Health at Every Size (HAES): Why You Should Work With a HAES Dietitian

What is health at every size and why you should work with a HAES dietitian
Nutrition
Eating Disorder
Written By:
Jennifer Huddy, MS, RD

You may have seen the term “HAES” before when reading about an eating approach or a registered dietitian’s philosophy. If you’re wondering what Health at Every Size is and what it means to work with a HAES dietitian, here’s everything you need to know. 

What is HAES?

Health at Every Size (HAES) is a framework for supporting a weight-inclusive approach to healthcare. It means taking the focus off of intentional weight loss and fighting against weight stigma while providing equitable healthcare to all. 

The HAES movement, trademarked by the Association for Size Diversity and Health (ASDAH), was created to counter the standard weight-normative approach to health care. Weight-normative health care focuses on interventions that target weight as the primary means to improve one’s health status.

There is growing evidence that focusing on weight isn’t the most effective or inclusive way to improve health. The research shows that intentional weight loss (losing weight on purpose through dieting, exercise, or medication) is generally a short-term fix. Numerous long-term studies have found that the vast majority of people who intentionally lose weight will regain that weight within a few years, regardless of how well they follow the diet plan. Further, one-third to two-thirds of these people regain more weight than they initially lost. 

This weight loss and subsequent regain repeatedly occurs with chronic dieting and is known as weight cycling, which is harmful to health. Unfortunately, this “failure” of dieting is often blamed on the individual’s willpower or self-control rather than biology. HAES acknowledges this evidence and aims to shift the perspective around weight in healthcare. 

Health at Every Size is commonly misinterpreted as promoting the idea that all people with larger bodies are healthy. The reality is that people can be healthy or unhealthy at any size or weight. At its core, the purpose of HAES is to advocate for equitable healthcare for everyone without putting the focus on weight. 

Health at Every Size Principles

There are five principles that make up the Health at Every Size Approach: weight inclusivity, health enhancement, respectful care, eating for well-being, and life-enhancing movement. Let’s dive into what each of these HAES principles means. 

Weight Inclusivity

The concept of weight inclusivity is at the center of the Health at Every Size paradigm. It means that all people should be able to access health care regardless of weight or size. Unfortunately, medical fatphobia and weight stigma are commonplace in our healthcare system. 

Some medical providers believe that people in larger bodies are lazy and don’t follow health recommendations. This incorrect belief causes harm because it can influence the type of medical care given. Weight stigma may lead to specific treatments being denied (i.e., not allowing a person to have a necessary surgery until they lose “x” amount of weight). 

There is also evidence that when a person experiences medical weight stigma, they are less likely to pursue health-promoting behaviors. Further, it can cause people to avoid seeking medical care in the future because they want to avoid judgment. 

Health Enhancement

Many people believe that weight is the cause of various health concerns. The HAES approach argues that many factors can impact a person’s health. Socioeconomic status, genetics, environment, and personal habits are just a few of these factors we must acknowledge when considering the concept of health enhancement. 

Research shows that the HAES approach can help improve blood pressure, cholesterol levels, insulin sensitivity, disordered eating, physical activity level, and body image – independent of weight change. This evidence is important because it shows that weight loss is not the only way to improve health. 

Respectful Care

The principle of respectful care emphasizes the importance of identifying our own biases around weight. It means we must push back against weight stigma, especially in the medical setting. Respectful care involves not making assumptions about a person’s health status, eating habits, or worth based on their size. 

Eating for Well-Being

The nutrition principle of HAES, “eating for well-being,” means shaping your diet around your hunger and fullness cues, personal nutrition needs, and enjoyment of food. The HAES approach avoids labeling foods as morally “good” or “bad” and supports a healthy relationship with food. 

This is in contrast to diet plans that focus on external factors, such as portion sizes and calorie counting, and aim to change your weight.

Life-Enhancing Movement

Many people have a negative relationship with exercise, stemming from diet culture messaging that exercise is for burning calories and losing weight. The concept of “life-enhancing movement” means that people of all sizes and abilities should be able to participate in physical activities that bring them joy (if they so choose). 

An important concept of HAES is that people are not obligated to pursue healthy behaviors, like eating more vegetables and being active. It also acknowledges that access to these things is a privilege. A person’s lifestyle choices and habits should not determine their ability to access equitable healthcare. 

Why You Should Work With a HAES Dietitian

If the Health at Every Size approach resonates with you and you’re concerned about your nutrition and health habits, you might consider working with a HAES dietitian. 

What is a HAES dietitian?

A HAES dietitian has the same credentials as a traditional registered dietitian but implements the principles of HAES in their practice to provide weight-neutral care. If you’ve worked with a registered dietitian for weight concerns before, there’s a good chance you were put on a reduced-calorie diet with an exercise plan. You likely had a specific goal weight and had your weight closely monitored. This is the weight-normative approach taken by many dietitians. 

When we follow a specific diet plan and build habits for the sole purpose of weight loss, and then that weight loss doesn’t happen or isn’t sustained, we tend to lose motivation to continue those healthy habits. In addition, frequent dieting can increase the risk of developing an eating disorder or disordered eating. 

Working with a HAES registered dietitian is different because the approach takes the focus off of weight. HAES dietitians do not view weight as a behavior or something we can set specific goals to change. Instead, the focus is on behaviors we can successfully change, with the end goal being building healthy habits for the sake of improving our health, not for weight loss. Weight may change as a side effect of these habits, but it is not the focus. This key difference leads to more sustained changes that impact our long-term health for the better. 

Who can see a HAES dietitian?

HAES dietitians are trained in medical nutrition therapy and are qualified to counsel clients with a wide range of health concerns. There are a few types of individuals who particularly benefit from the HAES approach. 

You should consider working with a HAES dietitian if you have concerns about your weight but dieting has not been productive or effective for you. This approach is also beneficial for helping improve your relationship with food and your body. Many HAES dietitians also have training in Intuitive Eating, which is a food philosophy focused on respecting your body’s natural hunger and fullness cues. 

The HAES approach is known as a standard practice in the treatment of eating disorders. Since yo-yo dieting and fatphobia are known risk factors for eating disorders, HAES serves to counter these common practices and beliefs. Regardless of your health concerns, attending nutrition therapy through the lens of Health at Every Size can be useful. 

Other HAES healthcare professionals

Health at Every Size is not only practiced by registered dietitians. There are doctors, therapists, and other healthcare professionals who subscribe to the philosophy. 

You may be interested in finding a doctor who follows the HAES principles. A weight-neutral approach can reduce weight stigma and improve the quality of your care, particularly if you are living in a larger body. Many people have had the experience of visiting the doctor for a health concern and being told to “just lose weight.” HAES doctors focus on the root cause of the problem without focusing on weight as the primary factor. 

A HAES therapist may also be something to consider if you are in therapy and desire weight-inclusive care. Therapists who specialize in eating disorders also tend to align with the HAES approach. 

How To Find a HAES Dietitian

If you’re interested in working with a HAES dietitian, there are a few things you can look for when searching. Look for keywords such as “HAES,” “Health at Every Size,” “Intuitive Eating,” “weight neutral,” and “non-diet.” Additionally, the Association for Size Diversity and Health is building a database to help individuals find HAES healthcare providers. 

Why Nourish?

Finding a HAES dietitian can be challenging. At Nourish, our registered dietitians implement the Health at Every Size philosophy in their practice. Our evidence-based approach to care focuses on building sustainable habits to promote long-term health outcomes and improve your relationship with food. 

Appointments are conducted online and are covered by insurance, allowing you to access individualized, weight-neutral nutrition care from the comfort of your home. Get started with Nourish today.

Sources

Asdah.org

Weight Science: Evaluating the Evidence for a Paradigm Shift

Medicare's search for effective obesity treatments: diets are not the answer

How effective are traditional dietary and exercise interventions for weight loss?