A large component to our work as RDs here at Culina Health is inclusivity and cultural competence. We know that people have lived lives in different bodies, amid various life circumstances, and that so much of that impacts our relationship with food. It’s not as simple as “eat this, don’t eat that.” It’s un-learning, or re-framing, how we’ve done or experienced something our entire lives. Then we can figure out what truly will help us thrive. As providers using the HAES approach to nutrition, we don’t take that responsibility lightly.
Far too often, our patients have experienced discrimination or mistreatment by other medical professionals because of their weight. And the resulting shame and fear of judgment often leads people to be wary of seeking care. But there is a movement out there that’s aiming to remedy this. As HAES-aligned providers, we want to talk about this healthcare framework you may or may not have heard of, and why it’s so important. Read on to learn more about Health at Every Size!
What is HAES?
Health at Every Size, is a nutrition framework that prioritizes health goals and intuitive eating over weight loss or dieting. It was developed in response to the oppression that people in larger bodies and BIPOC individuals face in medical settings. HAES works to educate both providers and patients that weight and body size is not necessarily a direct corollary to health. It also aims to promote body acceptance and intuitive eating over diet culture and shame.
HAES is gaining momentum in recent years. There are more nuanced conversations around weight loss and weight management happening in popular media. Many of the RDs at Culina Health employ a HAES approach, especially when working with patients with an eating disorder or disordered eating habits. Instead of prioritizing weight loss and promoting restrictive dieting, HAES encourages eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
And the research is clear—in six randomized controlled trials, HAES groups experienced improvements in: physiological measures (e.g. blood pressure, blood lipids) and health behaviors (e.g. physical activity, disordered eating), as well as psychosocial outcomes (such as mood, self-esteem, and body image). Plus, over 200 studies support intuitive eating—which employs HAES principles, too.
Some key principles of HAES
- Weight Inclusivity: Accepting and respecting the inherent diversity of body shapes and sizes. Also, rejecting the idealizing, stigmatizing, or pathologizing of specific weights.
- Health Enhancement: Supporting health policies that improve and equalize access to nutritional information and services. In addition, promoting practices that improve well-being, including attention to individual physical, economic, social, spiritual, and emotional needs.
- Respectful Care: Healthcare providers must acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. At Culina Health, we provide information and services that acknowledge and address the intersectionality of socio-economic status, race, gender, sexual orientation, age, and other identities with weight stigma.
- Eating for Well-being: Promoting flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure in place of externally regulated eating plans focused primarily on weight control.
- Life-Enhancing Movement: Support for physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement,to the degree that they choose to participate.
HAES and chronic health conditions
At Culina Health, we specialize in providing nutrition care as a treatment for chronic conditions. Common conditions we treat include high cholesterol, heart disease, and diabetes. Weight loss has been the cornerstone of nutrition therapy for these types of health conditions for many years. However, there is growing evidence that HAES approaches have a place in treating these patients as well.
As HAES dietitians, we understand that many of us have complicated relationships with food and body image. We also know that people with diabetes, hypertension and high cholesterol are no exception to this. Additionally, a constant focus on the scale can actually be a barrier to implementing key health behaviors. This is possibly due to the impact of internalized weight stigma.
At the same time, we are finding evidence that health behaviors like physical activity alone can have a positive impact on health outcomes, independent of weight loss. It therefore makes sense to offer patients with cardiometabolic conditions weight neutral options for nutrition care.
A registered dietitian who is knowledgeable in nutrition therapy for these conditions and adept at supporting patients who are healing a charged relationship with food can identify when it is advantageous to introduce these options; and safely integrate them into evidence-based nutrition care for disease management.
How HAES-aligned healthcare can help more people get medical treatment
Weight stigma and fatphobia can lead doctors to attribute most medical conditions to weight. For example, if a patient in a larger body goes to the doctor to seek medical care, a provider may only focus on their need to lose weight and think of weight loss as a cure-all, rather than looking deeper into the problems that patient is experiencing. Many medical diagnoses can get overlooked when looking through a solely weight-focused lens.
Furthermore, when weight is a focus, patients may avoid health screenings based on fear of shame or facing mistreatment from medical providers.This delay in care can have severe impacts on their health and allow underlying conditions or symptoms to worsen. HAES strives to make it safe and shame-free for people in larger bodies to get medical treatment and reach their health goals, while being treated with respect and dignity.
When is HAES not appropriate to use in nutrition care?
Because intuitive eating is a cornerstone of HAES-aligned nutrition, HAES is not an appropriate treatment plan for people experiencing active, restrictive eating disorders such as anorexia. This is because someone actively struggling with this type of eating disorder currently lacks the awareness needed to eat intuitively—understanding cravings, hunger, and fullness cues. Intuitive eating may also not be appropriate for patients with certain medical conditions that require very specific dietary modifications in order to avoid serious, acute medical consequences. That’s why it’s important to implement these frameworks under the care of an experienced Registered Dietitian.
Debunking common myths and misconceptions about HAES
Assumption: “Size and weight are important factors in healthcare, because overweight and obese die sooner than leaner people.”
Our take: Almost all epidemiologic studies indicate people in the overweight or moderately obese categories live at least as long—or longer—than people in the “normal” weight category based on Body Mass Index (BMI). A comprehensive review of the research pooled data from 26 studies and found overweight status to be associated with greater longevity than “normal” weight status, and analysis of the National Health and Nutrition Examination Surveys I, II, and III, which followed the largest nationally representative cohort of U.S. adults, also determined that the “ideal” weight for longevity was in the “overweight” category.
Studies rarely account for factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status when considering connections between weight and disease. Yet all play a role. When scientific studies do account for these factors,the connection between weight status and increased risk of disease disappears or is significantly reduced. What’s likely happening is that these other factors increase both disease risk and risk of weight gain – hence the observed association we often hear about.
Assumption: “Anyone who works hard enough can just lose weight.”
Our take: The vast majority of people who try to lose weight regain it. This is regardless of how they maintain their diet or exercise program, or the type of diet or exercise they utilize. Many studies also show dieting is a strong predictor of future weight gain, whereas intuitive eating correlates with weight loss.
Assumption: “Losing weight is the only way an ‘overweight’ person can be healthy.”
Our take: Most health indicators can be improved through behavioral changes, regardless of weight loss. For example, lifestyle changes such as nutrition therapy and intuitive eating can reduce blood pressure and blood lipid levels. This is largely or completely independent of changes in body weight. Improvements in insulin sensitivity and blood lipids as a result of aerobic exercise have been documented even in people who gained body fat while practicing the program.
Assumption: “There’s an obesity epidemic that’s leading over a decline in the overall health of the population.”
Our take: While it’s true that the average body size has increased, life expectancy has increased, too. It increased from 70.8 years in 1970 to 77.8 years in 2005. Not only are we living longer than ever before, but chronic disease is appearing much later in life.. Both the WHO and the Social Security Administration project life expectancy to continue to rise in coming decades.
Work with a HAES-aligned provider
While HAES-aligned approaches to healthcare are gaining traction, many medical providers still adhere to guidelines that center weight and body shape as key markers of health.. Ask to find out if a potential provider uses the HAES framework. If they don’t know what HAES is, they may not be HAES aligned. Any type of healthcare provider can incorporate HAES principles, whether they are a Registered Dietitian, a primary care provider, or specialist. While the Culina Health approach to nutrition care for all patients is distinctly anti-shame, anti-stigma, and culturally affirming, we have many providers who specifically specialize in HAES care. To find a HAES dietitian at Culina Health, you can search the team’s bios on our website. You can also confirm that the dietitian you selected is HAES aligned by contacting our Patient Success team.
You deserve dignity, support, and respect from your healthcare providers, regardless of your weight, body size, or health status. We hope that this information will empower you to seek out a provider who offers HAES aligned care if it sounds like the correct approach for you (and remind you that those providers *do exist!*), so that you can feel supported in your pursuit of well-being, whatever that looks like for you.
