One Size Fits All

Health at Every Size® or One Size Fits All?

Health at Every Size® is both an idea and a trademark. The trademark is owned by the Association for Size Diversity and Health. The idea is all about a view of health independent of a person’s weight. So folks who travel in the HAES® orbit take a dim view of the word obesity – even call it a “slur.” It doesn’t feel right to them, even though it’s a legitimate medical term. There’s just too much stigma that has attached itself to that diagnosis.  However, we find that in zealously fighting the stigma and denying the legitimacy of any concern about obesity, some of the folks promoting Health at Every Size ideology wind up also promoting a one-size-fits-all paradigm for health.

In a perverse way, this kind of inflexibility can actually isolate and stigmatize people who have real medical issues related to obesity.

Misunderstanding Obesity

In his overview of obesity care in 2022 on Friday, Lee Kaplan explained how the popular misunderstanding of obesity fuels prejudice and stigma about this disease. Oddly enough, the view that obesity is not a legitimate disease is something that fat haters and fat acceptance activists have in common. The folks with prejudiced ideas about fatness promote the idea that obesity is nothing but the product of bad behaviors. They deny the medical science about the pathology and the physiology of obesity that has nothing to do with behavior.

Likewise, we hear fat acceptance advocates denying the science that defines the pathophysiology of obesity. It’s “made up,” says the chair of the National Association to Advance Fat Acceptance.

One Size Fits All Hurts Real People with Real Health Concerns

Thus, the unfortunate synergy between fat phobic thinking and fat acceptance activists becomes a real issue for people with medical needs related to obesity. Fat phobia is pervasive in health systems and health benefit plans, denying care for obesity-related concerns. Fat activists, denying the reality of obesity as a real disease, see no problem with that. Their concerns, which center on discrimination in routine medical care, are indeed very important.

But for someone with NAFLD, the real problem behind their condition is the accumulation of fat tissue in the liver. Without treating the obesity that’s causing this, it’s well nigh impossible to reverse NAFLD. Thus, by denying the reality of obesity, fat activists cause real harm to persons living with this disease. This is but one example of the harm that promoting a misunderstanding of obesity can do.

We have genuine respect for the ideals of Health at Every Size. But when folks who believe in it also promote misunderstanding of medical science, they can do very real harm to people living with obesity. This is an unfortunate mistake.

For further perspective, click here and here.

One Size Fits All, photograph by Ted Kyle / ConscienHealth

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June 26, 2022

5 Responses to “Health at Every Size® or One Size Fits All?”

  1. June 26, 2022 at 8:56 am, Allen Browne said:

    Unfortunately healthy at any degree of percent body fat doesn’t work. Just as diabetes is disordered glucose metabolism, hypertension is disordered control of blood pressure, and cancer is disordered growth of a group of cells, obesity is disordered control of the amount and location of adipose tissue. And the problem with obesity is the disturbance of health. We know there are over 200 complications of the disease of obesity.

    If the problem is the amount and location of adipose tissue, the treatment should involve adjusting the amount and/or location of the adipose tissue. To do this one has to acknowledge energy regulation. Cutting the fat tissue out leads to regrowth. Starving the body to reduce the amount of adipose tissue leads to metabolic adaptation and eventual reaccumulatioin of the fat tissue. Adjusting the energy regulation system works as long as the adjustment is maintained. So, actually it is simple – adjust the energy regulation system as soon as you know it is going awry and before complications occur or become permanent. And maintain the adjustment of the energy regulation system to maintain health.


  2. June 27, 2022 at 8:13 am, John DiTraglia said:

    What about skipping the issue and say ok obesity is not a biggie. But if you have high blood pressure we should treat that. If you have high cholesterol let’s treat that. If you have type 2 diabetes treat that. If you hate yourself that might be treatable. The possible residue, including NAFLD, is not treatable and relatively small potatoes..

    • June 27, 2022 at 8:54 am, Ted said:

      It’s hard for me to agree that NAFLD is small potatoes. Liver failure and liver cancer is a big deal.

  3. July 02, 2022 at 2:21 pm, Valerie said:

    How would you treat NAFLD in a patient with normal weight?
    Let me guess: same treatment as for a patient with obesity, right?

    That’s my understanding of Health at Every Size: Treat the the actual disease, and stop focusing on the size of the patient.

    • July 03, 2022 at 5:19 am, Ted said:

      You’re right Valerie. Neither obesity nor NAFLD is a disease of size. They are both diseases of excess or abnormal adipose tissue. Doctors should focus on the disease. Not the size of the patient.