What is Health at every size (HAES)®?
The Association for Size Diversity and Health (ASDAH) and Size Inclusive Health Australia affirm a holistic definition of health, which cannot be characterised as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.
The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES® model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES® approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.
The Health At Every Size® Principles are:
The Size Inclusive Health Australia Position Statement on Weight Neutral Care clarifies how these principles are applied to the health support of individuals.
The Association for Size Diversity and Health holds the Trademark for both terms 'Health at Every Size®' and 'HAES®' in the USA.
Health at Every Size® (HAES®) has been trademarked to ensure correct use.
We recommend reading the guidelines provided by ASDAH when looking to use the terms Health at Every Size® as the term 'Health at Every Size®' and 'HAES®' are registered Trademarks of the Association of Size Diversity and Health.Full guidelines for the use of the trademark can be found here.
Glossary of terms
Weight-neutral: an intervention or service where weight change or weight control is not an intended outcome, and that trials have shown to have a negligible impact on body weight.
Weight-centric: an intervention, service or perspective where body weight change or body weight control is considered necessary or desirable.
Size Acceptance: unconditional acceptance of the past, current and future body weight and shape of yourself and others.
Size Diversity: Humans are a biologically diverse species, with great variation in factors including height, weight and body composition. Even with the most health-supporting environment (timely medical care, no poverty, affordable & accessible nourishing foods, opportunities for physical activity etc) the population would still be physically diverse.
Size Inclusive: a service or intervention that caters for and welcomes people of all shapes and sizes.
Body Positive: a service, intervention or perspective where people of all body shapes, appearances, abilities, races (and other characteristics used to marginalise people) are considered unconditionally worthy of respect and care.
Weight bias: the medical preference for BMIs between 18.5 and 25, and assessment that a BMI over 25 is 'unhealthy'. In the same vein, both terms 'overweight' and 'obesity' are a direct result of weight bias because they are BMI based rather than being determined by an individual's pathophysiology.
Thin bias: the social preference for thinner bodies which is also related to western social constructs of beauty ideals and appearance standards.
Anti-fat bias: Rejection of the appearance or perception of body fat (including on smaller bodies) and can extend to disdain for body composition fat percentage above a given number. A focus on becoming leaner alongside or instead of performance goals in sport is also an example of this kind of bias.
Fat Stigma: the negative social consequences of thin bias. This can include being catcalled, romantically rejected, infantised, harassed, bullied, dehumanised and humiliated due to having a larger body size. Fat stigma is most corrosive to someone's sense of self when it occurs in the family of origin. If the larger-bodied person agrees with the negative beliefs attributed to their body they have developed internalised fat (or weight) stigma. Fat stigma is reinforced by negative portrayals of people with larger bodies in the news and entertainment media, for example the 'headless fatty' images that typically accompany news stories about 'obesity' and the ubiquitous fat-to-thin personal transformation narrative.
Weight stigma: the negative interpersonal consequences of weight bias in medical and healthcare settings. For example, a primary care provider (eg GP) who berates a client for their weight, dismisses their primary complaint to discuss their weight, advises weight loss for a condition that a smaller-bodied person would receive a different treatment for, assumes that someone with a larger body has a sedentary lifestyle or poor eating habits (without actually assessing either), assumes poor health literacy based on body weight etc. The consequences of weight stigma (understandably) include avoidance of healthcare services, diminished sense of self worth, shame, missed/delayed diagnosis of serious illness and exacerbation of mental health conditions such as depression and anxiety. Weight stigma also affects people outside of health and medical contexts, such as social settings e.g. family and friends, and community settings e.g. public transport, shops, gyms, schools, workplaces, which affect people's ability to participate in activities that benefit their health and well-being.
Size Discrimination: when access to services or activities differs between larger and smaller bodied people. For example, if access to IVF services is arbitrarily limited due to BMI instead of functional testing, when access to adoption services are based on potential parents' BMIs, when joint replacement surgery based on BMI instead of strength and function tests.
Weight neutral approaches are experiencing a rapid growth period in research right now, although the foundational work began in the 1950s when intentional weight loss was first recognised as unlikely to be sustained, and social justice movements during the 1960's recognised clear discrimination against people with larger bodies.
These academic articles will get you started:
GENERAL OVERVIEWS OF SIZE ACCEPTANCE VS WEIGHT CENTRIC PERSPECTIVE
Mauldin, Kasuen, Michelle May, and Dawn Clifford. "The consequences of a weight‐centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight." Nutrition in Clinical Practice (2022).Tylka, Tracy L., et al. "The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss." Journal of Obesity 2014 (2014).
Bombak, Andrea. "Obesity, health at every size, and public health policy." American journal of public health 104.2 (2014): e60-e67.
Hunger, Jeffrey M., Smith, Joslyn P., and Tomiyama, A. Janet. "An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy." Social Issues and Policy Review 14.1 (2020): 73-107.
Tomiyama, A. Janet, et al. "How and why weight stigma drives the obesity ‘epidemic’ and harms health." BMC medicine 16.1 (2018): 123.
Dollar, Emily, Margit Berman, and Anna M. Adachi-Mejia. "Do no harm: Moving beyond weight loss to emphasize physical activity at every size." Preventing chronic disease 14 (2017).
O'Hara, Lily, and Jane Taylor. "Health at every size: A weight-neutral approach for empowerment, resilience and peace." International Journal of Social Work and Human Services Practice 2.6 (2014): 272-282.
SYSTEMATIC REVIEWS OF WEIGHT NEUTRAL INTERVENTIONS
Dugmore, Jaslyn A., et al. "Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: a systematic review and meta-analysis." Nutrition reviews 78.1 (2020): 39-55.
Clifford, Dawn, et al. "Impact of non-diet approaches on attitudes, behaviors, and health outcomes: A systematic review." Journal of Nutrition Education and Behavior 47.2 (2015): 143-155.Schaefer, Julie T., and Amy B. Magnuson. "A review of interventions that promote eating by internal cues." Journal of the Academy of Nutrition and Dietetics 114.5 (2014): 734-760.
Ulian, M. D., et al. "Effects of health at every size® interventions on health‐related outcomes of people with overweight and obesity: a systematic review." Obesity Reviews (2018).