As the temperature increases, so does the volume of ads and emails espousing ways to drop pounds to be “lean and healthy” for the summer.
This connection between weight and wellness is an outgrowth of a misdirected cultural weight stigma that affects our economic, social, political, and healthcare practices.
However, the equivalency between thinness and health is ubiquitous and widely accepted by doctors’ offices, public policy efforts, and social media messaging.
The “Health At Every Size” (HAES) movement, however, interrogates this.
HAES is a healthcare philosophy that diminishes weight as a barometer for health and instead seeks to help people aim for greater health outcomes in a non-stigmatizing, non-harmful, and weight neutral way.
HAES does this by recognizing the natural diversity in body shapes and sizes, addressing social determinants of health, and advocating for holistic wellness promotion in people of all sizes.
This approach is predicated on a burgeoning body of research that disassembles various aspects of the weight-focused healthcare approach.
There is significant evidence that weight and body mass indexes (BMI) are poor predictors of disease and longevity. Using BMI as a proxy for health leads to misdiagnosis and inadequate treatment of health conditions in people of all sizes because of differential and impersonal treatment.
Accurate preventative health care is often not provided to people in larger bodies. Insurers can also deny healthcare coverage simply because of a high BMI, independent of overall health. And this happens despite research showing that weight cannot be directly correlated to health.
People in larger bodies are constantly assailed by fat-phobic messages in popular culture, education, healthcare, public policy, and the built environment. People in larger bodies are constantly and improperly associated with laziness, negligence, unattractiveness, and unworthiness.
“There have been studies released saying that fat children are less likely to receive parental support in education, that it is harder to get into medical and other higher education programs with in-person interviews if you’re in a fat body, that there is discrimination in employment from hiring to pay … the list goes on,” said Erin Harrop, founder of the UW Size and Weight Advocacy Group.
The traditional health paradigm contributes to the weight-based stigma experienced by people in larger bodies.
In fact, research shows that healthcare providers, when talking to obese patients, tend to provide them with less health information, spend less time with them, and view them as undisciplined, annoying, and noncompliant with treatment.
This stigma degrades the ability of people in larger bodies to feel comfortable and safe engaging in behaviors to enhance their health. This can result in avoidance of healthcare and of healthy eating options and result in poor health outcomes.
Greater burdens of stigma and shame carried by those in larger bodies, especially those who experienced it from a young age or who possess other intersecting marginalized identities, also have intense and measurable effects on the holistic health of individuals.
“The allostatic stress load, a measure that affects hormonal levels, blood pressure, cortisol … are significantly higher in people living in stigmatized bodies — whether that be of size, race, gender expression, etc., due to stigmatization,” Harrop said. “This is not controlled for in studies that correlate for negative health outcomes and weight.”
HAES asserts that the effect of stigmatization, shame, mistreatment, and avoidance of preventative healthcare can more directly account for the health disparities experienced by those in larger bodies than weight itself.
In a study testing the HAES model against a diet approach, both had similar improvements in metabolic fitness, activity levels, psychological measures, and eating behaviors, even though only the dieters had lost weight. After two years, however, the dieters had regained their weight and lost the health improvements, while the HAES group sustained their health improvement.
This is likely due to the emphasis placed on holistic wellness, body respect, and self-value encouraged within a HAES framework. Weight stigma can also increase the risk for adverse psychological and behavioral issues, including depression, poor body image, binge eating, avoidance of physical activity, and internalization of stigma.
Weight stigma is pervasive in our culture, from overt messaging demonizing fatness to insidious “concern trolling” that makes unfounded claims about someone’s health based on their physical appearance.
This pushes a narrative that weight gain is equivalent to unworthiness, affecting people in all bodies but particularly those in larger bodies. This reality has led many HAES advocates to categorise the movement as being inherently political in nature and a necessary aspect of any intersectional framework.
“It propagates an idea that we can and should control our bodies, when in fact weight has always been on a bell curve,” said registered dietitian and UW graduate Carrie Dennett. “The body has so many mechanisms for protecting itself and regulating its weight range. We can’t permanently and healthily change our natural body size any more than we can our height.”
Our culture has come to equate aesthetics with health, forgetting that an individual’s “ideal” body is completely unique to their own genetic inheritance and is not something that can be manipulated in the long-term. This has a devastating effect on our holistic wellbeing.
“Weight stigma is a form of discrimination, and weight stigma and health stigma are a form of oppression,” Dennett said. “No one benefits from not being good enough.”
On the whole, diet cultural messages linking higher weights with adverse health outcomes and individual inadequacy is not only an ineffective way to promote holistic wellbeing, but also a contributing factor to a larger system of marginalization and oppression of people in larger bodies.
By rejecting diet culture messaging, embracing intuitive eating and exercise principles, and recognizing sizeism in intersectional frameworks, the HAES philosophy is offering an alternative to the traditional healthcare paradigm and to the way we approach our bodies.
Reach writer Claire Bacon at firstname.lastname@example.org. Twitter: @ClaireUWDaily