Is the health at every size philosophy legitimate?

Jennifer Hicks, like the vast majority of women in Canada, was unhappy with her physical appearance.

At 30 years old, the Toronto-based speech language pathologist had a sudden mental health crisis and developed anxiety. This led to anorexia and an exercise addiction.

“If I wasn’t sleeping, I was exercising,” she said. “And this went on for years.”

Hicks’ road to recovery was long and challenging. When she began teaching Nia fitness classes — a health and fitness alternative focused on mind and body conditioning — in 2008, her life took a turn for the better.

A few years later, Hicks discovered the Health at Every Size (HAES) movement on Instagram.

HAES is a medical approach that seeks to de-emphasize weight loss as a health goal and “address weight bias and stigma in individuals living with obesity” while promising a “public health approach beyond the prevailing focus on weight status as a health outcome,” according to an article in the American Journal of Public Health.

It’s no secret that individuals with larger bodies, especially women, receive a lower quality of healthcare in North America. Medical professionals often tell patients that any ailments they experience are the result of obesity, whether true or not. Larger people are even less likely to receive empathetic care in general.

People like Lindo Bacon, a nutritionist and author, have popularized HAES on social media alongside several other activists who are advocating for a view of health beyond one’s weight.

For Hicks, the HAES ideology just clicked.

“My whole view on wellness shifted dramatically,” she said. “I realized that how we feel is more important than how we look.”

Changing attitudes to health and care

HAES is not exclusive to body positive Instagram posts. Some health professionals, like Dr. Kerri Fullerton, ND, a Barrie-based naturopathic doctor, are adopting HAES into their real-life practices.

Fullerton says many of her clients have had traumatic experiences with medical health professionals in the past where size had been the only factor in determining one’s health.

“That kind of thinking is so damaging, and yet in medicine, it just is,” she said. “There are a lot of people’s bodies that have zero health concerns. They just don’t have anything to treat. Their blood sugars are good, their blood pressure is good, their lipids are good. Everything’s great, and yet we’re putting them under so much pressure to try and lose weight.”

Fullerton said if people are coming into a medical system and they’re being shamed and stigmatized, that’s not creating a healthy environment for them.

“If we’re labeling obesity as a disease, that is just a form of oppression,” she said. “It’s like labeling somebody with a disease because of their skin colour, their ethnicity, or their sexual orientation.”

Simone Si, a Scarborough-based clinical social worker, has also adopted HAES into her work.

When Si first read about HAES, she was skeptical. However, after several failed diet attempts of her own, she revisited the movement and became a devoted follower.

“A big piece of work I do with clients is to look at their dieting history and what they’ve gained from dieting and what they’ve lost, the ways that dieting has interfered with their lives,” said Si. “Usually people can point out some benefits, but always short term. There are a lot of harms in terms of their mental health.”

The most prominent way HAES comes into play in Si’s work is through grieving the loss of the “thin fantasy.”

“So many of the clients that I work with have been dieting for decades and have been waiting until they reach their goal to live their life,” she said. That includes waiting to wear certain clothes, go to the beach, or even begin dating before reaching a certain size.

“I help my clients recognize their self-worth. Regardless of what their body looks like on the outside, they have so many good qualities on the inside,” she said.

Controversy with HAES approach

The HAES movement is not without its criticism, which argues the ideology promotes obesity and is anti-weight loss.

Georgie Fear, a registered dietician from Kenmore, Alta. used to be a HAES follower herself. The online community and anti-weight loss mentality turned her away.

“The [HAES] movement has been great to let people know no matter what your size, you have the right to decide goals for yourself,’ she said.

Fear added what she has an issue with is when HAES proponents tell people that losing weight is wrong, even when it’s for health reasons.

“If someone comes to me and says, ‘What are evidence-based ways that I can live longer?’ I would not be doing my job if I didn’t include attaining a healthy body weight, and being obese is part of that.”

Fear said she doesn’t believe weight loss should be the most important thing in determining a person’s health. However, when it comes to lowering blood pressure, decreasing arthritic problems, decreasing risk of diabetes complications and other medical ailments, most of the medical evidence suggests a lower body weight is beneficial.

“Is it worthwhile to pursue health separate from weight loss? 100 per cent,” she said.  “But there are people who are not okay with [weight loss] because they think anything that reduces their body weight comes from diet culture that is just harming you.”

Fear added, “I feel like it’s ethically wrong to not talk about weight and to avoid it as a topic, and I think we can have those conversations without anybody being shamed or stigmatized.”

In response to this criticism, Fullerton clarified HAES is not anti-weight loss, but rather anti-intentional weight loss.

“There [are] no advantages to being obese in our society,” she said. “The goal is weight neutrality, which means I’m not going to praise you for weight loss, and I’m not going to praise you for weight gain.”

Instead, Fullerton said people with larger bodies should not be treated with disdain, but respect.

For those like Hicks, the Nia dance coach, HAES still plays a large role in accepting her own physicality. HAES has made her feel balanced in all aspects of her life, not just her body.

Though she is living in a bigger body, Hicks said she feels the most fit she has ever been.

“I have these unique traits about me, that I would define as my spirit, that really also deserve nurturing,” she said.