At Second Breakfast Nutrition, we are fully committed to weight inclusive, Health at Every Size aligned care because it is the only ethical approach to healthcare.
What is a Health at Every Size (HAES) Approach to Healthcare?
The tenets of Health at Every Size as defined by the Association for Size Diversity and Health are as follows:
- 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.
- 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.
- 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.
- 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.
As can be seen by these principles, the HAES approach to healthcare is one that believes in health-affirming care for people of all sizes, and makes the steps necessary to achieve this kind of medical equity.
Developing a HAES Approach
There are various misconceptions or misperceptions floating around about the HAES movement that contribute to many clinicians and practitioners dismissing the life-enhancing concepts of HAES. One of these misconceptions is that a full, unwavering commitment to a HAES approach is a “rigid” or “black and white” way of viewing the different ways we can approach healthcare.
While I will concede that most HAES proponents are very passionate, I reject the notion that our perspective is one of rigidities. Rather, it is an approach that practices nuance in understanding how people in different kinds of bodies experience the healthcare system and the world. These inequities must be addressed if we hope to create a truly health-promoting society.
I have also seen RDs who see the truth in HAES, but get nervous about not giving the client what they want. This often looks like a client coming into your office for a weight loss intervention. Despite this RD in question believing in the concepts of HAES, this RD will make the argument that they are “meeting the client where they are at” if they help them engage in weight loss efforts. Or they may state that they “focus on health not weight” in their sessions, but still share content that evokes diet culture. In truth though, while we are always trying to meet clients where they are at, we are also tasked with a responsibility to inform our clients of the reality of attempting intentional weight loss. If our job as RDs is to do no harm and enhance our clients health, then a client coming in desiring weight loss is an opportunity for us to challenge normative ideas about weight and health, help this client come to understand more about how their body responds to dietary restriction, and more. In this way, we still meet the client where they’re at, but we do so in an ethical and effective manner, rather than in a way that colludes with their own internal diet mentality.
Why a HAES Approach is the Only Ethical Healthcare Paradigm
A firm, unapologetic commitment to HAES practice is the only ethical approach to nutrition practice for various reasons. Here are a few of my favorites, and ones that I use to help other RDs understand the HAES approach better:
- The robust body of weight loss intervention research supports the conclusion that long term, sustained weight loss is possible for only a tiny fraction of people who attempt it.
- HAES advocates for informed consent when it comes to weight loss interventions
- HAES supports body autonomy
- HAES is a social justice movement