A Beginners Guide to HAES (+ rambles)

I felt this post was important because the Health At Every Size approach was not something I had ever even heard of when I began my recovery. If I had known more about it I think I would have really looked at my treatment differently, more optimistically and from a more positive perspective.

On learning about HAES, my eyes were opened to the prevalence of fat phobia amongst health care professionals. I have been able to hold myself accountable for my own implicit biases and hopefully am helping others to pick up on theirs too.

I really hope this is useful 🙂

Right, where to begin…?! This may end up being a bit of a ramble (it really does) but I hope you will bare with me.

Before we delve into HAES itself, we first need to look at the opposite end of the spectrum: Diet Culture.

The main crux of diet culture is that thin equates to healthy and that if you don’t have a thin body you must have to lose weight to be healthy. This is, of course, lies.

Diet culture thrives off making people feel awful about themselves in order to make money. The diet culture industry makes over $60 BILLION per year with a 95% failure rate (i.e 95% of diets don’t work).

This means people get sucked in and end up yo-yo dieting for years on end. Yo-yo dieting is linked to type 2 diabetes, insulin resistance, cancer, bone fractures, heart disease, higher blood pressure, inflammation, increased mortality, long-term stress… Health who?

Not only that, dieting is also one of the biggest triggers for full-blown eating disorders and for those living in bigger bodies, diet culture encourages self-hatred and discrimination. People in larger bodies are discriminated against ALL THE TIME which in itself can cause both physical and mental health problems.

The bottom line is that diet culture is dangerous and harms people of all sizes. It makes recovery from eating disorders a trillion times harder than it should be and our society is rife with it.

Gahhhhhhhhhh! 🤦‍♀️

I think it’s time to look at HAES.

Health At Every Size (HAES) is an alternative approach to the current public health policy (which makes assumptions based on size and weight). It originated in the 1970s and was popularised by Lindo Bacon, who went on to write the book Health At Every Size.

The HAES principles:

✨ A neutral approach to health care.

✨ Accepting and respecting the diversity of all bodies.

✨ Promotes behaviours that are healthy for the individual, such as enjoyable movement, body acceptance and honouring hunger cues.

✨ Places importance of eating for pleasure as well as satiety, appetite, hunger and nutrition.

✨ Celebrates both body neutrality and positivity and stands for social justice.

✨ Promotes all aspects of health and wellness for people of all sizes.

✨ Doesn’t consider BMI as a representative measure of health because BMI ignores behaviour, genetics, financial development, education, employment, food security, social support, effects of medication, access to healthcare etc.

✨ Recognises that health is multi-faceted and complex, and includes physical, social, occupational, emotional, intellectual, spiritual and mental factors.

✨ Opposes weight stigma and removes damaging discrimination against those in bigger bodies by treating everyone with equal respect.

✨ Promotes the idea that every body is worthy of acceptance and health, regardless of size.

It is important to note that the HAES doesn’t mean to say that everyone is automatically healthy. Of course this can’t be true, as thin people can also be very unhealthy, as can people of every size.

Instead, HAES encourages acquiring healthy behaviours regardless of your size.

Controlled and empirical trials testing the HAES paradigm have shown to improve not only improve health but self-esteem, psychological well-being and metabolic health – all without placing pressure on weight-loss or restricting food intake.

These include:

⭐️ Multiple studies suggesting a focus on weight alone as a criteria for health is often harmful and misdirected. ⁽¹ ² ³⁾

⭐️ Evidence showing that if a patient is 5lbs “underweight” on the BMI scale, it is much more dangerous that being 75lbs “overweight”. ⁽⁴ ⁵⁾

⭐️ Weight and BMI are actually pretty poor at predicting the likelihood of disease or longevity in patients. ⁽⁶ ⁷ ⁸⁾

⭐️ People with a BMI between 25-35 actually often live longer than people with a BMI between 18.5 and 25. ⁽⁵ ⁹⁾

And there is SO much more evidence out there.

But still, medical fat phobia is real and it is rife in eating disorder treatment.

If eating disorder professionals could acknowledge the principles of Heath At Every Size, patients would not be fed weight-bias every single day as is currently happening. They would not fear weight gain and instead would celebrate the fact they are learning to adopt healthy habits, no matter what the scale says. They would not be told ‘you will never get fat’ and feel belittled when they do. The diagnosis of ‘atypical’ anorexia would not exist.

What we can take from all this is that FAT IS NOT THE PROBLEM! Fat stigma is the problem.

Warning: *here comes the ramble…*

Diet culture has brainwashed us into automatically associating “thin” with “healthy”. But ooh, not too thin, because that’s “gross” and “scary”(trust me, I learnt that one the hard way).

People often restrict their food, go on diets and embark on ✨fitness journeys✨ in order to “get healthy”. Most of the time though what these people are actually wanting, is to get thin.

Thin is a body type. Health is a complex amalgamation of physical, mental and even social wellness and an absence of disease and infirmity (WHO, 1948).

Personally, when I was my thinnest, I was also my least healthy. I was an extremely healthy person before losing weight. I was sporty, energetic, wasn’t on any long-term medication, ate what I wanted whenever I wanted and I was HAPPY.

Losing weight does automatically make you healthier. I can already hear the anti-HAES folk screaming “but what about the ob*se people?! Surely being thin for them is healthier than being that fat!”. Well Karen, here’s what I say to you lot:

Imagine you are “overweight”. You love your life, you eat foods you can afford and that you like and you have no underlying or current health conditions. You listen to your body and enjoy movement when you have the time. You love and respect yourself. One day when out on a walk with your dog, you encounter a fat-phobic wizard (please, bare with me here) that threatens you with “if you haven’t reached a healthy BMI in 8 weeks when I next see you, I will kill you”. Odd. But obviously, you’re a bit freaked. You start a diet of pickle juice because you’ve seen a skinny celebrity say it works wonders for weight loss. Only pickle juice. You experience odd side effects and you feel pretty rubbish. You don’t have energy to exercise, you become depressed and irritable and you get weird heart flutters sometimes. You try to ignore of all that though because this is all in the pursuit of HEALTH! 8 weeks have passed. The wizard comes back. You survive. You’ve lost the weight. You’re healthy now! But bro, for realises, you are not healthy. In fact, you’re the least healthy you’ve been in years.


Health will look different for everyone.

Dieting, for me will never, ever, be healthy. For me, cutting out chocolate or having low-calorie meals will never, ever be healthy. Adopting behaviours that improve my wellbeing and looking after my mind, will make me healthier. Eating chocolate and resting my body, improves my health.

I will live with the anorexia gene for life. When I go into energy deficit, this gene is triggered and both my mental and physical states become compromised.

Every day I have to actively fight against society’s warped vision of health and thinness because of diet culture. Every day when I hear or see someone yabber on about one of diet culture’s lies, I feel the urge to scream from the top of my lungs that “FOR GOD’S SAKE, STOP PRETENDING YOU WANT TO BE HEALTHY! YOU JUST WANT TO BE THIN!”

If these people truly wanted to “get healthy” they’d:

🤗 Do more of what they love

🤗 Prioritise their mental wellbeing

🤗 Listen to what their body needs (rest, certain foods etc)

🤗 Minimise stress

🤗 Practise self-love and body acceptance

🤗 Move their bodies IF they want to

🤗 Completely disregard weight as a marker for health!

Sound familiar? Well, I hope so. Because those are literally the (slightly re-worded) principles of HAES that I’ve stated above.

To summarise this excessively long post:

⁃ Weighing yourself as a marker of your health is like taking an IQ test to judge your flexibility (stupid and frankly pointless).

⁃ Fat does not equal unhealthy just as thin does not equal healthy.

⁃ BMI is bullshit (ooh there’s a corker of a post coming on this one).

⁃ If you want to lose money, waste time and feel rubbish about yourself, go ahead and dedicate the rest of your life to the prison that is diet culture! Enjoy!

⁃ If you want to be the healthiest, both physically and mentally, version of yourself, try adopting and researching the HAES principles 🙂

1. Kang X, et al. Impact of body mass index on cardiac mortality in patients with known or suspected coronary artery disease undergoing myocardial perfusion single­photon emission computed tomography. J Amer Coll Card, 2006; 47:1418­26.

2. Oreopoulos, A et al., Body mass index and mortality in heart failure: A meta­analysis. Amer Heart J,; 2008; 156:1, 13­22.

3. Olsen, TS, et al., Body mass index and poststroke mortality, Neuroepidemiology 2008; 30:93­100

4. Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause­specific excess deaths associated with underweight, overweight, and obesity. JAMA, 298(17), 2028­303

5. .Campos P (2004). The Obesity Myth. New York: Gotham Book

6. Gaesser, G. (2002) Big Fat Lies: The Truth About Your Weight & Your Health. Carlsbad, CA: Gurze.

7. Flegal, KM et al. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15) 1861­1867.

8. Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause­specific excess deaths associated with underweight, overweight, and obesity. JAMA, 298(17), 2028­3037.

9. Olson MB. Weight cycling and high-density lipoprotein cholesterol in women: Evidence of an adverse effect. Journal of the American College of Cardiology 2000;36:1565-1571.

⁃ Goodrick GK, Foreyt JP. Why treatments for obesity don’t last. Journal of the American Dietetic Association 1991;91:1243-1247.

⁃ Field AE, Austin SB, Taylor CB, et al. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics 2003;112:900-906.

⁃ Coulston AM. Obesity as an epidemic: Facing the challenge. Journal of the American Dietetic Association 1998;98 (suppl 2):S6-S8.

⁃ Guagnono MT. Risk factors for hypertension in obese women: The role of weight cycling. European Journal of Clinical Nutrition 2000;54:356-360.

⁃ Holbrook TL, Barrett-Connor EL, Wingard DL. The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. International Journal of Obesity 1989;13:723-729.

⁃ Blair SN, Shatten J, Brownell K, Collins G, Lissner L. Body weight change, all-cause mortality, and cause-specific mortality in the multiple risk factor intervention trial. Annals of Internal Medicine 1993;119:749-757.

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