring their weight, but because they have found a love for food and cooking, a taste for food and have healed rather than hide from previous trauma their eating disorder was a distraction from. To hear mother's talk in front of their children not about their weight, but about doing things to be strong and healthy so that the 7 year old doesn't think she needs to lose weight too. Providing someone an place that's safe to talk to about his body image and to provide an alternative to bariatric surgery because he doesn't feel ready for that lifestyle change (and permanent one). To me that is where HAES fits.

    So I don't walk towards HAES, I run towards it because I see value in it not only professionally with the many people I have had the honour of supporting, but also personally. There's no better feeling than waking up in the morning and having inner peace because you know what is best for you.

    Kori Kostka, Registered Dietitian

    1. Kori, this resonated with me. I'm an MD working to support parents who have feeding and weight worries with their children. I practiced in the standard approach that was weight focused before I learned about HAES and eating competence and the Division of Responsibility. I never felt it worked, the kids and parents were ashamed and felt defeated. Very few lost weight, and those that did might have done so in spite of our interventions, not because of them. Now, when I work with parents to support healthy behaviors, and helping children learn again to self-regulate, be active, get good sleep, honor relationships, it's a different experience. The goal with children is to find a growth curve that is roughly stable, and to address acceleration or deceleration in the curve. I too now wake up energized and excited to help families, because finally I feel like I AM helping, and not harming. And I work with children at both extremes, from "failure to thrive" to "obese." With a HAES framework, the "treatment" is the same— healthy behaviors. I think there are some great comments here that address the concerns of the original author. My question is if she wants to walk away from HAES, what is she walking to? The Fat Nutritionist just did a great piece on HAES and Fat Acceptance http://www.fatnutritionist.com/index.php/health-at-every-size-is-not-fat-politics/ Might help with this discussion.

  11. Maybe I am a bit slow, but I thought HAES was about adopting health-promoting behaviors. Regardless of your weight. Is it not?

    Those health-promoting behaviors might include avoiding junk food, being active and getting enough sleep, or they might focus on drinking in moderation, not smoking and buckling your seatbelt. Regardless of your weight.

    If you chose to change your weight for medical reason, well, good luck. You don't control your weight. You control your behaviors. The behaviors you chose to adopt might have an impact on your weight, but they might not. Again, maybe I misunderstood, but I thougth HAES was about adopting health-promoting behaviors. Is it not?

    1. That's my interpretation for sure Valerie!

      I think we also need to define what we mean by health in order for this discussion to have any context. If people believe health = weight then they will adopt paradigms that support and surround that belief. Whereas for me health is not some single fixed point that all of us can or will arrive at (be pretty darn crowded I imagine). Instead as I heard recently described, HEALTH IS A DIRECTION, NOT A DESTINATION. Could there be other explanations of health? For sure. So let's keep it simple and say depending which of the above two resonates more with your internal belief then you will feel less or more inclined to a HAES perspective. To me the second one fits my model of the world, my experiences and understanding of the world around me. The reason being is that none of us can achieve the same level of health either by choice or circumstance. The 20 year old, the 80 year old, the western individual, the starving child, a disabled person etc can't all achieve the same level of health. But can they have more health, a better quality health than they currently have? Absolutely. That to me is the essence of HAES is that individuals potential to experience a greater level of health than they currently have. That includes us all. Inclusivity is the key factor for me and why I choose this paradigm. It opens up the possibility for each individual to make better choices. To choose the direction of health and realise than can have more. Regardless of size IMO we can all have more health but it will never the same as another person's, more.
      So if I can help someone have more and do it in a way that respects the individual and where they are at and how they choose to go about that, including the choice to lose weight, then that's what I do. I honour that person and respect their right to choose their direction. If they chose to lose weight then I support them. I'm just not the right person to help them achieve that, but then neither am I the right choice if they wanted to learn maths.

    2. Anonymous6:23 pm

      Yes! The objective of HAES, as I understand it, is to promote health-supporting behaviors, without using the scale as the judge of success. My concept of it is similar to what Dr. Freedhoff has sometimes said -- that your best weight is the weight you're at when you're living the healthiest life you can enjoy.

  12. The principles of HAES are excellent, and I firmly believe it is possible to be healthy at any size, including some sizes that many would consider to be too small (too thin). I am fat and healthy, and very fit as well.

    Unfortunately, the HAES movement does seem to have been at least partly hijacked by people who don't want to hear about it if you want to lose some fat. But the reality is, most women don't like being fat (there! I said it). They don't like how they look or feel. For many, there is a zone where they are happy with their weight, and it varies from person to person. But why is it that I feel I can't say to a HAES follower that I am working on losing a inch around my waist without feeling like I just broke some unspoken rule? It's as if I am only allowed to be happy with myself if I have given up on losing weight. In an online forum, I actually saw people be chastened by a HAES supporter for mentioning that they wanted to lose weight. She told them that if they mentioned it again, she would unfriend them!

    There is a difference between wanting to lose weight because you hate yourself, and wanting to lose weight because you love yourself. To decide you want to change yourself out of love for yourself means that you have been able to filter out the negative noise created by media hysteria about the obesity epidemic, and the social and economic pressures placed upon women to meet certain standards of beauty and acceptability. All of this negative noise makes it difficult for women to sort out what size and shape they would be truly comfortable with. Sadly, being censured by HAES people for even saying I would like to lose weight just creates more negative noise, this time coming from a movement that purports to support women's choices.

    As another commenter mentioned, the movement seems to have some people in it who have not worked out their own health and weight issues. These people censure others and promote a dogmatism within the movement that undermines its credibility and alienates potential supporters.

  13. Oh, gosh, where to start? I'll try not to replicate comments by others, Kori, Kerry, Marsha and Atchka in particular. Two things I'd like to add though.

    First, with regard to the 'triggering' comment from Anonymous, which was nicely addressed by Kerry's response. One additional point though. Those of us within the HAES movement often wear different hats, and even within our own community, there are a range of forums. Many of us are helping people who have sought us out to help them navigate their own journeys of burgeoning discovery and self-acceptance. When we are playing these roles, we will generally not tolerate you coming in with comments that we feel are misdirected, misleading, and potentially harmful. For example, this would be true on my facebook page, where diet talk is not allowed. Period. However, within the 'expert' community, these discussions absolutely take place. We question. We discuss. We are absolutely open to this. Given the activism role that some of us have taken on, it is absolutely critical that we are able to converse with all people, whatever their perspective, and address very real issues and concerns that people may have, and this takes up a huge proportion of our time. At least, I speak for myself here, YMMV.

    As has been pointed out above, often, the 'issues' with HAES are due to the many many misunderstandings about what it means and what it stands for. HAES does NOT say every body is healthy whatever their size. It does not say weight loss is evil, or people who lose weight are (although I have heard some individuals imply this - as Atchka pointed out, this is NOT HAES). HAES is an APPROACH to health. Distilled to its most basic components, HAES simply states, if you, as an individual, wish to improve your health, focus on doing healthy things. That's it. Everything else is just detail. What health means for any individual will be up to them. But we are firmly of the opinion that health cannot be measured on a scale. If you lose 10 lbs, or an inch, or whatever, that does not equate to being healthier. What if you lost the weight because you are ill - I've heard of people complimenting friends for how their cancer is making them look. It's madness. For some people, newly adopting healthier habits will lead to weight loss. HAES is not against weight loss (and anyone who says it is, again, doesn't understand it). HAES objects to the PURSUIT of weight loss as equivalent to improving health. For many people, in particularly those with a propensity to weight gain and a history of yo-yo dieting and disordered eating, improving health behaviours will, contrary to popular opinion, not lead to much, or even any, noticeable weight loss. It may well lead to alterations in body composition, in particular, exercise is great for reducing visceral adipose tissue (the one that seems most connected to health), but that may well not be reflected on the scale. Health habits make you healthier, regardless of whether you are thin, fat, or somewhere in between. Weight loss per se is not equivalent to improved health. The cancer example above is extreme, but long-term liposuction studies have shown that having the fat sucked out of you does NOT improve metabolic health. So if somebody loses weight by improving their diet and exercising more, and their blood sugar, cholesterol, blood pressure etc improve, it is likely the healthy habits that made the difference, not the weight per se. Sometimes the two go hand in hand, but often they don't.

  14. Continued from above:
    Secondly, in reply to Marchwinds, you're right. We don't want to hear about your pursuit of that extra inch. We don't begrudge you your goals. You do not need our permission to do whatever you want with your own body (that is very HAES) and we completely support your choice. We may be of the belief that your goals are guided not by any inherent truth with regards to the unacceptability of fatness but because of a cultural construct that you have been sold your whole life and could therefore be forgiven for buying into. If you lived in a different country or a different culture, you might well be trying to go in the opposite direction, and wishing that you could get fatter because you just don't feel yourself, don't feel happy or attractive at this thinner weight.

    We also would take issue with trying to lose weight 'for your health'. See above paragraphs for explanation. If you want to be healthier, do healthy things. Your weight will then settle wherever it is going to settle, which will largely be based on your genetics and your dieting history. If you have a dieting history, your weight will likely settle at a much higher level for your genetic make-up than it otherwise would have done. There is very little chance of getting around this and getting to and maintaining a weight below that level. Some people do, true, but they are rare, and many who have been documented in the literature of "successful" weight losers maintain these artificially (for them) low numbers by doing things that are decided unhealthy and not good for their bodies. This is what happens when it becomes about the number on the scale. But if you think fat is ugly, or unhealthy, and wish to talk about your desire to lose that extra inch of your waist, there is a whole world out there of people who want to talk about this with you, help you achieve it by whatever means they happen to be evangelical about, and will congratulate you wholeheartedly for getting there. Please do not come into our little house, piss on the rug, and then get hurt when we don't thank you for it.

    1. You have just confirmed what I said above. Congratulations!

    2. Without repeating Angela too much I hope, I think the problem you are coming up against, marchwinds, is that you feel you are using HAES principles for the most part, while at the same time still *wanting* to change your weight as a goal. The difficulty for some with HAES is that unfortunately it cannot co-exist with a goal of weight loss, because that goal renders many of the tenets of HAES moot regardless of one's reason for wanting to lose weight. HAES is a non-weight focused paradigm, and your goal for losing an inch off your waist is weight-focused. I am not judging you for this, people can choose what they want to do. I am merely trying to illustrate why you are getting flack from the HAES community for trying to discuss your goal of weight loss with them. Many in the HAES community have fled from a weight-focused paradigm and since there are so many weight-focused forums available, why should HAES have to make space for it?

      You may be talking about wanting to lose weight to someone who has just made the very difficult decision to finally give up that pursuit. I liken it to talking to a recently recovered alcoholic about how much you enjoy good glass of wine with dinner - it's not *wrong* per se, but it is an appropriate place for this discussion?

      Please don't take my disagreement with you as censure. It's just that what you want to pursue and discuss - weight loss - isn't particularly pro-HAES. As Angela has said, there are many paradigms out there where intentional weight loss discussion does fit, HAES just isn't one of them.

    3. Alison Brandon3:08 pm

      I think of fat acceptance as a human rights issue. People shouldn't be denied employment, health care etc due to their weight/size. I hate the fat shaming that happens in the media (especially in media aimed at kids) for example and think that needs to stop. I think there need to be a bigger variety of bodies out there and that plus sized models should be just called models and include many levels of body types and shapes. I don't think the "fat girl" should be the joke in entertainment as the "worst person a guy could end up with", a trope I grew up seeing.
      I also don't believe you have to have a sub-25 BMI to be considered healthy. I have great bloodwork (asides from iron levels) and blood pressure. I need a kick to exercise a little more (though am rarely found just sitting on the couch watching TV) but I do watch what I eat for the most part. I live my life for now and not waiting to be a smaller size which is what I used to do.
      That said I feel alienated a bit when reading the works (okay blogs) of people who ascribe to the HAES philosophy. One was bemoaning the fact and generalizing the thought that obese people are that way because they are emotional eaters - I gained 90lbs through emotionally eating my way through 3 very difficult years - I understand conditions like PCOS or hypothyroid can do the same thing, but that isn't my own story, the emotionally overeating is. I maintained a smaller size for 4+ years before I got pregnant. I have read people saying that losing weight is for people who hate themselves - I don't hate myself but I want to lose weight and that is not fair to ascribe biases to other peoples' feelings. I have been at a place where I hated myself for not having a 6 pack and little body fat, but thankfully I'm not there anymore.
      So if I have healthy bloodwork and blood pressure and am not metabolically obese but am obese from 3 years of binge eating then why on earth do I want to lose weight? I have been dealing with arthritis from before my weight gain which has been getting worse over the past few years. I also want to be pregnant. I had a short lived pregnancy earlier this year and was in much much more pain than I had been previously pregnant . Do I think some weight loss will cure everything, absolutely not, but it may give me a fighting chance with getting up off the floor when I am 50 without having to crawl to a couch or have someone help me . I'm also hoping losing a little weight will help me not be in so much pain for my (here's hoping) next pregnancy.
      If HAES wants to be truly inclusive of everyone, it is something they'll have to consider. If they were called Health at Larger Sizes (something which I feel I have asides from the arthritis) or Health without Intentional Weight Loss - go ahead, don't speak about the possibility of choosing to lose weight loss, I'd be fine with that, but *every size* is determining what is right for a person. That if they don't want to lose weight, fine, no shame in that, but it needs to work the other way too. You may argue that "everyday is losing weight to be 'healthier' day" but for some people it really may be a better option *for them* and they shouldn't feel shamed for that either. I can understand the hesitation of having people who have a vision of what perfect health looks like and that we should *all* try and be just like that, in the movement (since that is pretty much the antithesis of HAES from how I understand it), but what about people who really are finding better health results when their weights go down, but aren't looking for a size 2 results (unless they're a very petite person who naturally has that body type)? Basically even though I agree with much of the movement, I'm hesitating about ever calling myself a HAES proponent.

  15. You have just confirmed what I said above. Congratulations!

    1. Lizbeth11:53 am

      @marchwinds - you do seem to be seeking a lot of validation from the people you disagree with, to the point where you are tuning out what they ARE offering you. Please don't go away mad - or sarcastic - and please don't confuse the choice not to validate you as an attempt to hurt or reject you. Please be open to what a HAES community genuinely does want to offer you - even if we definitely don't want to hear about your specific intent to lose an inch. THAT is how we want to reinforce your worthy goals of loving yourself more.

  16. I applaud the decision that you have come to. Obesity I think is a mental and emotional issue as much as it is a health or a social issue.

    I feel that the fat acceptance community is one in denial. Yes, there is a considerable amount of stigma and yes, it is counterproductive. Yet at the same time, discouraging people from trying to lose weight is a bad thing too, as is the denying of the fact that obesity carries the increased risk of many diseases. I feel that the fat acceptance movement itself is in denial about the potential risks, often cherry picking data to support their arguments.

    1. I will never understand how people look at the tenants of HAES and see an argument against losing weight or for poor health. HAES specifically advices people to eat and exercise moderately. It's almost as if some people aren't comfortable unless the advice is 'lose weight at all costs and the more it hurts the better.'

  17. Monarchangel10:04 am

    Observing the reactions to this blog post there are two distinct things happening. 1) People stating that they had been alienated by the group or walked away because the preaching didn't match the ideology, and 2) People stating that what these people experienced is not HAES ideology.

    What does that tell us? It tells us that there are more than a few groups advocating HAES incorrectly, which is the exact complaint of the original blog post.

    Like all start up movements you will have individual groups or people co-opting the overall message either: (intentionally) incorrectly, to serve their own purpose, or because they simply do not understand what it is they're advocating in the first place.

    This is problematic for grass-root movements because it causes people to walk away form the movement. The overall effect is that the movement is unorganized, or illegitimate because anyone can take the label and simply run with it.

    What the advocates of these movements need to do, then, is organize. If someone wants to run a small or large HAES group, and hold talks and workshops - they need to be trained on how to do it so that they are not misrepresenting or co-opting the movement. Then these groups need to be checked in on by formally trained advocates to make sure the group is still maintaining it's original function.

    If it's not, get rid of the deadweight (no pun intended). Movements can't survive or accomplish successful outreach when it's outspoken grass-roots, local "leaders" are sabotaging it willfully or otherwise.

    Instead of restating consistently taht these groups do not represent HAES, make sure these groups stop representing HAES. You'll go a lot farther.

  18. This is my problem with this entire issue. The vast majority of people who lose weight, regain it, as well as additional insurance pounds, which causes a yo-yo syndrome. Statistics say that 95% of people regain their weight within a few months to a couple of years.

    I can speak from experience here. I started dieting when I was 126 pounds- not to the point of anorexia nervosa, but just because I thought I "should" be thinner. After 4 decades of trying every diet there is (no surgery), fasting, taking supplements, vitamins, being a regular exerciser, doing stress relief, etc... I CANNOT lose weight. (I am even gluten free). I was a chronic under-eater, even when I wasn't on on a diet. Now I eat whatever I want, mindfully, to satiation. (I actually have to force myself to eat more). I am not gaining weight, and I am not losing weight. I am accepting myself the way I am.

    I work with women exactly like I used to be. Those women who are unhappy with weight, and will do anything, and try any diet or exercise to lose weight. It's NOT going to happen. They may lose a little, but for 95% of them, the weight comes back; and they blame themselves, and feel even worse. But it's NOT their fault. It's the way a normal healthy body responds to dieting!

    I'm tired of the Diet Industry telling people: You HAVE to lose weight- when there is NO way to keep it off. It is more stressful, which is worse for your health, to bang your head against a wall wanting something that you cannot physically make happen!

    I really want to see without my glasses- and I can try, and try, and try..... but I will never have perfect vision. It's time for the Diet Industry and doctors who tell people to lose weight to get REAL.

    Yes, if someone is binging (generally the result of attempting to avoid that particular food), or if someone is using food as a comfort drug (even called comfort food), they can learn other methods to deal with their stress. Stress creates constant cortisol flow which makes belly fat, slows the metabolism, and a host of other VERY dangerous physical changes when it is chronic. Low self-esteem, depression is more damaging for a person being told to do something that is physically impossible, as evidenced by the stats of permanent weight loss.

    And if there is a chance for someone to be in that 5% of people who maintain weight loss, it's going to be because they have learned to manage their stress, or found out they have a Thyroid problem and get proper treatment, or get a fecal transplant from a thin person.

    1. Anonymous10:20 am

      Citation needed for the 95% number, from a medical journal please.

  19. Anonymous10:16 am

    Weight is not a symptom of another disorder, what a joke. Being obese is a disorder that can be reversed for 99% of the population if you put a little effort into life.

    You are trying to say 65% of the population in the U.K. has another ailment causing them to be obese? Really?

  20. Obesity is not a disease - it is a condition. In fact, it's not even an unhealthy condition, except when the person is sedentary- as it is in a slim person as well.
    Furthermore, I can "hear" a thin person blaming overweight people for lacking discipline, and lazy in your statement. It sounds like you are really angry at people who "don't put an effort" - and that they SHOULD be thin. And yes, at least 65% of the population is suffering from chronic stress: which changes the metabolism, causes both over and under-eating, which can cause weight gain in all cases.
    If you investigate the research, ( Stunkard and McLaren-Hume's 1959 study of 100 obese individuals, which indicated that, 2 y after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb) or more (1). More recently, a New England Journal of Medicine editorial titled Losing Weight: An Ill-Fated New Year's Resolution (2) echoed the same pessimistic message.) you will find that diet failure is the norm.
    Ancel Keys, and a myriad of other researchers are showing that different people metabolize food differently, and their ability to lose weight is not all the same. Some people can eat copious amounts of food without weight gain, others not. In fact, after bouts of dieting, the metabolism has been suppressed so much that often people will gain weight during a diet.
    Here's a synopsis for you: http://www.makeitsomindset.com/keys-starvation-
    And perhaps the best source for you to learn about the subject is: "The Obesity Myth:Why America's Obsession with Weight is Hazardous To Your Health", by Paul Campos. It's filled with source material.