By: Glenda Miranda, CSUN Dietetic Intern 2021-2023 Cohort 

Have you ever had someone comment on your body and point out the fact that you gained weight? In today’s society, this seems to be so common that it might even be done without thinking. Have you been to your doctor’s office, got weighed, and then received an unwelcome lecture on why you should lose weight? I encourage you to think about where this bias comes from that associates being in a larger body to being “unhealthy” or it being a “bad” thing. But in order to do this, we first need to discuss how weight stigma began.  

Defining weight stigma takes us back to the 1960s, when society really began to establish “thin” as the ideal body type, largely due to slender fashion models of the time like Twiggy, who accentuated ‘thin’ as the new ideal.¹ Additionally, emerging weight loss programs such as Weight Watchers quickly became popular.¹ During this decade, there was an article written by Lew Louderback titled “More People Should Be Fat!” that was published in a major US magazine.¹ The purpose of this article was to expound on the discrimination and judgment faced by individuals in larger bodies. This caught the attention of Bill Fabrey, who was an engineer married to a woman in a larger body, since he had been seeking a way of advocating on behalf of folks in larger bodies. Together with the writer of the article, Fabrey founded the National Association to Aid Fat Americans (NAAFA) in 1969, a nonprofit human rights organization, known today as the National Association to Advance Fat Acceptance.¹ This is when the Health at Every Size ® (HAES) movement originated, to steer away from the weight-obsessed society, and help reduce stigma towards those in bigger bodies.¹ Thus, the purpose of HAES was to advocate in favor of those in larger bodies, stating that this culture where the thin body was the ideal according to beauty standards was something that would cause negative healthcare and psychological consequences to those affected.¹ It was then that the size acceptance movement was born.¹ There has been great controversy around HAES, as many individuals believe its purpose is to “glorify” being overweight or obese. Nonetheless, it is merely seeking inclusivity, respect, and equality, for folks in larger bodies. This approach has 5 principles that will help us have a better understanding of the beliefs and values that it advocates for. In the following section, we will delve into the details of what each principle represents for those individuals that are interested in joining the movement to reduce weight stigma.  

The 5 Principles of Health at Every Size: 

1. Weight Inclusivity:  

• This refers to the idea of not labeling a certain body type as better than another. For example, a larger body is not “bad” and a smaller one is not “good” or the ideal. The goal is to respect all body shapes and sizes.² 

2. Health Enhancement: 

• This refers to the idea that in order to decrease weight stigma, it is key to ensure we provide equal access to health services for individuals of all body types and sizes. This also includes the way in which individuals in larger bodies are treated within the health care setting.² It is important to note some of the situations that larger individuals might face, such as shorter appointment times, less comprehensive exams, fewer referrals for specialists and imaging, and prolonged waiting times for procedures. Additionally, healthcare providers associate a larger body to “laziness” and “lack of self-control”, and thus might overlook serious conditions and emphasize weight as the only concern.²   

3. Eating for Well-being:  

• Weight loss should not be the main goal of diets. Eating should actually emphasize and promote individualized care and encourage individuals to follow their hunger and satiety cues, without jeopardizing their nutritional needs or the joy that nourishing our bodies provides.²  

4. Respectful Care:  

• This principle really encompasses the big picture of the HAES movement, which is to acknowledge the fact that we all have biases, and in order to reduce or eliminate weight stigma and discrimination, we need to address our own beliefs and challenge them, and strive for a world in which individuals in larger bodies can receive the same care without these biases affecting the outcomes.² Examples of these biases include believing that overweight or obese individuals are lazy or irresponsible, and that their medical conditions are directly related to their weight and the thought that it is their fault because of their actions.  

5. Life-enhancing Movement:  

• This principle supports the importance of having physical activities that are inclusive to individuals of all body shapes and sizes. Everyone regardless of size should participate in and at the same time enjoy movement.² Mindful movement can be included in daily activities such as walking, swimming, other water exercises, and dancing.  

Health at Every Size in Research 

We live in a weight-centered world, where weight-based oppression, which encompasses negative attitudes about body weight, as well as harassment, stigma, and discrimination based on body weight, are so present that they can directly cause poor wellbeing and health. Concepts such as body positivity or body neutrality foster body acceptance and appreciation, with a purpose to protect overall health and wellbeing. HAES has been evaluated through research. In a study in 2021, the objective was to “evaluate the impact of a brief health promotion activity informed by Health at Every Size® and critical health promotion principles on body positivity and internalized weight-based oppression in female students at Qatar University”.³ The study found that body acceptance and appreciation increased significantly after the activity, and these improvements remained at the 10 week follow up.³  This study concluded that “Brief HAES informed health promotion activities show potential to improve health and wellbeing”.³   Another study in 2018 had the purpose of examining “multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women”.⁴ This study found that their new intensified HAES®-based intervention “improved participants’ eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels”.⁴ Lastly, another study done in 2018 looked at the outcomes of a Health at Every Size (HAES) intervention in a real-world setting.⁵ The intervention in this study consisted of the following: ​​14 weekly meetings provided by health professionals, with a focus on intuitive eating, self-acceptance, and following a healthy lifestyle.⁵ The evaluation of this HAES intervention demonstrated its “effectiveness in improving eating, weight, and psychological-related variables among women struggling with weight and body image”.⁵  Following a HAES approach in healthcare appears to be effective in positively changing health and wellbeing outcomes for those in larger bodies.  

Join the Movement and Help Reduce Weight Stigma 

Many healthcare providers hold strong negative attitudes and stereotypes about people in larger bodies. However, we can certainly make a change as professionals or in our daily lives when it comes to reducing weight stigma.⁶ Below are some actions you can take to continue this movement: 

• Don’t make assumptions on a person’s lifestyle or eating habits based on their physical appearance 
• Identify bias and assumptions that you may have 
• Practice patient-centered communication, meet the patient where they are at 
• Provide a safe space  
• Continue to educate yourself on the topic 

HAES is an important movement because it prioritizes individual needs and advocates for equal quality of care. If you are interested in joining the movement, a good starting point is to educate yourself and others on the importance of recognizing and decreasing weight bias.  

References 

1. Altman Bruno B. History of the Health at Every Size® Movement, Part 1. Association for Size Diversity and Health. April 30, 2013. Accessed February 2, 2023. https://asdah.org/history-of-the-health-at-every-size-movement-part-1/.  

2. Association for Size Diversity and Health. ​​The Health at Every Size® (HAES®) Principles. Accessed February 2, 2023. https://asdah.org/health-at-every-size-haes-approach/.  

3. O’Hara L, Ahmed H, Elashie S. Evaluating the Impact of a Brief Health at Every Size®-Informed Health Promotion Activity on Body Positivity and Internalized Weight-Based Oppression. Body Image. 2021;37:225–237. https://doi.org/10.1016/j.bodyim.2021.02.006.  

4. Dimitrov Ulian M, Pinto AJ, de Morais Sato P, B. Benatti F, Lopes de Campos-Ferraz P, Coelho D, J. Roble O, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Rogero MM, Toporcov TN, de SaPinto AL, Gualano B, Scagliusi, FB. Effects of a New Intervention Based on the Health at Every Size Approach for the Management of Obesity: The ‘Health and Wellness in Obesity’ Study. PLOS ONE. 2018;13(7):1-19. https://doi.org/10.1371/journal.pone.0198401.  

5. Bégin C, Carbonneau E, Gagnon-Girouard M-P, Mongeau L, Paquette M-C, Turcotte M, Provencher V. Eating-related and psychological outcomes of health at every size intervention in health and Social Services Centers across the province of Québec. American Journal of Health Promotion. 2018;33(2):248-258. doi:10.1177/0890117118786326  

6. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity. Obesity Reviews. 2015;16(4):319–326. https://doi.org/10.1111/obr.12266.