Exhuming the HAES Files

Updated 12.21.2014; reformatted 9.19.2015
Much of what follows was drafted awhile ago. I began reading about the Health at Every Size (HAES) movement in 2013. For the most part, though I’ve been reading sites and papers about it since then my original opinion is unchanged. Many of the concepts of HAES are supportable, but the insistence (and for many adherents it is an insistence) that weight in no way relates to health is simply, and demonstrably false. I also reject the premise that weight is beyond the control of the individual. Other related concepts about which I’ve read a great deal is so-called “thin privilege” and “fat acceptance.” I have issues with the entire “privilege” argument, and that might be worth a separate post at some point. Fat acceptance, perhaps ironically, I have no problem with. All people of all sizes deserve to be treated with respect. Where fat acceptance that the concept of “thin privilege” intersect is where I begin to have issues with the movement. But this discourse (I really can’t decide what to call these writings) will only deal with HAES, and it plenty long enough even so.

Where I began

I began reading in the fatosphere to try and understand the concepts or health at every size (HAES), fat acceptance and thin privilege. In most cases, it is a given that the author believes that weight is like height, in that it is genetic, and there's not much anyone can do about it. Before going further however, I need to note that unlike most of my posts, I’m not going to link to many specific sits in the fatosphere. First because I’m speaking generally about attitudes that are pervasive among writers there. But second, and more important, because most of these writers (who are overwhelmingly women) are often genuinely in pain. Some of the pain results from discrimination, but some of the pain results from the medical issues so many of them have— even while insisting that these issues have absolutely nothing to do with their weight. Occasionally, one will admit that the weight is a problem, but that is rare, and generally they go silent at that point. I have no interest in shaming anyone for their habits or beliefs, hence the lack of linked or named examples.

Most of these women will claim to have tried “everything” to lose weight. Most will then state categorically that diets don’t work, and some will even cherry pick the scientific evidence to support their case. But if you read for long enough and carefully enough, the truth of the situation is revealed. Sure, they “dieted” and then binged on mountains of food, indicating that the habits (diet) they were trying to adopt was not sustainable for the rest of their lives. I’ve written about my own experience with altering my eating habits (my diet). Changing habits is not an easy thing, but when I set about to change them, I recognized that the change had to be permanent.

I’m also not going to clutter this post with a lot of medical links. This is an opinion piece, rather than a discussion of science. My position is based on science, but HAES people claim that theirs is as well.

It’s not all genetics.

I want to deal with the genetic argument first. Height is typically the analogy proffered, that just as genetics determine height, so genetics determines weight. There is no question that genetics play as role in both height and weight, however BOTH those characteristics are affected by environmental factors and personal habits. Humans with the genetics to be tall will not reach their genetically possible height if they are malnourished or have poor nutrition during childhood. And there is a time limit While I agree genetics has a role, it is simply not true that weight in unchangeable. No woman’s genetics predestin her to be over 300 pounds, but her habits might.

You can't change your genetics, but you CAN change your habits. The tough part seems to be understanding that the habit change HAS to be permanent. No one (and I mean NO one) gets fat spontaneously. Yes, genetics or illness can make gaining weight very easy and losing weight more difficult, but the energy balance always applies. I’ve written about the energy balance before, and my frustration that so many don’t want to accept its reality. Every single “exception” that can be named for why weight is hard to lose IS included in the energy balance.

Not everyone accepts that weight gain and loss is down to habits and personal choices. No, there is a sizable segment of the fatosphere which fervently believes that weight gain is NOT a matter of personal choice. That somehow the weight is magically added to the body, all because food companies work to make their products extremely tasty. Or because their metabolism is slower than average (this, per Yoni Freedhoff, is NOT true for most obese humans. Metabolism scales with weight. The larger you are, the more energy required to keep you running.)

The fact that some people face a more difficult genetic or metabolic situation doesn’t change the reality. Nor does the reality mean that you can’t practice “ruthless self-love” as some in the fatosphere like to assert. I loved my body when it was heavier, and I love it now that it is smaller. As a bonus, that body now functions and feels better at its lower weight.

No one gains weight without eating more than they expend. NO. ONE.

Diet vs the Diet Industry

Everyone on the planet is on a diet, at least if the word is used properly. Diet is simply the word used to describe the intake of food and drink. Diet varies with geography, perhaps less so now in the modern transportation age, but there are still recognizable regional differences. There are also areas of the world that still subsist mostly on what is locally grown or available. However, the word “diet” in the fatosphere means calorie restriction to starvation levels, usually following some fad regimen. I wasn’t immune to the fad diet industry as a young adult, but I was fortunate enough to recognize early on that none of these schemes were long term solutions, and a long term solution was what was needed.

The diet industry, on the other hand, exists to separate people from the money in their wallet. Most people gain weight slowly, eating more than they expend for an extended length of time. And then one day they zip up their favorite jeans, or don’t like how they look in the mirror, and want to undo the results of years in a few weeks or months.

It’s all about habits. Habits for a lifetime.

Eating is fun. Eating high calorie (energy dense) food and drinking high calorie drinks is part of the modern culture. Where food had to grown or found, now you can walk into a market and choose between packaged convenience foods. Not cooking or cleaning required. The taste good, they save time and you can train your body to expect that level of calorie intake. The fact that it’s fun to eat doesn’t negate the energy balance equation though. I’ve written before that I think we train our bodies (or brains if you want to separate out the systems involved) to expect a certain amount of eating and at certain times. Thus when you try to change the pattern the brain expects, the body acts against the change.

That makes change hard. Not impossible.

Not all of HAES is bad

HAES apparently began has a treatment for people with eating disorders. For anorexics, it’s important to take away the stigma of eating. It’s important for binge eaters and bulimics too, but having had personal experience with those conditions, I’m not convinced that the same treatment should be applied. Many binge eaters and bulimics are not thin. Anorexics need learn to give themselves permission to eat, binge eaters need to learn how to recognize how much to eat is the right amount. For many, bingeing results from calorie restriction and fad dieting. To the extent that HAES helps people escape from that harmful cycle, I can support it.

Actually, as I’ve noted previously in other writing, part of the reason I started reading about HAES is that I used many of the percepts unknowingly in my journey to a healthier and yes, smaller, body. HAES focuses on developing healthy eating and movement habits, with the idea that these new habits are ones to be followed for the rest of your life. Not a fad diet, not a short term fix.

To the extent that HAES pushes eating healthy foods regularly and eating those foods in healthy amounts, I think it is useful for everyone. But the insistence that there is no unhealthy size hampers its usefulness. I get the concept guiding the “eat intuitively” advice, but if you don’t have any idea of how many calories are in your food and how much you need, then what’s intuitive to you might not be healthy for you. But that’s only obvious if weight is since as part of health. It’s the decoupling of weight and health that I do not accept. Medical science doesn’t accept it either.

The whole body matters

Health is based on the state and condition of the body— the WHOLE body. Adipose tissue (fat cells) are part of the body, therefore the state and condition of fat IS part of health. In recent years, researchers have realized that far from being a simple storage sack, adipocytes (fat cells) play an active role in the body and thus affect health.

It varies by individual, as all health markers do, but the number, size and location of of fat cells are a part of a body’s health and DO affect the body’s health. Demanding that doctors ignore that part of your body and the effect that it’s having on your health is ridiculous. So much of what HAES preaches is good, but this false holding that weight is unrelated to health renders it more harmful than helpful in my view.

And the sad thing is, that obese women that do adopt HAES habits, often do lose weight, and then find themselves apologizing for it. Because somehow losing weight (or admitting that weight and health ARE related) eliminates your voice, at least in the fatosphere. There are multiple examples to be found if you search on the web.

A very Dangerous Patron Saint

One of the patron saints of the HAES movement is Linda Bacon, Ph.D. She’s not a physician, she’s a researcher who happens to be thin, who has adopted the HAES movement as her life’s work. Linda Bacon (in part because she is thin) is a particular favorite among the HAES followers. Bacon didn’t conceive of HAES, nor is she one of the early founders or proponents. However at this point, she is probably the best well known proponent.

And I think she’s done a lot of damage. Weight says Bacon, tells you nothing about health. And I agree that simply looking at someone you don’t know what their health is. But as stated several times now, I dismiss as nonsense the notion that weight and health are unrelated. Bacon, no surprise, is a big believer in “thin privilege.” In this article Bacon allows that do work, but because people struggle to keep weight off (for reasons I’ve discussed numerous times at this site.) For Bacon, this means diets don’t work. For me, this means short term changes in habits don’t work. Long term changes in habits DO work. They improve health, and they can decrease weight, if energy intake is less than energy expenditure. No starvation is required, and no elimination of food groups is required.

As this is overly long already, I think I will leave it at that. This is unlikely my last word on HAES, an idea I think could be truly valuable, if only fiction portions could be eliminated.

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