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Choosing Health At Every Size: Understanding Size Discrimination

“By choosing healthy over skinny, you are choosing self-love over self-judgment.” 

Steve Maraboli

Health at Every Size (HAES) is a movement and approach to health that focuses on promoting health and wellbeing for people of all sizes rather than focusing on weight loss.

HAES acknowledges that weight is not the only factor determining health and that there are many ways to be healthy regardless of size.

The HAES movement teaches people to accept and appreciate their bodies, despite being fat. Focusing on healthy habits and getting more exercise is a far more productive mindset and it takes the focus from the shame and blame that often accompany fatness.

HAES counteracts “fatophobia.” Fatphobia is the fear and hatred of fat bodies. It is a form of weight bias and discrimination that can manifest in many ways, including:

  • Negative stereotypes about people who are fat such as that they are lazy, unintelligent, or unhealthy.

  • Microaggressions, such as making comments about someone's weight or staring at them.

  • Discrimination in employment, housing, and healthcare (yes, this means health coaching too!).

  • Self-hatred and body image issues among people of higher weight.

Fatphobia is harmful to the physical and mental health of those with weight issues. It can lead to depression, anxiety, low self-esteem, and eating disorders. It can also make it difficult for fat people to access healthcare and participate in society. In addition to the above, those with fatphobia are more likely to have the following:

  • Body image dissatisfaction

  • Sleep problems

  • Pain

  • Fatigue

  • Social isolation

  • Discrimination in employment, housing, and healthcare

"Fatphobia is not just about weight. It is about race, class, gender, and sexuality. It is about all how our society tells us that we are not good enough if we are not thin." 

Sonya Renee Taylor, author of "The Body Is Not an Apology."

Does the Scale Tell the Whole Story?

Certainly not - our body weight and Body Mass Index (BMI) does not account for body composition. For instance, more muscular people may have a BMI that appears overweight or obese. On the other hand, someone who has a lower body weight may have something called “skinny fat,” encompassing higher percentages of visceral fat, increasing disease risk.  Criteria for healthy body weight or BMI are based primarily on white people and are not appropriate for people of all races and ethnicities (Reinagel, 2019) yet most health coaches are taught the standard BMI criteria blanketly applied to all.

The HAES approach has six core principles:

  1. Weight Inclusivity: HAES affirms all people's inherent dignity and worth, regardless of size. It opposes weight discrimination and bias in all forms.

  2. Health Enhancement: HAES promotes health and well-being for people of all sizes. It emphasizes the importance of physical activity, healthy eating, and stress management, regardless of weight.

  3. Eating for Wellbeing: HAES encourages people to eat in an enjoyable, satisfying way that meets their nutritional needs. It opposes dieting and weight loss as a way to improve health.

  4. Respectful Care: HAES promotes respectful care for people of all sizes by healthcare providers. It opposes weight-based discrimination in healthcare settings.

  5. Life Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose. 

"Fatphobia is a form of oppression. It is a system of power that benefits thin people and disadvantages fat people. It is a system that we must dismantle if we want to create a more just and equitable world." 

Aubrey Gordon, author of "What We Don't Talk About When We Talk About Fat."

Some have criticized the HAES approach for promoting unhealthy lifestyles. However, HAES advocates argue that the focus on weight loss is often counterproductive and can lead to disordered eating and other health problems. They believe a more holistic approach to health, focusing on overall wellbeing and not just weight, is more likely to succeed.

Critics of HAES fear size acceptance may lead to excessive consumption and weight gain. Yet six viable random control trials utilizing HAES interventions did not find adverse effects, including weight gain. There was maintenance or improvement in behavioral, psychological, clinical, and physiological outcomes. (Bombak, A. 2014)

"Fatphobia is the fear, hatred, disgust, prejudice, and discrimination directed at people who are fat. It is a form of body shaming that is rooted in the belief that fatness is a moral failing." 

Virgie Tovar, author of "You Are Not Your Body"

The HAES approach is not a quick fix for weight loss. It is a long-term commitment to living a healthy lifestyle. However, HAES advocates believe it is a more sustainable and effective way to improve health and wellbeing for people of all sizes.

Health Coaches can help people understand HAES approach and that they are not part of a healthy versus unhealthy moral hierarchy.

They can:

  1. Apply their training in fostering unconditional positive regard for clients, providing an invaluable support base.

  2. Helping clients consider other ways to view their bodies and fatness (if the client identifies that as a concern), changing mindsets for improving overall wellbeing. 

  3. Develop longer-term relationships with clients creating inclusiveness through the understanding of fatness, the science of weight and weight loss, and the bias, micro/macroaggressions, and discrimination that an individual can go through on any given day. 

Health Coaches are well-positioned to create a space in healthcare that will contribute to a genuine HAES approach.

"Fatphobia is not about health. It is about control. It is about policing bodies that do not conform to narrow beauty standards. It is about keeping people in their place." 

Ragen Chastain, author of "Body Image: What Every Body Needs to Know."

HAES is an important concept and the School of Inclusive Health Coaching is the place to learn about applying vital inclusion skills with clients. Join one of the fastest-growing inclusion coaching programs. 

Bombak A. “Obesity, health at every size, and public health policy.” Am J Public Health. 2014 Feb;104(2):e60-7. Seen on: Obesity, health at every size, and public health policy

Reinagel, Monica, “Can You Be Healthy At Any Size? It’s not that your weight doesn’t matter. It’s just that it’s not the only thing that matters.” Scientific American, September 5, 2019, Seen on: July 15, 2023.

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