Health at Every Size: Health at Every Size
I am what nutritionist Michelle Allison, known professionally as The Fat Nutritionist, calls a “dieting casualty.” From the time I was 16 and joined Weight Watchers for the first time to the day I decided to give up dieting forever when I was 23, I lived in a cycle of weight losses and gains, diet after diet, exercise for penance and “cheat days” for pleasure. I never thought I was thin enough, even when friends started to insist I was really very thin and should probably stop striving to be even thinner. I pursued thinness at all costs, trusting that temporary side-effects like dizziness, nausea, constant preoccupation with food and inability to focus were necessary to achieving my goals. After all, these effects were temporary, but being thin would make me healthier and happier - right?
It may not be quite that simple. There is an increasingly accepted philosophy and movement called Health At Every Size (HAES), that disagrees with the popular notion that being thin is always healthier than being fat.
Body size doesn’t tell the whole story about someone’s health; markers such as blood pressure, cholesterol level and blood sugar vary over populations regardless of weight. People who are thin also develop conditions such as heart disease and diabetes, even though popular media and health promotion associates these diseases with obesity. Weight is greatly affected by genetic factors and is not easily altered either up or down by altering food or exercise.
The idea that you can learn about a person’s health by looking at them is also fraught with ableism. How do we measure and value health? Is someone less healthy if they have a visible disability? If they have an invisible disability? When a conventional definition of “healthy” is the ideal, people with disabilities and chronic illness might never meet these ideals. And for people who don’t conform to this ideal, there’s a really dangerous, slippery-slope kind of moralizing going on. There is a strong sense of individual responsibility in the way we are taught about health, and it puts pressure on people to conform to societally-approved, superficial markers: thin, able-bodied, fit and neurotypical people are considered healthiest, and people who aren’t healthy are considered somehow less-than.
From the Health at Every Size website:
Health at Every Size is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting health habits for the sake of health and well-being (rather than weight control). Health at Every Size encourages: - Accepting and respecting the natural diversity of body sizes and shapes. - Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite. - Finding the joy in moving one’s body and becoming more physically vital.
Let’s break down each of these tenets of Health at Every Size and explore them a little further.
1. Accepting and respecting the natural diversity of body sizes and shapes.
Respecting diversity of size is a pretty popular mainstream opinion - you might be familiar with famous people like Kate Winslet and Jennifer Love Hewitt speaking out against judgement about their bodies, and with singer Adele commenting in People magazine: “I’ve never wanted to look like models on the cover of magazines. I represent the majority of women and I’m very proud of that.” This type of “love yourself” movement has some problems, especially when thinness is shamed (ever hear someone telling a very thin person to “eat a burger”?).
Fat acceptance is seen by some people as a synonym for size or body acceptance, but others think they’re quite different. Margarita Rossi, a self-identified fat Queer Latina woman, differentiates between them: “Body acceptance, for me, is the process of learning to love and appreciate your body and do what is best for you and your body, whether or not whatever is best for you is socially acceptable or not. I think it includes fat acceptance, but fat acceptance is a specific kind of body acceptance which focuses on the specific battles faced by fat people to learn to make peace with their bodies. While I appreciate the inclusiveness of ‘body acceptance,’ ‘fat acceptance’ is more relevant to my life and struggles with self acceptance.” Fat acceptance is a movement specifically advocating for acceptance of and respect for fat bodies and an end to discrimination based on larger body size.
But why are we using the word fat? you might wonder. Isn’t that a bit harsh? Rossi disagrees, saying she actually loves the word. Cynara Geissler, a self-identified fat white woman from Vancouver, says “I treasure and honour ‘fat’ like the hardest-won Girl Guide badge (loving yourself should really be a Girl Guide badge— It’s way harder to do that than it is to lead a campfire).” Fat activists generally use the word “fat” as a neutral descriptor, arguing that it should be no more loaded a term than “tall” or “dark-haired.”
But Carrie* [name changed] has mixed feelings about the word. It’s hard to reclaim a word that has been used as a slur against her, she explains. “Fat is not a neutral term,” she says. “I don’t like having others impose it on me because it still has connotations beyond body size.” While activists work toward freeing “fat” from negative connotations like lazy, gluttonous, greedy and ugly, individuals must always have the freedom to self-identify in whatever way feels right.
Using the more general term “body acceptance” can fail to acknowledge that fat people experience oppressions specifically related to their body size. Fat acceptance is a social justice movement, like other struggles for equality and rights. Margarita notes: “Queer liberation and the struggles against racism, and for civil rights for People of Color, have paved the way and informed the Fat Liberation movement. We owe those who fought and are fighting (intellectually and physically) these struggles a huge debt, and fat acceptance would not be possible without them.”
The following video is from the It Gets Fatter project. A transcription can be found at the video source.
2. Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
Fat acceptance implies acceptance of fat bodies as they are, which for many activists means a no-dieting stance. Health at Every Size proponents believe there are many reasons why people are fat, and that genetics play an important role.
What’s more, evidence has shown us that diets don’t work. Sure, they do work for a small number of people, and some people have lost weight and kept it off for more than five years - but these people are the exception, not the rule. During my dieting years, I needed to return to restrictive eating behaviours again and again in order to maintain a lower weight. Every time I eased up on my diet, I gained weight. I was proving that my body’s natural set point weight was higher than my desired weight. This cycle of behaviours, known as yo-yo dieting or weight cycling, has been shown to have negative health consequences.
Health at Every Size promotes an alternative to restriction and diets called intuitive eating. Intuitive eating means following your body’s cues; while diets or calorie-counting rely on external factors to determine what, when and how much you should eat, intuitive eating means listening to your bodyM when it comes to hunger and fullness cues. This might sound simple - eat when you’re hungry and stop when you’re full - but for someone who has been dieting for years, it requires work to get back in tune with their body’s cues. The Fat Nutritionist, Michelle Allison, cites Ellyn Satter, a nutritionist who spearheaded a program of teaching eating competence, in defining normal eating:
Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it—not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.
People sometimes try intuitive eating in the hope that it will result in weight loss. For most, though, it won’t, and the goal is to reach a stable weight or set point that doesn’t require yo-yo dieting or restriction to maintain, and to improve health outcomes through naturally eating a variety of foods. It make take years (it took me about four years to reach a stable weight).
As in Satter’s definition above, normal eating doesn’t have a strict definition or rules. It’s about finding out what works for you, and it takes experimentation and flexibility. Unlike a diet, there is no one-size-fits all, and there is no failure or “falling off the wagon.” If you overeat, you’re not a bad person. If you don’t get enough veggies today, you might eat more tomorrow or next week. If you have food intolerances or conditions that are exacerbated by eating certain things, it’s completely your call as to how best to manage your food choices.
And normal eating is way better for your mental health, as Cynara relates: “it makes me very angry to think about the time I wasted on trying to force my body to conform with an impossible and unsustainable ideal of thinness. I isolated myself, and thought cruel and ugly thoughts about my classmates who did normal things like eat a sandwich for lunch.”
On the other hand, the concept of intuitive eating is a privileged one. People who live with their parents or in shared living situations may not have control over their meals. Folks who work long hours may not have the luxury of eating when they feel hungry. Access to traditional and culturally appropriate foods can be limited for Indigenous people due to ongoing effects of colonization. And people living in poverty may not be able to choose the foods they like best or that have a high nutritional value. As Carrie points out, “it’s incredibly difficult to eat intuitively when you don’t know where your next meal is coming from.”
3. Finding the joy in moving one’s body and becoming more physically vital.
It’s no wonder that some people hate to exercise: many of us are taught (explicitly or implicitly) to look at it as a chore to get through in order to deserve the food we eat, or even as punishment for eating food we’ve already eaten.
You might have guessed already that since there is no single factor that makes fat people fat and thin people thin, exercise isn’t a simple equation of burning calories and shedding pounds. Thank goodness - people who are highly active would constantly be in danger of starvation if that were the case! But there are all kinds of benefits to moving one’s body that have nothing to do with body size. Some of the benefits include improved mood, better sleep, better concentration and mental focus, and improved strength and flexibility. Physical activities can also be great ways to meet people and expand your social circle, improve your self-esteem and set and meet personal goals. I’ve had my own positive experiences with fitness and movement since coming to fat acceptance; I recently became a certified spinning (indoor cycling) teacher!
Finding positive ways to relate to your body through movement can be incredibly rewarding. Lisa Papez, founder of Body Positivity Yoga™, shares:
I found my way to loving my body through my personal Yoga Practice. Yoga radically changed my outlook on my body. Through yoga, I began to see myself as graceful and balanced, poised and confident. Yoga taught me how to turn inward and truly connect with my body instead of trying to disassociate from it … when I realized that I was learning to love my body, I was amazed. I’d spent my whole life until that point hating my body, and trying to change it. Through yoga, I realized that transformation is beautiful but so is coming to the mat, exactly as you are.
However, the issue of privilege in the HAES message to “become more physically vital” needs to be examined. Joining a gym is expensive; going for a run outside could be unsafe for a whole host of reasons (threat of harassment or worse, negative environmental impacts, etc.); exercise equipment is expensive; who has access to a pool?; can you find workout clothes in your size? And if you are able to financially access a gym, is it physically accessible? What forms of exercise are accessible to you, and which are not? How do you exercise with chronic illness? With mobility limitations? With depression?
It is crucial to view joyful movement as an option, not a directive, and to view a wide range of activities as positive. In fact, any movement that feels good to you is positive. If you love to go for walks, great. If you like to jump on a spin bike and sprint your guts out like I do, please come and join me! If you like to stretch, lift weights, throw a ball around or dance, fabulous. “Body-positive fitness empowers you and gives you the freedom to let go of all the hype and just do what you love, no matter what your size or shape,” Lisa emphasizes. And if you know that trying to be physically active on any given day is not in your best interest for whatever reason - don’t. Take a bath or take a nap or read a book or do whatever makes you feel best. The best thing about divorcing exercise and activity from being “good” is that choosing to opt out is morally neutral. Only you know what is best for your body and mind.
As we have seen, Health at Every Size is only one point of entry for a conversation about body autonomy and social justice. As Carrie explains, colonization has impacted the way she sees herself in relation to her ancestors. “My great-grandparents lived traditional lifestyles and were fat,” she says. “I’ve seen photos of Indigenous people in the 1880s who were fat. Their bodies were considered acceptable in their context. The media portrays fat as a new-fangled thing. Why is my body, that looks like theirs, not acceptable in my context?” She also has relatives who worked physically demanding jobs on farms and were both fat and thin, showing her from a young age that lifestyle and size are not directly related in the way current Western culture insists they are.
From Margarita’s perspective, “being in a marginalized group absolutely increases the impact of fat hatred. Fat hatred is often used to uphold racism, and vise versa …being fat (and a [self-identified] Queer Latina woman) has made me want to seek out images of people like myself throughout history, since they are so few and far between in mainstream media today.”
Health at Every Size can also been used negatively to set up a (false) dichotomy of fat people who are healthy (“good”) and those who are not (“bad”). This sets up a hierarchy where fat is only acceptable on people who are active and eat scrupulously healthy diets. Cynara sums up the issue:
Our cultural moralizes food and exercise and fears death to the point where I think some people actually believe that if they triathlon to work everyday and eat only boiled kale they will actually live forever and cheat death … do we really want to live in a society where only “genetically perfect people” are valued? Where a person wants to end their life because they won a silver medal instead of a gold? Most things happen for no reason. And there are a lot of aspects of our health and the human body that we cannot control one bit.
Rather than seeing this lack of control as a failing, maybe it’s time to see it as an opportunity to learn to let go of judgements about health and body size.
Health at Every Size resources: Dr. Deah’s Body Shop Size Diversity and Health Health at Every Size by Linda Bacon Rethinking Thin by Gina Kolata Fat Politics: The Real Story behind America’s Obesity Epidemic by J. Eric Oliver The Diet Myth by Paul Campos Losing It: False Hopes and Fat Profits in the Diet Industry by Laura Fraser Fat Shame: Stigma and the Fat Body in American Culture by Amy Erdman Farrell