Truth and Fiction from Health at Every Size

We are in the midst of a fundamental change in the understanding of obesity. Years of hand-wringing – with urgent calls to eat less and move more – promoted weight stigma more than it reduced obesity prevalence. To counter this, the trademarked Health at Every Size (HAES) movement rose up to call out the mistake of promoting weight stigma and to advance the idea that many people can do much to improve their health without losing weight.

These two core concepts are reasonable and true. But the advent of new and better options for treating obesity is leading people to adjust how they think about obesity. In this new environment, some of the talking points for HAES no longer ring true.

So we wonder. Will the Health at Every Size movement adapt? Or will it start pushing harder on false and apocalyptic messages?

Turning Up the Volume

Right now, it’s hard to miss the volume of false messaging. Three threads of them stand out. First is the assertion that obesity is not really a health problem. Rather, it’s a fabricated medical construct that equates body size with health and by itself promotes stigma. But in fact, obesity is not defined by size. It is abnormal or excessive adipose tissue causing harm to health that defines it.

The second false thread is that the only point of obesity treatment is to make fat people thin. This presumption comes from social pressure for thinness, which indeed is not helpful. But in fact the object of obesity treatment is to help a person meet their own goals for better health. That may involve some short-term weight loss, but for the longer term, it requires attention to stabilizing many health factors beyond weight.

The third point is that obesity treatment is futile and dangerous. In this thread, activists see the availability of new and better options for young persons with severe obesity as especially threatening. In Self magazine, HAES dietitian Christine Byrne says a new evidence-based guideline for obesity from the American Academy of Pediatricians is “appalling.” She falsely says the guideline is based “solely on weight.” She claims it “pathologizes normal growth and development” and suggests the guidance will promote disordered eating. An objective reading of the guideline supports none of these claims.

Divergent Experiences

Julia Belluz reports in Vox on people who embrace some of the truths of HAES principles but are having a hard time with some of the fictions. They like the strong stance of HAES against weight stigma. They believe in respecting diverse body shapes and sizes. But they cannot deny the health effects they are experiencing from obesity. And they are finding value in the health benefits of advanced medical care for it.

So without a doubt, the medical understanding of obesity is evolving. That evolution is bringing new options for care and people are seeking those options. As ever, different people will make different choices to meet their own personal needs. The best we can do is to seek the truth about those options and respect the choices that people make.

Click here for more from Belluz and here to read perspective on diversity and medical autonomy.

Full Moon, painting by Paul Klee / WikiArt

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February 10, 2023