Nearly everyone has experienced the process of going to the doctor’s office, whether it be for a routine checkup or illness. There’s paperwork to fill out, questions to be answered, and vital signs to be checked.
But, there is one element to the routine doctor’s visit that causes many people's anxiety — the weigh-in.
Stepping onto the scale at the doctor’s office is a matter of routine for most people. Many don’t think much about it at all. But this routine act is fraught with an uncomfortable feeling for some people.
Will the number on the scale be higher or lower than last time? What will the doctor say? These questions swirl in the mind of many who are self-conscious about their weight and size.
The truth is, many primary care physicians approach health from a weight-centric model, which views weight as one of the most important determinants of health (if not the most important).
There is a movement that disagrees with this approach and it is looking to shift the paradigm when it comes to health and weight — Health at Every Size.
The Health at Every Weight Movement
Established in 2003 under the Association of Size Diversity and Health, the Health At Every Size (HAES) initiative seeks to break down the walls and remove the stigma associated with body weight and health. Proponents of HAES are opposed to the idea that an individual’s body weight and size reflect an accurate representation of the individual’s health.
For many, this approach goes against the grain of all that has been taught concerning health. For decades, things like body weight, BMI index, and size have been established corollaries to obesity and thus poor health for decades.
However, proponents of HAES believe these indicators do not reflect an accurate picture of health.
Also, HAES advocates stand in contrast to the notion that weight is a choice. In fact, it is regarded as a myth that has done much harm to body image. They believe these stigmas can breed dire consequences for seeking healthcare.
The Concerns of HAES Advocates
For example, one study found that over 21% of patients with high body mass index (BMI) scores felt judged about their weight by primary care providers. Many also believe that doctors tend to be more biased against patients with high BMI scores — even affecting the quality of care.
This made individuals less likely to receive follow-up care from physicians. Advocates of HAES also believe these stigmas erode trust among larger patients towards doctors.
Proponents of HAES adhere to a holistic definition of health that doesn’t have body weight at the forefront of negative health indicators. They believe health exists on a continuum that varies from person to person depending on circumstances.
Health at Every Size Principles
The HAES approach believes that pursuing health is not an individual obligation or moral imperative that everyone must adhere to. Therefore, advocates believe that health status should never be used to oppress, judge, or determine the value of a person.
HAES activists rely on social connections, a diverse community, and a social justice framework to bring awareness to the movement. There are five basic principles to the campaign.
The foundational principle is accepting and respecting all body shapes and sizes. Respecting the diversity of body shapes and weights also means rejecting the idealization and pathologization of specific weights.
Eat for Wellbeing
This principle promotes individualized and flexible eating that is based on hunger, fullness, pleasure, and nutritional needs. This stands in contrast to regulated eating plans that focus on weight control.
In terms of physical activity, this principle seeks to support physical activities that allow individuals of all shapes, sizes, abilities, and interests to participate in enjoyable movements — to whatever degree that may be.
This is another principle advocates use for supporting health policies that improve and equalize access to services, information, and practices that seek to improve wellbeing. This includes social, spiritual, emotional, economic, and physical needs.
This principle seeks to end weight discrimination and stigmas by confronting and acknowledging biases. Also, supporting environments that address the inequalities that impact weight stigmas is crucial.
A Good or Bad Approach to Health?
While the intentions of the HAES approach are certainly admirable, the movement is not without criticism. It sounds nice, but can you be healthy at any size? Reason would tell us no, at least if we are talking about health in the traditional sense: The state of being free from illness or injury.
Sure, health can certainly be a state of mind, especially when it comes to emotional and spiritual health, but physical health must contend with the evidence and research.
It’s been proven that losing excess weight can prove quite beneficial for our health. Many critics of HAES believe that the underlying premise behind the movement is flawed from the outset.
Does Weight Equal Health?
HAES advocates will respond with a resounding “no” if asked if weight equals health. There is some merit to their rebuttal. Weight does not always mean health. For example, there is such a phenomenon known as “skinny fat.”
This essentially equates to high percentages of body fat and low amounts of muscle. They may be light on the scale but chock full of visceral fat. Basically, it's metabolic obesity without the scale tipping.
But even with this in mind, the health risks associated with high body weight and obesity are real. In fact, the research regarding the associated health risks with obesity is overwhelming. Here are just a few to consider.
- Heart disease - This term is used to describe several conditions. It is considered an obesity-related condition by the CDC. Issues like high inflammation levels are also considered a risk factor that can affect the health of the heart.
- Type 2 diabetes - While this metabolic disease is not unique to overweight and obese individuals only, the risk of Type 2 diabetes increases significantly when obesity is involved.
- High blood pressure - Obesity can be a major corollary to hypertension. Over time, this can put a strain on the heart, blood vessels and lead to conditions such as strokes. For some, losing weight and lowering blood pressure go hand-in-hand.
- Stroke – This condition is often caused by a blockage of a vessel, particularly in the brain. While hypertension is a precursor for stroke, obesity is also a risk factor as well.
The Final Verdict
There are many that say weight is just a number, and they are certainly right. But is the Health At Every Size movement sending the right message? Yes, but with a caveat.
The motives behind the movement are admirable — advocating for the acceptance of all shapes and sizes is important for mental and emotional health. Even the desire to take on the perceived stigmas is noble.
But at the end of the day, the most important component of this conversation hinges on the notion of physical health.
While there are certainly untrue stigmas floating about, there are also mountains of research that suggest correlations between physical health and obesity.
These facts cannot be neglected.
- Health at Every Size | Home
- The Health at Every Size® (HAES®) Approach | ASDAH
- Patients who feel judged about their weight have lower trust in their primary care providers | NIH
- Thin Fat Obesity: The Tropical Phenotype of Obesity - Endotext | NCBI Bookshelf
- Health Risks of Overweight & Obesity | NIDDK