We all go through seasons of personal growth, some more intense than others. And many of us go through seasons of professional growth, some more intense than others. We are always learning and nobody knows everything so I don’t think it’s fair to expect other people to know about the things we know and visa versa. When I began my career as a dietitian in the summer of 2012 I hadn’t even heard of Intuitive Eating (IE) or Health At Every Size (HAES). And I wouldn’t hear about these paradigms for about 2 more years. I practiced the best way I knew how given what I had learned.
I wasn’t trained as a dietitian with an HAES/IE framework and I wasn’t trained as a nurse or nurse practitioner with an IE/HAES framework. I haven’t been to medical school, but I think it’s pretty safe to say doctors aren’t trained with a IE/HAES framework either. So although I really wish I had known about these concepts, I think it’s unrealistic to expect health professionals, or anyone in general, to “know” these concepts. But I do think it’s realistic for us to be able to engage in open, honest and vulnerable conversations so we can educate ourselves, learn different perspectives, and shift gears when necessary so we can provide the best, most effective and ethical care possible. I think sometimes the HAES/IE movement can be clapping its hands at its own audience and while that isn’t a bad thing, I do hope the conversation can continue to be opened up and remain open to everyone in a way that facilitates healthy dialogue.
When I began my career as an RD, among other things I helped people with, I helped people lose weight through dieting. It didn’t “look” like dieting, but in essence it was. The goal was improved health by way of weight loss. I had every good intention to really help people live healthier lives. I think there are many clinicians out there recommending weight loss with really good intentions because they care about people. But similar to my story, they haven’t been exposed to IE/HAES. Shaming anyone who recommends weight loss doesn’t help the problem, it doesn’t create a safe environment to learn and grow. But I do think it’s frustrating when there are really black and white claims made about the necessity of weight loss to improve health outcomes when one hasn’t actually sat down and truly educated themselves on both sides of the coin – dieting and pursuing weight loss vs HAES. These concepts (IE and HAES) take time and patience to dig through, wrestle with, and get really clear on. It took me a really long time to get super familiar with the two paradigms and the research behind them. And I by no means know even a fraction of what I hope to know in 5, 10, 20 years. We are all always learning.
When I read or hear others say, “Intuitive eating and Health At Every Size are just an excuse for people to eat whatever they want and do whatever they want.” I get really frustrated because that’s a really poorly informed statement. That person(s) hasn’t actually educated themselves on IE/HAES, yet there is a pretty strong opinion being shared. I love when people are passionately opinionated! But it’s important to be as informed as we possibly can so we can share educated opinions.
Health At Every Size (HAES) and Intuitive Eating (IE) are not anti-health. In fact, they are very much concerned with health. And they are both evidence based paradigms with well thought out principles to them. While HAES and IE are very concerned with health – both of these paradigms acknowledge the reality that health is so much more than food/exercise/weight and are based on research that shows 1) diets don’t work and 2) a person’s body size/weight is not a direct reflection of their health. A weight centric view of health is a very narrow minded and simplistic view of health.
Intuitive Eating is not about eating whatever you want whenever you want. Trust me, none of us would feel physically well if we did. And Health At Every Size is not saying anyone is healthy at any size, rather it’s saying people can be healthy at a wide variety of body weights and sizes. There is no one body size or body fat percentage that will protect a person from getting an illness, chronic disease or dying. And there is no health issue that only happen to people living in larger bodies. While there are certainly associations between higher (and lower) body weights and certain diseases and symptoms – that doesn’t mean someone’s weight is CAUSING that disease/symptom.
The problem with prescribing weight loss is that we simply don’t know how to help people do that in an effective, sustainable way. Literally, we have zero research out there that provides evidence on how to lose weight AND keep it off for more than 3-5 years. If there was research, that would be an entirely different story. For the 5ish% of people who do lose weight while dieting and keep it off past 5 years, they typically have developed disordered eating/exercise habits in order to do so. Beyond the evidence, you’ve probably seen this play out in real life either with yourself or other people in your life. When the body experiences a negative energy balance 1) metabolism decreases and slows to compensate 2) the appetite hormone, ghrelin, is increased and 3) the reward response to food is heightened. So now this person is burning less energy throughout the day and is more driven to eat. This is one of the main reasons diets don’t work and why it takes extreme behaviors to keep weight off that was lost while dieting. No willpower can overcome the body’s brilliant survival mechanisms.
What dieting does lead to is weight regain. Dieting also can cause low self esteem and self efficacy, eating disorders, depression and anxiety, food obsession and other harmful psychological and physical effects. We would never routinely prescribe a medication to people that only worked in 5% of people long term and likely led to negative side effects. We would never recommend someone get in a car if they only had a 5% chance of not being injured when riding. We would never perform surgery on someone if there was a 5% success rate. So why do we continue to do this for dieting?
Weight loss is an outcome, not a change someone can make. And weight is not something we have full control over. We all have genetics and are faced with different environmental factors. The difference between a weight centric view of health and a weight neutral view of health is that the weight neutral view focuses on health behaviors vs numbers. It’s the behaviors that help someone get healthier, not the number itself.
HAES is not anti weight loss. If someone begins…
- honoring hunger and fullness cues
- eating foods that are satisfying and nourishing and make them feel physically and emotionally well
- moving their body in a way that is enjoyable aka exercising in a way they actually enjoy doing
- caring for their mental/emotional health
…and they lose weight, that isn’t seen as “bad” by the HAES world. It just is. Weight is a neutral outcome as a result of health promoting behavior change. What’s applauded isn’t weight loss at the expense of one’s mental, emotional, spiritual or physical health. Rather what’s applauded is someone feeling empowered and improving their health – their mood, blood pressure, cholesterol levels, blood sugar etc. The research has shown those things are improved independent of weight loss. I think that’s encouraging!
Using a HAES framework, a person diagnosed with high cholesterol in a larger sized body would be given the same advice as the person diagnosed who is in a “normal” size body. For example: eat fruits and vegetables, move your body, get good sleep, manage stress etc. Those are things someone can change and will actually lead to better health.
Pursuing weight loss and pursuing health are not interchangeable. People will do very unhealthy things to achieve weight loss because society says, “you’re not trying hard enough.” when really our bodies work against weight loss with the mechanisms described above. Ignoring your hunger cues, doing daily high intensity workouts, going to the gym instead of getting 8 hours of sleep, not eating carbs even though you feel lightheaded – these are not healthy things. These are behaviors to manipulate body size, not to pursue health.
Our culture applauds weight loss at any extent. Somebody could be struggling with depression and lose weight and there’s a high likelihood they will be complimented on their weight loss. Somebody could be recovering from an illness or diet mentality/years of yo-yo dieting and there’s a high likelihood their weight gain will be seen as if it were a bad thing. A body getting smaller is not an universal sign that people are doing well and a body getting bigger doesn’t mean somebody is not doing well.
Pretty much everything we’ve been doing to “help” people get thinner and lose weight for the past five to six decades hasn’t worked. The prevalence of “obesity” is worsening. These efforts aren’t working and instead are likely making people less emotionally, mentally and physically healthy. Even if after really digging into the weight-centric vs weight-neutral research someone truly does believe “obesity” and all larger bodies are the cause of disease and symptoms, it makes no sense to continue approaching the “problem” in the same counterproductive way.
HAES and IE do not support the misinformed assumption, “Consume nutrient poor foods because that what is most palatable and don’t worry about being active.” That makes zero sense. Exercise is good for us. Eating fruits and vegetables and whole foods are good for our bodies too. But we don’t have to go to extremes with food and exercise to get healthier. Engaging in restrictive eating and exercising as a way to burn calories never leads to a healthy place (physically, mentally or emotionally) in the long run. HAES and IE are a different way to approach the health issues our society faces in a way that actually promotes health and that actually helps people get healthier. Dieting (which is any set of rules to guide a person’s eating) and a weight centric approach hasn’t worked for the past 50+ years, so it’s not going to start working tomorrow.
If you’re new to HAES and/or IE or feel like you’re not quite understanding the research and concepts, I totally get it!! We are all always learning and I was there once too. Here’s a post I wrote that includes many, many resources that will help you in your learning and Christy Harrison also shared lots of resources in this post. It took me months to really grasp these concepts and I asked a lot of questions. So I would love to hear you thoughts and/or questions in the comments!
This is an exceptionally well written article. Reading your HAES articles over the last year has caused me to change my approach to patients and weight loss. I stil wrestle with some of the concepts, in particular the concept that it’s *always* behaviours rather than weigt loss that result in positive effects for health – if a person who is 400 pounds loses 250 pounds through gastric bypass surgery and their knee pain improves … it makes sense to me that less weight and strain on the joint = less pain, therefore weight loss resulted in a direct benefit. Or using gastric bypass to “cure” diabetes ..other than eating less, the person doesn’t have to change any behaviours but they see a beneficial result to their health that in my mind is a direct result of weight loss. These are the kinds of concepts that really challenge me when I try to use a HAES framework (and I’m sure similar questions have challenged you as well in the past!!) Thank you for your continued work educating about HAES and IE! It is so important. Sorry if the grammar is really poor in this comment – my phone won’t let me go back and edit for some reason so it’s more of a stream of my thoughts!!
I too feel there are a couple of less-addressed topics- I mean, speaking as 250+lb person, I have seen many mental and physical health improvements after embracing IE/HAES. But some of them were directly related to my weight loss (which was a result of some treatment for PCOS) one being, acid reflux from abdominal pressure. When my body changed and my weight dropped, my acid reflux went away. The acid reflux started after I had gained approx 40lbs one year—it screwed up my sleep terribly which then further harmed my hormonal balance. Being so far above my ‘set point’ WAS injurious to my well-being. I feel like a lot of the HAES discussion is oriented around women who may be in smaller bodies to begin with, maybe 10-50 lbs above their comfortable set point but there ARE some health concerns that disappear with weight loss in people who are 100+ lbs over their comfortable set point. I 1000% don’t believe that dieting and treating fat people like second or third class citizens does anything positive for our health, but there are certain health benefits to being in a smaller body that just can’t be denied. I think it’s silly to deny that a person who is 450 doesn’t have unique challenges that appear because of fatness, and that happen to disappear when there is less fatness.
I think that 450 lb person deserves truthful perspective, just from a completely accepting and neutral, respectful provider who doesn’t package them into One Big Problem to solve.
I feel both of these comments a lot. As someone with thin privilege, it feels very presumptuous of me to say that weight loss shouldn’t be a focus – when as mentioned, certain people will experience improvements in their life with losing weight. Even just the idea of “doing joyful movement” is not possible for some ppl until they lose weight and regain mobility etc. I look at some who have regained their life after gastric bypass and I think that’s great. So I don’t know, perhaps some middle ground can be necessary. Gentile approaches to weight loss as you said, while keeping HAES in mind as a long term approach to health…?
Andrea – thank you so much for your warm response and for having the courage to wrestle with these concepts and to really dig into them. I admire you! I’d encourage you to dig deeper into the sustainability of weight loss surgery. Keep weight off and not experiencing weight regain is also a struggle and challenge for bariatric surgery patients. We also have to consider a person’s mental/emotional health after surgery. If physical markers improve, but mental health doesn’t improve, can we actually say that is life enhancing and improves one’s quality of life? Lisa Du Breuil is an RD who works in the bariatric surgery realm and is a wealth of info to continue your learning. She breaks down the research on a Food Psych podcast (www.christyharrison.com/139) and Untrapped podcast (http://untrapped.libsyn.com/weight-loss-surgery) Keep staying curios and open to learning as you grapple with these challenging concepts – we are all in our process!
Hani – I think you echo what HAES is not saying –> that anyone can be healthy at any size. If a person is above their set point that can be associated with (not necessarily a direct cause) of health issues. “Being so far above my ‘set point’ WAS injurious to my well-being” I 100% hear you in these very valid feelings and desires a person living in a larger body with have – desiring to be more mobile, find clothes easier, etc – there ARE both physical and psychological challenges those living in larger bodies face (making the recognition of thin privilege important). To not recognize these is ignorant and invalidating. The reality is, we have too much data to support the harmful effects of telling someone to lose weight. HAES doesn’t shame weight loss. Rather it supports sustainable, life enhancing, health promoting behaviors – from there the body will go where it needs to go. I would really encourage you to continue digging into the research (use the resources I’ve provided if that’s helpful) and concepts as I hear your dissonance and think that is a normal place to be!
Hi LD – I’d really invite you to continue to dig into the social justice piece of HAES as someone living in a thin body. To dig into the oppression, shame, stigma that people living in larger bodies face. Their bodies have been pathologized, shamed and seen as needing “fixed” probably for most of their lives and that is trauma. As people living in thin bodies who have never experienced this, it would be insensitive to assume that someone has come to a whole and healing place (especially mentally and emotionally) after gastric bypass or losing weight. We haven’t lived their experience. We can of course have compassion and want to help but also have to recognize this oppression and the immense amount of pressure one is under living in a body that society sees as needing “fixed” From your last sentence I totally empathize and relate to wrestling through these concepts and trying to find a way to bridge the two. But after much wrestling, I have realized that HAES is for everyone and not for after someone has lost some weight. That further promotes the problem. I hope this helps a bit in your process <3
Great information! What about the weight gain, inflammation, and emotional changes that naturally come with menopause for some? Suddenly nothing makes you feel ‘normal’ or good! To add to the above mentioned changes….. nothing you do seems to reverse the changes. Any advice is so appreciated!
Hi Annette! Fat storage shifts are a natural and normal part of menopause. While diet culture tells us that we need to fix this and stay the same says, that goes against our body’s biology. Since endogenous estrogen decreases with menopause, a woman’s body stores more fat in order to store more estrogen to deal with the decrease in production. And with the shift in hormones we will experience emotional changes that don’t need to be “fixed” rather can we shift towards self care and compassion that helps us cope with this change and transition. I would love to expand on this in a post if you have some questions! As for inflammation…can you expand on that a bit?
I LOVE this!! Such a good explanation of HAES 😊 In HAES/IE circles the messgage can sound like eat whatever you want to whenever you feel like it & exercise only if you feel like it because everyone is a bit afraid to say anything that sounds like it promotes health because don’t want to sound pro diet so for some I think they aren’t exposed to the part where we all do care about health & just because someone doesn’t diet, that doesn’t necessarily make the an intuitive eater!!
I can totally relate to not wanting to make movement recommendations or diet neutral nutrition recommendations for fear of contradicting HAES – but we can TOTALLY present nutrition education and a neutral, HAES way and I think it’s so important to have that conversation!
Hi Robyn – I am a registered dietitian working in a large healthcare system. I often get referrals from doctors for weight loss education in my outpatient clinic and patients come in expecting a set diet plan (what to eat at what time) in order to achieve weight loss. I have been an RD for 14 years and practice IE myself, but have not figured out how to incorporate it into this practice when the goals of the physicians is “weight loss” through diet education. Most patient insurance covers only one visit, so I don’t even get follow-through with my patients. This a an area of struggle for me, especially since I work with many RDs in our system, not private practice.
CJ this is so hard and I feel for you!! Being in private practice, I recognize the privilege that allows for both practicing in line with my philosophy and having way way way more time with clients. So I hear you! This is so challenging. I think the tricky part is gauging whether or not a patient/client is willing to pursue health over weight loss. I work with people all the time who desire weight loss, but are in a place where they are willing to not have that be the focus of our work together. I think we can do more harm than good if we are trying to convince someone to take a weight neutral approach because it can invalidate their desires and feelings. I’d encourage you to use a lot of motivational interviewing so you can hear their desires/goals – although given the brevity of your time with them this is tricky! Perhaps it would be helpful to seek out some supervision from a trusted RD in this field. I find that so helpful in my own process and growth!
I fundamentally disagree with your claim that, “weight is not a direct reflection of health.” An anorexic woman under 70% of her ideal body weight is dangerously unhealthy. Her organs are at risk of failure, her brain isn’t properly myelinated, her metabolism has stalled, her bone density may be decaying, etc. The first part of anorexia treatment is refeeding and weight restoration. Only after weight had been restored can the woman fully address the underlying psychological issues that lead to her disorder, and ultimately reach recovery. Weight is the primary reflection of health in that scenario.
A morbidly obese woman is also dangerously unhealthy. She may have diabetes, high blood pressure, bone and joint pain, etc. It is unethical to ignore this patient’s weight in her treatment. We can prescribe weight loss in a gentle, caring manner, but we cannot treat her health conditions without addressing her weight. Many of the comorbidities of obesity are reversible when the individual reaches a healthy body weight. The individual does not need to slim down to a size zero to be healthy, but she must shed excess body fat in order for her heart, brain, lungs, and mind to properly function.
Health at every size is a contradiction in terms. Being severely underweight or severely overweight can be life threatening. Sure, talking about weight can be uncomfortable. But it is unethical to dismiss it altogether simply because it is taboo.
Hi Andrea,
There are so any things that contribute to a persons’ overall health that using weight as THE DIRECT indicator of one’s health is simplistic and narrow minded. I am VERY aware of the dangers of being at 70% IBW, trust me.
“A morbidly obese woman is also dangerously unhealthy. She may have diabetes, high blood pressure, bone and joint pain, etc. It is unethical to ignore this patient’s weight in her treatment. We can prescribe weight loss in a gentle, caring manner, but we cannot treat her health conditions without addressing her weight. Many of the comorbidities of obesity are reversible when the individual reaches a healthy body weight. The individual does not need to slim down to a size zero to be healthy, but she must shed excess body fat in order for her heart, brain, lungs, and mind to properly function.”
There is a lot of misunderstanding, assumptions and weight biases coming across in the above paragraph that are very stigmatizing, oppressing and shaming that I too carried with me when I began practicing. I’m not sure if you live in a thin body or a large body, but I’m assuming you have the privilege of living in a thin body and have never experienced the trauma that living in a larger body brings. I would really, really encourage you to dig into the weight centric vs weight neutral research and educate yourself – I say that in the most gentle and inviting way. I think you’ll find, like I did, that after a lot of honest self reflection and giving myself the time needed to actually learn the literature…my opinions shifted greatly.
Love this comprehensive post, thanks for taking the time to write it!! I have several friends who do Beachbody programs and have lost substancial weight and kept it off. They claim it’s **liftstyle changes and mindful eating** but looks more like restriction and tracking to me. How do you recommend having convos about IE/ HAES with people in the “health and fitness” culture who are so entrenched in this type of thinking? It’s hard for me to watch cause they’re being manipulated by people who claim to be nutrition coaches!
If it doesn’t effect you, maybe just leave them alone- and I’m truly saying that with all due respect, not to stir the pot on a blog post. If someone is doing a program they find beneficial to their own health and well being, be it Beachbody, Whole30, or whatever it might be, perhaps that program is giving them tools they utilize to feel and be well. Many of these programs are not inherently restrictive or excessive, rather it depends on how the follower uses it. I love many aspects of IE and HAES but at the end of the day, it’s another philosophy that has not been definitively proven or disproven and we have much to learn and discover still. I get a little defensive as a healthcare provider when either side starts throwing around the term “ethical” as if you are doing known harm if you agree with weight loss or if you don’t, because again, we don’t know. I have been openly and objectively studying both sides. I would not be surprised if we find, like many things in life, the answer is somewhere in the middle ground. And I agree with the comment above that many IE/HAES clinicians work primarily with those who under eat, have an eating disorder or that aren’t morbidly obese
Hi Rebekah,
I agree with you on not giving unsolicited advice, people have full autonomy over their choices. My comment to Bella echos this. But I do want to note the reality that Whole30, Beachbody etc are restrictive because there are rules. As someone who has done Whole30 myself (never will again) it is restrictive because you cannot eat certain foods. If a person is doing it and feels all around physically, emotionally, mentally, and spiritually well, who am I to tell them to stop – that is entirely their choice. But I think we have to be honest with what food rules are, they are restrictive – they create limitations with black and white rules. I really appreciate your comment, but the research is rather clear. I’d really encourage you to dig into HAES and IE more if you are interested! Hope thats helpful in your own learning journey!
H Bella,
While i know it can be frustrating to see diet culture happening around you, I do think injecting unsolicited advice can be more harmful than good. If it is something they bring up and want to have conversation around, then that could perhaps be an invitation for empathetic, compassionate conversation where we can LISTEN more than we speak. I know it is so frustrating, but trying to tell someone what they are doing is “wrong” or harmful when they don’t want to hear it carries a high risk of them feeling judged, shamed and shut off…the opposite of what you’d hope for 🙂
Thank you so much for your posts and your work!! I recommend your blog/website/insta/FB to all the women/girls i talk to. Because we are just so surrounded by diets and body and food fads. It’s hard to not compare my body with others. Or the way I eat with the way other people eat. The past few years I’ve been struggling with some health stuff and I haven’t been able to be as active as I used to be. I’m so thankful for your encouragement so listen to my body, move it as i can, and feed it good delicious FOOD-not something fuel or macronutrients. Thank you!!!
So glad you are enjoying the content and finding it an encouragement in your journey Isabelle! Thank you for sharing it!
The comments in response to this article are what I struggle to explain to my husband when we discuss HAES. I would love to see your reply to the issues they have brought up! My view of HAES is not that everyone is healthy at every size, but rather that there is not one weight that everyone will be healthy at. People can also be unhealthy at every size. I think it comes down to behaviors and not specific numbers. When I was first diagnosed with anorexia I was really confused because they didn’t want me to focus on weight, but all they ever did was weigh me and tell me that I needed to gain more. I understand that weight is an easy, non-invasive way for medical practitioners to feel like they are tracking some sort of metrics, but it sends a very mixed message. I also think that the big takeaway from HAES is that weight itself is also a symptom, not the cause. Even for those who are severely below and above their body’s set points, it’s working on changing unhealthy thoughts and behaviors versus strictly focusing on weight. All that to say, it is not easy work. Finding compassionate professionals is extremely important and we should continue to fight to get insurance coverage for eating disorders, RD appointments, mental health, etc. That was probably somewhat convoluted because this is such a tough topic to wade through!
I hear you Hillary!! I hope my responses above have been helpful for you. This can take time to dig through and it’s not something that we will “convince” others of in one conversation, blog post, comment etc. Echoing along the lines of your comment, it is SO IMPORTANT to acknowledge that different bodies have different risk profiles for health problems – everyone has different genetics, environmental factors, etc that contribute to their overall health. You are right, this is not easy work but so rewarding and challenging!
I so so appreciate you saying this. I wouldn’t have ever thought they were anti health, but I love how you lay it out so succinctly. It’s so important to remember that these terms are pro health in every way, movement, eating, food freedom, and all that are all part of truly coming to that peaceful, healthy vibrant relationship with our bodies. Thank you Robyn for taking the time to write out such succinct, well informed posts.
Thank you for being a voice for so many people and for clarifying a philosophy that is so often misinterpreted! Shared this on all my social media because we all need to raise awareness!
So awesome, Robyn! Love the article.
Thank you so much for clarifying the concepts of IE/HAES!!!! So well written and well articulated. Love 💗
A well written article and I appreciate the constructive conversation in the comments! It helps clarify questions and issues.