Patients seeking medical care are typically first evaluated on the basis of their weight, regardless of whether or not it is relevant to their presenting concern. This weight-centric approach can overshadow other health needs and lead to false positives for larger individuals (i.e. misdiagnosing a healthy patient as unhealthy due to weight and prescribing weight loss). An emphasis on weight loss most likely results in weight cycling and cumulative weight gain, which can lead to frustration and termination of healthy behaviors.
An alternative to this traditional, weight-based tactic is the Health at Every Size (HAES) program. This philosophy promotes healthy behaviors for individuals of all sizes in an attempt to shift focus away from body weight and toward broader health. The basic conceptual framework includes beliefs in 1) the natural diversity of body sizes and shapes, 2) the dangers of ineffectiveness of weight-loss oriented dieting, 3) the importance of eating based on internal body cues, and 4) the critical contribution of physical, emotional, social, and spiritual factors to health and happiness. HAES discourages the use of externally structured eating regimens, such as counting carbohydrates or calories. Instead, individuals relearn how to eat in response to physiological hunger and satiety cues. HAES also promotes physical activity for improved quality of life and enjoyment, not for weight loss or calorie burning. Rather than concentrating on end-goals of weight-loss, patients notice what foods and behaviors make their bodies energetic and rested and incorporate those into their future behavior. By adopting this mindset, healthcare providers encourage patients to have a process focus for day-to-day quality of life.
Traditional Weight-Loss Paradigm
- For good health and happiness, everyone needs to be thin
- People are “overweight” because they eat too much, do not move enough and have no willpower
- Everyone can be healthy, happy, and thin by dieting
Health at Every Size
- Thin is not inherently beautiful and healthy, nor is fat inherently unappealing and unhealthy
- People have naturally different body sizes and shapes and different preferences for physical activity and food
- Dieting typically leads to an increased risk for disordered eating, weight gain, and decreased self-esteem
The HAES method has been measured against both control groups and traditional weight-loss approaches, with follow-up extending to 1-year post-intervention. When compared to controls, it was found that a Health at Every Size approach could have long-term beneficial effects on eating behaviors. Specifically, those who participated in HAES had significantly decreased susceptibility to disinhibition and hunger. In comparison to a diet intervention centered on weight-loss, a non-diet intervention focused on health produced similar improvements in eating behavior, psychology, and metabolic fitness. Despite these similarities, the diet and non-diet programs did differ in two main areas: weight-loss and attrition. Both of these measures were higher for the diet group than the non-diet group.
“Focusing on health is effective for helping individuals improve their health, whereas focusing on weight is not.”