What is HAES? Health at Every Size Explained by a Dietitian

Apr 28

Can you really be healthy at every size? The topic of weight and Health at Every Size (HAES) is very controversial and might be leaving you feeling quite confused. This post will help to clear up some confusion and provide a general overview of what HAES is (and what it isn’t).

If this is your first time here - hello and welcome! My name is Hannah and I am a HAES-aligned, non-diet dietitian with a mission of helping people ditch the diets and make peace with food.

As a HAES-aligned and weight-inclusive dietitian, I incorporate the HAES principles in my practice and I discuss the nuances of weight science frequently. However, there are many other resources I recommend to better describe the ever-changing HAES concept. The Association for Size Diversity and Health is a great place to start and to learn more than I could possibly cover in this one blog post.

I also want to acknowledge my thin privilege before proceeding. Check out this podcast episode to hear more about what that means. I recommend learning more about HAES and fat activism from others in larger bodies. I’ll share some of my favorite creators and resources at the end of this post.

what is haes can you be healthy at every size dietitian hannah

My story

Real talk - I have not always been a HAES-aligned registered dietitian. I went into my freshman year of college as a dietetics student with strong orthorexic tendencies (I was religiously undereating and overexercising) and I was determined to share my passion for “health and wellness” with the world once I became a dietitian. But as it turns out, “health and wellness” is not synonymous with thinness.

Over the past few years I have worked at unlearning the weight-centric method of nutrition counseling that I was taught. I have spent a lot of time reading and listening to the voices of people who look different than me and I have completely shifted my approach. I don’t think the version of Dietitian Hannah from even 2 years ago would recognize me today. I am still on this journey and I continue to learn new information every single day.

And I’ll be honest - it has been a bit dizzying at times. I spent so long with the belief that I was put on this earth to “cure obesity” and to help others eat like me (groan) and it has been hard to fully shake that concept. And it doesn’t help that the general public also thinks this is what dietitians do. We just tell people to eat more vegetables and lose weight, right?

All this to say that you are not alone if you think that the best version of yourself is the smallest version. This is what diet culture tells us on a daily basis. And this might even be what you hear from medical professionals like dietitians and doctors. If you are new to the HAES concept like I once was, I hope you can practice open-mindedness as you read this post.

Let’s start by defining what HAES even is.

What is Health at Every Size (HAES)?

Health at Every Size (HAES) is an increasingly popular movement. HAES makes the statement that our health and wellness are not determined by the number on the scale or our pant size (radical, eh?). This may be the total opposite of what you’ve heard in the past. Diet culture and all that it entails frequently leads us to believe that if we are “overweight” or “obese” then we are unhealthy. Diet culture also tells us that being thin automatically means you are healthy and that weight loss is always a health-improving outcome. But these diet culture statements are all untrue.

Rather than focusing on bodyweight, HAES prioritizes health-promoting behaviors (note: weight loss is not a behavior). There is growing evidence that prioritizing weight loss as a goal is not an inclusive or effective way to improve health. The research also shows that intentional weight loss through dieting is typically a short term fix. I have more information about why diets don’t work in this post here.

The HAES Principles

The HAES framework is based on five principles. According to the Association for Size Diversity and Health, these principles are likely going to be updated in the near future as they do not reflect the evolution of the HAES movement. That said, these are the current principles at the time this post is being written.

Weight inclusivity - Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
Health enhancement - Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional and other needs.
Eating for well-being - Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
Respectful care - Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
Life-enhancing movement - Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

what is haes health at every size explained by a dietitian

Debunking HAES myths

HAES has many critics and the concept is very controversial. There are a few common claims that I see frequently that I’d like to debunk.

Myth: Health at Every Size means that all people in larger bodies are healthy.

HAES critics love to comment on photos of people in large bodies exercising or eating nutritious foods and say things like “There is no way you are healthy! You are fat!” (as if they don’t already know that). People in larger bodies can absolutely be healthy. People in larger bodies can also be unhealthy.

HAES is not saying that all people in large bodies are healthy. But people in large bodies aren’t automatically unhealthy, either. HAES is not promoting the idea that every single fat person is an icon of health. What HAES does support is that fat people can be healthy, despite what diet culture and social media trolls will say.

Are you getting the idea here? Health is not a size or shape.

It’s also very important for me to point out here that health is not a moral obligation. You do not owe anybody “health”. Whether you are thin or fat, health is not something that should stand in the way of you receiving care and respect from others. Not to mention that “health” is very difficult to define and it looks different for every person.

Myth: Your body is healthy at every size.

Health at Every Size does not mean that every body is healthy at every size. For example, I would not be my healthiest if I was 75 pounds heavier or 75 pounds lighter than I am now. I personally feel my healthiest at my current body size. But this does not mean that everyone else should also weigh what I weigh. Everybody’s “best weight” is different!

When I was in college, I was about 20-30 pounds lighter than I am now. When you first hear this (or when you look at an old picture of me), you might automatically assume that I was healthier when I was smaller. But you cannot assess someone’s health by what they look like. Even though I weighed less at the time, I was also deep in my disordered eating days. I was chronically stressed, fatigued, and I even lost my period for a little while. Now that I have improved my relationship with food and exercise, I am much healthier and I feel way better, even though my body changed and I have since gained weight.

All bodies are healthy at different sizes. This does not mean that your body will be healthy at every size (although you likely will experience weight changes throughout your life - see next point).

Myth: Your healthiest weight will always stay the same.

Women tell me all the time “I just want to weight what I weighed in high school!” Diet culture has fed us the idea that our body should remain the same throughout all seasons of life. This is not the case! Our bodies will shift and look and feel different.

The set point weight theory states that there is a programmed weight that your body prefers to be at. The set point weight theory also states that your set point weight can and will change. Women, for example, go through many different stages of life that alter their set point weight - puberty, child-bearing years, pregnancy and post-partum (for some), and menopause. All of these different stages, which can be compounded by conditions such as PCOS, thyroid disorders, insulin resistance, etc., can affect your set point weight.

Bottom line - your “healthiest” weight will change. And that’s okay.

Myth: HAES promotes obesity.

Simply put, HAES does not promote “obesity". HAES promotes embracing your unique genetic blueprint and endorsing health-promoting behaviors. Remember the five principles from earlier in this post?

HAES is grounded in the evidence that shows body size is not a good indicator of health. I know what you might be thinking - “But Hannah, there is loads of evidence showing the ‘obesity’ causes diabetes, high blood pressure, and other conditions!’” There are studies that show correlation between weight and conditions such as type 2 diabetes and hypertension, but this is not the same as causation. Bodyweight alone is not shown to be what causes chronic conditions. There are many other challenges that people in larger bodies face that may explain these disparities such as weight cycling and weight stigma.

In most cases, I put the word “obesity” in quotation marks because it is defined by BMI, which is very flawed. The term “obesity” further stigmatizes those in larger bodies by shaming their body and telling them it is a problem that needs to be fixed. But as we’ve discussed, bodies are diverse. Fat bodies can be healthy and thin bodies can be unhealthy. And being in either of those camps does not make you any less deserving of care and respect.

We definitely cannot control our genetics and in many cases we cannot control some of the other social determinants of health, all of which can impact our body size. What we can control is our behaviors. I recommend focusing on these rather than on shaming yourself or others for what their body looks like.

What about BMI? Don’t people with a high BMI need to lose weight?

BMI is trash and needs to go. Seriously.

BMI (body mass index) has many flaws, the main one being that it directly correlates health to weight. As we’ve discussed, weight and health are not synonymous. Medical providers that use BMI as a health metric will sometimes make assumptions about one’s health based solely on their BMI. But BMI tells us nothing about one’s blood pressure, body composition, lab values, food choices, or sleep habits (all factors that are significant to our health).

I discuss BMI further in this post.

what is haes health at every size dietitian hannah

Should you work with a HAES dietitian?

Generally speaking, working alongside a HAES-aligned registered dietitian can be very helpful on your road to recovery from disordered eating or an eating disorder. If a weight-focused approach has not worked for you in the past, hiring a HAES dietitian could be the alternative.

Now, I do want to acknowledge that some members of the HAES community are unfortunately not very inclusive to those with the desire to lose weight. Weight loss has almost become a bad word to some HAES supporters. But we live in a diet-obsessed world and it makes sense that you may still be itching for weight loss. You should not be shamed or excluded for having these desires.

To be more clear, I am not anti-weight loss. Weight loss may happen when you ditch the diets (or it may not - check out this post to learn more). And although I do call myself an anti-diet dietitian, this does not mean that I am anti-dieter. I fully support those who have dieted or have the desire to diet. In my practice, I help clients shift from having intentional weight loss as a primary goal to focusing on health-promoting behaviors and allowing weight to be an outcome.

Other HAES professions

Health at Every Size is not only practiced and endorsed by registered dietitians. Doctors, therapists, and other healthcare professionals may also take this approach.

You may have gone to the doctor before and been told to “just lose weight”, even though you made the appointment for a cough or sore throat. If you’ve experienced this, my heart goes out to you. Many people in larger bodies experience weight stigma at the doctor’s office frequently and feel as though their medical issues are ignored or disregarded because of their body size. A HAES doctor may be a great fit for you if you have a history of disordered eating, poor body image, and/or you have had negative experiences with medical weight stigma.

In my professional opinion, the current healthcare system would be much improved if it included weight inclusivity amongst all medical professions. A girl can dream, right?