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Brianna Donnelly
Mar 12

Health At Every Size "HAES" & Eating Disorders

Source: Happy Bellies Nutrition


Did you know that in Australia, it's estimated that over 1 million people are experiencing an eating disorder? We also know that only 25% of these people will seek treatment, and even less of them (approximately 50-70%) will recover. That’s only 125,000 - 175,000 recovering from an eating disorder.


Unfortunately, we live in a society fixated on the unrealistic “thin ideal” and, as a result, up to 30-40% of individuals with an eating disorder will go undiagnosed.


This article will walk you through an overview of eating disorders, an empowering movement called HAES, and how HAES can revolutionize eating disorder treatment and improve the health and wellbeing of people living in ALL bodies.


Eating Disorders - What Are They?


Eating disorders are serious mental and physical health conditions characterized by abnormal eating habits that negatively impact physical, emotional, and mental well-being, that can happen to a person of any size. Common signs and symptoms may include sudden changes in eating patterns, body image concerns, extreme weight loss, excessive exercise, and significant anxiety around food. Common eating disorders include:

●       Anorexia Nervosa (AN) - purging or restricting type

●       Bulimia Nervosa (BN)

●       Binge Eating Disorder (BED)

●       Other Specified Feeding or Eating Disorder (OSFED)

●       Avoidant/Restrictive Food Intake Disorder (ARFID)

●       Unspecified Feeding or Eating Disorder (UFED)


Of people with an eating disorder, 3% have anorexia nervosa, 12% bulimia nervosa, 47% binge eating disorder (BED) and 38% other eating disorders (NEDC, n.d.).


Source: NEDC


Health At Every Size - “HAES”


Health At Every Size (HAES) is a recent movement rooted in the belief that health and well-being can be achieved at any size. This is extremely different from the commonly held belief that having a higher weight automatically puts you at risk of developing every health risk/complication under the sun.


There is mounting evidence that weight bias does not have as much “weight” as we once thought; as a matter of fact, weight isn’t the healthiest or easiest thing to lose. A revolutionary study discovered that the majority of individuals who attempt weight loss through dieting regain the lost weight within five years, most even regaining more weight than before (Mann et al., 2007). This cycle of weight loss and regain, known as "yo-yo dieting," is actually met with adverse health outcomes, including increased risk of cardiovascular disease and metabolic dysfunction (Montani et al., 2015). The irony!


On the other hand, HAES is a holistic health movement promotes sustainable health practices that focus on improving well-being, rather than achieving a specific body shape or weight.


HAES has 5 core principles:

  1. Weight Inclusivity

  2. Health Enhancement

  3. Eating for Wellbeing

  4. Respectful Care

  5. Life-Enhancing Movement




HAES & Eating Disorders


Evidence has shown that people with “atypical” anorexia nervosa share similar impairment or distress levels as someone with anorexia nervosa (Micali et al., 2017). The only difference being that those with “atypical” anorexia nervosa do not meet the criteria for being medically “underweight”. Even using the signifying term “atypical” can be harmful, and can stir up feelings of not being taken seriously, which is a very real experience for someone with an eating disorder.


Starvation syndrome, among many other features of eating disorders, can occur in a person of ANY size, weight or shape. You can read more about starvation syndrome in another article on our website.


Traditional health approaches can be very weight-centric, which can directly and indirectly promote unrealistic body ideals which motivates someone to alter their diet to lose weight. This, unfortunately, can contribute to the development or worsening of an eating disorder..


Research tells us that societal pressures to achieve the elusive thin ideal can lead individuals down a dangerous path of extreme dieting and exercise behaviours (Smolak & Murnen, 2008). Moreover, those who face weight-based discrimination often struggle with negative body image, which can further fuel disordered eating patterns (Durso & Latner, 2008).


Alternatively, HAES shifts the focus from weight to overall well-being, promoting self-acceptance and body positivity (Bacon & Aphramor, 2014). By challenging weight stigma and encouraging healthy relationships with food and exercise, HAES offers a path to recovery and general well-being that embraces all body sizes, avoiding stigma and discrimination.


Integrating HAES principles into treatment plans for eating disorders can be transformative. By prioritizing nourishment and self-care over restrictive behaviours, HAES helps individuals foster a healthy, positive connection with their bodies (Schaefer & Magnuson, 2014). This shift not only reduces disordered eating behaviours but also enhances psychological well-being.


There are some specific HAES practices that can be seamlessly imbedded into eating disorder treatment, with excellent results.

  • Intuitive Eating: attune to body's hunger and fullness cues, which is associated with improved psychological well-being and reduced risk of disordered eating behaviours (Tylka & Kroon Van Diest, 2013).

  • Joyful Movement: physical activity for enjoyment rather than weight loss, which is associated with greater motivation and adherence to exercise routines (Kwasnicka et al., 2016).

  • Body Neutrality: embracing body for its functions rather than appearance reduces body dissatisfaction and eating disorder risk (Alleva et al., 2016), and increases psychological flexibility and life satisfaction (Tylka & Wood-Barcalow, 2015; Veldhuis et al., 2018)


HAES: Myths vs. Facts


There are quite a number of myths that circulate about HAES, which discredits the power this movement can have on the health system. Let’s dispel a few of the more common ones…


Source: Florida Agency Network


Myth: Health is determined by body weight.

Fact: Health is multi-dimensional, influenced by various factors such as genetics, lifestyle choices, access to healthcare, and social determinants (NCD Risk Factor Collaboration, 2017). Weight alone does not define one's health status.


Myth: HAES promotes obesity.

Fact: HAES focuses on health-promoting behaviors rather than weight loss. Research has shown that adopting HAES principles is associated with improved metabolic markers, regardless of changes in weight (Bacon & Aphramor, 2014). What HAES actually does, is advocate for inclusive healthcare that prioritizes holistic well-being regardless of someone’s size.


Myth: Being in the “overweight” BMI automatically makes you unhealthy.

Fact: On the contrary, research suggests that the health risks associated with underweight and healthy weight BMI categories may be higher than those associated with overweight or moderately obese categories; the phenomena makes more of a U-shaped curve than an upward linear trajectory (Bhaskaran et al., 2018).


Conclusions & Resources


Even if you don’t subscribe to HAES as a general philosophy, it is essential to appreciate how much of a game-changer this can be to eating disorder treatment and education.


If you aren’t convinced enough, or would like to learn more, we’ve compiled some resources from the lived experience and HAES community that can speak to this as well.


Books:


  • "Health at Every Size: The Surprising Truth About Your Weight" by Lindo Bacon

  • "Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight" by Lindo Bacon and Lucy Aphramor

  • "Intuitive Eating: A Revolutionary Anti-Diet Approach" by Evelyn Tribole and Elyse Resch

  • "The Body Is Not an Apology: The Power of Radical Self-Love" by Sonya Renee Taylor

  • "Body Kindness: Transform Your Health from the Inside Out--and Never Say Diet Again" by Rebecca Scritchfield

  • "The HAES Coach Approach: Bridging the Health at Every Size Paradigm to Coaching" by Megrette Fletcher and Jill C. Sechi

  • "Embody: Learning to Love Your Unique Body (and Quiet That Critical Voice!)" by Connie Sobczak


Websites:



Podcasts:


Unpacking Weight Science with Fiona Willer: Explores weight-related research and HAES, offering critical analysis and interpretation of literature.


Food Psych Podcast with Christy Harrison: Explores topics related to intuitive eating, body positivity, and the HAES movement.


The BodyLove Project with Jessi Haggerty: Features interviews and discussions focused on body acceptance and HAES principles.


The HAES Files Podcast with Julie Duffy Dillon: Explores topics related to HAES, body liberation and fat acceptance.


References


➔    Alleva, J. M., Martijn, C., Van Breukelen, G. J. P., Jansen, A., & Karos, K. (2016). Expand Your Horizon: A Programme That Improves Body Image and Reduces Self-Objectification by Training Women to Focus on Body Functionality. Body Image, 18, 43–56. https://doi.org/10.1016/j.bodyim.2016.05.002

➔    Bacon, L., & Aphramor, L. (2014). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 13(1), 9. https://doi.org/10.1186/1475-2891-13-9

➔    Bhaskaran, K., Dos-Santos-Silva, I., Leon, D. A., Douglas, I. J., & Smeeth, L. (2018). Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. The Lancet Diabetes & Endocrinology, 6(12), 944–953. https://doi.org/10.1016/S2213-8587(18)30288-2

➔    Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16(S2), S80–S86. https://doi.org/10.1038/oby.2008.448

➔    Kwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: A systematic review of behaviour theories. Health Psychology Review, 10(3), 277–296. https://doi.org/10.1080/17437199.2016.1151372

➔    Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3), 220–233. https://doi.org/10.1037/0003-066X.62.3.220

➔    Montani, J.-P., Viecelli, A. K., Prevot, A., Dulloo, A. G. (2015). Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the ‘repeated overshoot’ theory. International Journal of Obesity, 39(6), 943–946. https://doi.org/10.1038/ijo.2015.13

➔    NCD Risk Factor Collaboration (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet, 390(10113), 2627–2642. https://doi.org/10.1016/S0140-6736(17)32129-3

➔    Schaefer, J. T., & Magnuson, A. B. (2014). A review of interventions that promote eating by internal cues. Journal of the Academy of Nutrition and Dietetics, 114(5), 734–760. https://doi.org/10.1016/j.jand.2013.12.024

➔    Smolak, L., & Murnen, S. K. (2008). Gender and eating problems. In T. D. Wade (Ed.), Encyclopedia of feeding and eating disorders (pp. 274–278). Springer. https://doi.org/10.1007/978-0-387-79801-4_35

➔    Tylka, T. L., & Wood-Barcalow, N. L. (2015). What Is and What Is Not Positive Body Image? Conceptual Foundations and Construct Definition. Body Image, 14, 118–129. https://doi.org/10.1016/j.bodyim.2015.04.001

➔    Veldhuis, J., Konijn, E. A., & Seidell, J. C. (2018). Equally Different: Exploring the Effects of Different Types of Body Image Dissatisfaction on Well-Being and Emotional Functioning in Men and Women. PLOS ONE, 13(8), e0203089. https://doi.org/10.1371/journal.pone.0203089

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