What is Health at Every Size?

Heard of Health At Every Size (HAES) but not really sure what it's all about? Here's a quick lowdown to get you started with some follow-up reading if you'd like to delve deeper into it.

The Weight Normative Approach

Health At Every Size is what we built The Spark Life Way upon. Currently, most health and fitness institutions work within a weight normative paradigm. This means that there is an assumption made that living in a larger body automatically equals ill health (or potential ill health) regardless of an individual's lifestyle and actual health markers. If you've ever been given blood test results, BP results, ECG results and cholesterol results that are all good but have still been told you can improve your health because you need to lose weight, you'll have experienced this!

A weight normative approach also assumes that our weight is entirely within our control and it is something we choose to 'manage' or not. It asserts that weight is an individual responsibility whereas the reality is that there are many factors which contribute to our weight. In fact, the Foresight Report identified over 100 variables which play a part in a person's weight:

"The common perception is that if only people ate less and did more, the problem of obesity would be solved... Ob*sity is the consequence of interplay between a wide variety of variables and determinants related to individual biology, eating behaviours and physical activity, set within a social, cultural and environmental landscape."

Reducing something so complex to something over simplistic as suggesting weight is an individual responsibility of energy in Vs energy out is extremely problematic for the people affected by this narrative.

The Problems

Above all, the weight normative approach causes weight stigma and discrimination. People in larger bodies have negative assumptions and judgements made about them on a daily basis often made under the guise of caring for someone's health. Yet the impact of this on the mental health of the recipient is never taken into account. In fact, there is a plethora of evidence which confirms that for those who experience weight stigma, mental health suffers severly as a consequence.

Perhaps worse still, people in larger bodies struggle to get the same level of health care as those in what society considers a 'normal' size. Doctors will 'prescribe' weight loss for someone without proper investigation into their symptoms and contrary to the medical interventions they would prescribe for someone else. This kind of approach pushes people away from health care and often serious illnesses can go undiagnosed.

34. People with a higher BMI told the Committee that they felt it was difficult to access quality healthcare as health complaints were automatically diagnosed as weight-related and not properly investigated:

"I’ve never recovered from a GP telling me they could see how overweight I was just from me sitting in front of them (she then pointed at my arms and made a hefty gesture). I was 8lbs overweight and just 22 years old. This was 10 years ago, and I’ve never been to the GP since. (Woman 25–34)" - Changing the Perfect Picture: An Enquiry into Body Image, House of Commons Womens and Equalities committee.

A focus on body size as health doesn't just cause problems for those in the higher BMI categories either. Poor body image can affect any one of any size.

[It] contributes to weight-based health problems such as eating disorders and obesity, as well as mental health problems including anxiety and depression.52 The GEO wrote to us and acknowledged that poor body image can lead to anxiety, depression and eating disorders, citing research found that over a third of 13–19 year olds have stopped eating or have restricted their diets as a result of low body image. - Changing the Perfect Picture: An Enquiry into Body Image, House of Commons Womens and Equalities committee.

The pandemic has increased incidences of eating disorders in the UK with BEAT reporting a 173% increase in demand for support between Feb 2020 and Jan 2021.

Why are we using it?

The biggest question I have in all of this is if this system is not serving everyone's health - which it clearly isn't - why are we still using it? Well, this is mainly due to the fact that 'Fat Phobia' is so entrenced in our culture that medical professionals, fitness professionals, government officials - hell! even you - still believe that weight = health!

The reason we're using it still is because there aren't enough voices shouting loud enough about the problems with it - although this year that has thankfully begun to change. This is a social justice issue, there are people who experience discrimination based on the size of their body on a daily basis and have done for most of their lives, yet we accept this because we're 'only trying to help' often with a follow up judgement of 'if only they'd try to help themselves'! After all, isn't it important that every time someone visits the doctors surgery they're told how to reduce their weight? Or everytime they visit a fitness professional they're advised on how to eat 'right', restrict their food and exercise more .. because health, right?

Wrong! This is all based on the BMI scale.

The BMI scale has no actual independent supporting evidence on its use as a tool for diagosing health. Sure, it has the evidence from a group of bariatric surgeons behind it, and some drugs companies that make weight loss solutions, but we have to accept that there is clearly a vested interest in their presentation of the 'facts' and 'statistics' right?

What we do know about the BMI scale:

It was created in the 1830s by a Belgium Mathematician called Adolphe Quetelet who created the formula for the 'ideal' human. This was not in terms of health (he was not a physician) but in terms of the mean of the population being the ideal. This was based on white, European, men.
Since then it's been used as a scientific justification for both eugenics and health.
It's first inception as a tool for health was in the early 20th century when insurance companies began using it as a way of categorising people and what to charge them.
In the 1970s Ancel Keys and his colleagues determined from a research pool of 7500 predominantly white men that the BMI scale was the best exisiting measure. However, based on the South African men in the study, they did note that it “could not be suggested to be a representative sample of Bantu men in Cape Province let alone Bantu men in general.” - so not even representative amongst a completely male population then?! In all, they noted that all measures in existance were weak, but the BMI was the strongest of those weak measures!
In 1985 the medical community adopted the BMI scale but slightly changed the measures on the advice of a group of bariatric surgeons, lowering the threshold for everyone in the higher weight categories.
In 1998 the categories of 'overweight' and 'ob*se' were changed again lowering the threshold again for everyone in these categories and it is here that the language and policies of the 'ob*sity epidemic' began.

Please tell me you can see the problems here! Some people will tell you that whilst it's problematic, it's still the best approach to health that we have.

That. Is. Not. True!

HAES

Health at Every Size is all too commonly derided because people don't actually know what it means; the general assumption being that HAES suggests weight is never an impact on health.

However, the reality of HAES is that it is a health first, individual first, compassionate approach. Sure, weight can be a contributing factor to ill health, but we've already established the problems with a sweeping assumption that those in the higher BMI categories are automatically suffering from ill health (and it also needs to be noted that, although less common, individuals in lower weight categories can be misdiagnosed for something like TII Diabetes because their BMI is too low!).

The HAES approach works from the following basic components:

Respect: Honour differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes
Critical Awareness: Challenge scientific and cultural assumptions;Value body knowledge and lived experiences.
Compassionate Self Care: Find the joy in moving one’s body and being physically active; Eat in a flexible and attuned manner that values pleasure and honours internal cues of hunger, satiety, and appetite, while respecting the social conditions that frame eating options.

Health at Every Size doesn't place the onus of health on the indivdual with reductive notions such as 'being overweight causes ill health' and offering basic advice such as 'eat well' and 'move more' to be healthy. Instead it recognises that:

"health outcomes are primarily driven by social, economic, and environmental factors, requiring a social and political response. It also supports people of all sizes in adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well." - Health At Every Size

Health and Every Size is social justice for all people, for all bodies, for ALL! The weight normative paradigm is not only fat phobic but it's an incredibly privileged approach. If you're someone who still can't see the problems with it, then you're probably holding many privileges that you've not yet recognised; if you're interested in what these may be, the further reading suggestions below may help. As will they support you if you're just looking to find out more about this topic and how it can support you on your journey to better physical AND mental health.

The Spark Life Way

As we said at the beginning, our way of doing things at Spark Life is the HAES way of doing things. We prioritise health gain over weight loss because the two are not mutally tied. We know that with the right support you can feel healthier, happier and more confident in your body than you've ever felt before, but that doesn't mean you have to change your body. We're careful with our language - you'll never hear us discussing which season summer bodies are made in!! And we're careful with you... we want you to find the self compassion to look after yourself as best as you possibly can and to find the joy that comes from moving your body without punishing it. If we sound like your people, then get in touch!

Further Reading

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