healthateverysizeblog

October 24, 2011

the HAES files: is the body mass index a good measure of health?

by healthateverysizeblog

The BMI is a measure of height and weight – specifically weight divided by height squared. It is the predominate measure by which health professionals and governments determine what is and is not a “healthy weight” for a particular individual, thereby informing them if they are “at risk” for morbidity and premature mortality. In reality, however, BMI is not only not a good measure of health, it is actually not a measure of health at all.

The formula itself was created around 1850 by the brilliant Belgian mathematician, astronomer and statistician Lambert Adolphe Jacques Quetelet – and appropriately named The Quetelet Index. Dr. Quetelet was not a health professional and he was not interested in fat or health risk. He was fascinated by the idea of using statistics to draw conclusions about societies – and the “average man.” Some of us will remember the 20^th century figure portraying the average family as having 2.4 children. Not only was his formula not health related, it was never meant to be used on individuals, only on populations. As Stanford University mathematician Keith Devlin (the Math Guy on NPR’s Weekend Edition) recently commented, “the absurdity of using statistical formulas to make any claims about a single individual is made clear by the old joke about the man who had his head in the refrigerator and his feet in the fire: on the average he felt fine!” A wonderful expose of the inherent mathematical absurdities associated with the use of this formula can be found in Dr. Devlin’s article Do You Believe in Fairies, Unicorns or the BMI?

The Quetelet Index remained as such until 1972 when Dr. Ancel Keys appropriated it as a proxy for body fat percentage (renaming it the Body Mass Index) in an article in The Journal of Chronic Diseases. The rest, as they say, is history.

So the formula is being used for something for which it was never intended and in a manner that is mathematically indefensible. Are there any other problems? We have been told that the BMI serves as a measure of health because it is a good indicator of body fatness, and therefore a good predictor of health problems and premature mortality. Is this true or isn’t it?

Statistician Dr. Gregory Kline examined this question in an article in The Healthy Weight Journal in 2001. He found that while the BMI can give us a pretty accurate average body fat percentage for a large group of people, on an individual level it is a poor predictor of body fat percentage. For example, Kline showed that in a sample of 1,000 people from Central Massachusetts, for a BMI of 35 the average percent body fat was around 32. However, individuals with a BMI of 35 had a range of body fat percentages from 18 to 47! (Remember the guy with his head in the fridge?) Dr. Kline also encountered the same problem when he used BMI to predict individual fitness or blood pressure concluding that:

“Using BMI to assess degree of adiposity and, more importantly, health risk for an individual is questionable and unwarranted due to the magnitude of error in prediction.”

But wait, there is more! Not only is BMI not a good predictor of body fat, fitness, or blood pressure, it is also not good at predicting mortality or morbidity. In 2006 a large systematic review of the relationship between bodyweight, mortality and coronary artery disease in the esteemed British medical journal The Lancet concluded that BMI was a poor predictor of either. In an accompanying editorial, another physician researcher wrote:

“BMI can definitely be left aside as a clinical and epidemiological measure of cardiovascular disease for both primary and secondary prevention.”

Two years later, back in the States in the Archives of Internal Medicine, Wildman et al. analyzed a representative sample of the US population and found that using BMI as a proxy for health resulted in misdiagnosing 51% of the healthy people as unhealthy. Dr David Haslam, clinical director of Britain’s National Obesity Forum got it right when he said; “it’s now widely accepted that the BMI is useless for assessing the healthy weight of individuals.”

So, there we have it. The measure we are using for the supposedly most serious health problem facing us today is mathematically bereft, lacks a theoretical foundation and is a poor indicator of health. According to the Math Guy this realty should come as no surprise as:

“The BMI was formulated, by a mathematician, not a medical physician, to provide a simple, easy-to-apply mathematical formula to give a broad, society-level measure of weight issues. It has absolutely no scientific or medical basis. It is based purely on a crude statistical analysis. It measures a general society trend, it does not predict.”

The sooner the health establishment gets its head out of the sand and owns up to this reality the better. I probably wouldn’t bet much on that happening anytime soon. For now, however, it is at least somewhat comforting to know that the people who really know about these things are willing to lead the way – again quoting the Math Guy:

“Since the entire sorry saga of the BMI was started by a mathematician – one of us – I think the onus is on us, as the world’s experts on the formulation and application of mathematical formulas, to start to eradicate this nonsense and demand the responsible use of our product.”

Come on health professionals – Now it’s our turn!

Posted in Jon Robison | 9 Comments »

October 17, 2011

the HAES files: can i love my body and still want to lose weight?

by healthateverysizeblog

by Deb Burgard, PhD

Many people who are intrigued with the Health at Every Size® approach find the notion of “weight neutrality” the hardest aspect to accept. “Loving your body” is not too controversial, unless your body is not a “correct” body. If your body is a non-conforming body, then there is real debate about how much you should “love” it, especially if that means rejecting the assignment to try to lose weight.

People who are trying to love their bodies need to be curious, not ashamed, about the desire to lose weight. It is not a surprise to find ourselves fantasizing about weight loss. All the triggers for wanting to lose weight that have always been there are still there polluting our environment. We are told to lose weight to make sure no one will reject us. To comply with our doctor’s orders. To fit into plane seats. To be able to get a sense of control. To become a “whole new person!” To buy the social approval that we are at least “trying.” To participate in the workplace dieting along with everybody else. And as of this fall in some states, maybe even to be able to qualify for health insurance.

“Love Your Body Day” represents a movement to challenge all the messages that our bodies are not good enough. But even organizations that support “self esteem” and “body acceptance” seem to get confused about the part about pursuing weight loss. For example, the National Eating Disorders Organization (NEDA) has partnered with the “Stop Obesity Alliance” (an organization trying to frame fatness as a disease in order to create markets for “weight loss” drugs and surgery) to sponsor events to reframe the pursuit of weight loss as “not about appearance but rather about health.” These actions have been the cause of confusion and concern among NEDA members, who are wondering how the very same practices that are diagnosed as eating disorder behavior at one weight are being prescribed to people at a higher weight.

So what does “loving your body” mean? And is it ever compatible with pursuing weight loss?

Loving your body means you don’t blame it for the cruelty of other people. Loving your body means you appreciate that wherever you were before you were born and wherever you go after you die, the chance to live your human life depends on this body. Loving your body means you try to care for it as best you can. Loving your body means you respond to its signals for sleep, water, food, stimulation, pain, movement, pleasure, as best you can. Loving your body means you negotiate for what you need from people whose agendas may not be in your best interest – that you are willing to make some fuss to be sure you are safe, cared for, listened to, etc.

Loving your body does not mean you are always “confident,” whatever that is. It does not mean you think every part of your body is pretty.

Do all the actual people you love have to be pretty? No. Do you even have to like all the aspects of the people you love? No. Loving is not shallow. The people you love, and the body you love, are not perfect, and you can have mixed feelings about them and still love them. It’s about the relationship, not the visuals. It is about the effort, commitment, nurturing, appreciation you bring.

One way to answer the question of whether it could ever be loving to try to lose weight is to imagine someone who supposedly loves you telling you to lose weight. Does it feel loving? Could it? Would you ever tell someone you love to pursue weight loss?

I actually would not tell anyone to pursue weight loss, whether I loved them or not. We have plenty of evidence that the practices associated with pursuing weight loss make people sick. For almost everyone, weight “loss” is really weight cycling. For some of the “maintainers,” maintenance is really an eating disorder. I know people who have ended up at a lower weight as a side effect of other changes that have been important to them, and they are doing just fine. But I don’t know people who have lost weight by organizing their lives around it who are really at peace with food and their bodies. They are not fine.

But that does not mean I would never encourage someone I loved – of any size – to feel entitled to treat herself well, to care about the practices that make her feel better in her body. Those practices are worth doing regardless of weight outcomes, and I think they are more likely to become sustained efforts when people find intrinsic reasons for doing them, rather than associating them with the pursuit of weight loss.

It also does not mean I would never speak up to someone I loved – of any size – about practices I might believe are harming her. “Loving your body” does not mean ignoring disordered eating, addictive and compulsive acts, self-harm, or neglect. But none of that is necessarily linked to a particular weight. And the great news is that many many people recover from these kinds of struggles when they get enough support.

The Health At Every Size model criticizes promoting weight loss as an iatrogenic cause of ill health across the weight spectrum. So it is clearly not consistent with the HAES^SM model to link it to the promise of weight loss. But weight stigma is quite real, and most people rightly want less weight stigma in their lives, which they expect to diminish with weight loss. They are also being told by every conceivable source that they will be healthier if they weigh less, whether there is evidence for that promise or not. So people wonder, “Am I practicing the HAES approach if I am trying to lose weight?” Or maybe they even wonder, “Am I practicing the HAES approach if I am glad if I lose weight?”

I would answer these two questions differently. In the first situation, the overt goal of “trying to lose weight” conflicts with the focus on what you find sustainable on a day-to-day basis. We help people look at what practices make sense in their individual lives with their individual preferences and limitations, and then ask them to trust their bodies to reveal the weight that their genetics dictate as the result of those practices. This focus on the truth of what is possible for you to choose, on a long-term basis, is the exact opposite of organizing your life around the temporary attainment of a specific number on the scale, come hell or high water. In this respect, the HAES model demands an ambitious degree of trust that your body really is in charge of regulating your weight, while you are in charge of regulating your acts of self-care, to whatever degree is possible and sustainable in your individual life. The HAES model is weight neutral: not for or against weight loss, but rather for a focus on the practices that support your well-being.

For the second question, the answer is more complicated. It is hard to imagine someone who would not be relieved to face less weight stigma, less stereotyping, less medical profiling, or fewer experiences of not fitting, not belonging, not being considered in the design and size of the physical world. It is hard to imagine someone who would not be relieved to have more social power. All of these things are valuable changes that could make an individual’s life a little better even if the broad conditions of weight stigma did not change.

But it is also true that a part of us identifies with our fatness – regardless of how much that “fatness” exists in the real world. Contrary to the diet industry rhetoric, that part never goes away – because it is connected to universal human feelings of vulnerability. If you give yourself more value when you are thinner, it backfires, because that is exactly the same experience for your “fat self” as weight stigma was in the bigger world. It’s like the internal version of being less valued in the world for being fat. So being glad about weight loss is tricky. It is sometimes hard to be glad about an easier life without granting more value to your thinner body.

Perhaps one reason it is hard to be glad about having an easier life without granting more value to your thinner body is that from the beginning, we are trained to see our bodies as the reason that we are treated well or poorly by other people, rather than holding the other people responsible for their actions. It takes the awareness of weight stereotyping, stigma, discrimination, and of thin privilege, to begin challenging our body blame. If we experience weight loss, it is seductive to give our bodies credit now for the friendlier reception we get; but it is really not about our bodies at all. It is about stigma and privilege. Stigma and privilege are not fair; they are not earned. Moreover, we all have so much experience with weight cycling, we rightly feel wary about gaining thinness privilege when we could lose it so easily. Better to solve the problem of weight stigma by fighting weight stigma than leaving the stigmatized group.

So it behooves us to be careful not to reproduce the external conditions of weight stigma in our internal life. It also behooves us to remember that as long as we are trying to solve the problem of the way people treat each other by changing our bodies, we fail to address the actual problem of the way people treat each other. This is another way that the HAES model is different from approaches that only focus on individual choices. Individual choices are certainly part of it, but it is only the focus on changing weight stigma and all the environmental, economic, cultural, and social problems that affect our well-being that will make it possible for each person to achieve their potential and purpose.

So can you love your body and still want to lose weight? You tell me.

This post is part of the 2011 Love Your Body Day Blog Carnival

Posted in Deb Burgard | 31 Comments »

October 11, 2011

the HAES files: hypocrisy of obesity war exposed; the HAES peace movement makes inroads

by healthateverysizeblog

by Linda Bacon, PhD

Woulda, coulda, shoulda. And now, did! Drowned as we are in pronouncements from the fat-fighting world, how much do we long to take the fight to their door? How often do we wish we could hash it out in public, and test the Health At Every Size^® model against baseless claims about the perils of obesity?

Well, at long last, I did enter the lion’s den (backstory in a recent post) to face conventional weight loss advocates and make a public case for a HAES^SMapproach. I did poke holes in studies that supposedly show evidence for sustained weight loss (link to excerpt), did show the evidence behind why intuitive eating works and dieting doesn’t (link to excerpt), and did explain the social psychology that underlies resistance to the HAES message. Did lay out the evidence that the War on Obesity has done more harm through collateral damage to its own side than through vain attacks on the “enemy,” fat.

My debate with John Foreyt, PhD, a prominent anti-obesity researcher, took place before an audience of well over 1,000 dietitians and other professionals on September 25 at the Food & Nutrition Conference and Expo (FNCE) in San Diego, the annual meeting of the American Dietetic Association (recently rechristened the Academy of Nutrition and Dietetics). (An audio recording is available from the ADA for $15.)

Just a couple of good things to come out of the session were stronger bonds in the nutrition-HAES community, a petition for the ADA to form a HAES dietetic practice group (please sign if you’re an ADA member), and a promise from ADA staff to tighten FNCE conflict of interest disclosure requirements for speakers. Above all, though, the event represented one more breakout for the HAES message from behind the longstanding “obesity sound barrier.”

A recap follows, my take on where points were scored for the HAES side and lessons and fixes to take with me to the podium next time.

(“Next time” is already on the calendar, by the way – in June, vs. leading Canadian obesity expert Arya Sharma, as blogger Quantum Acceptance describes. And more “next times” undoubtedly will follow. As for Quantum’s suggestion that the two sides “hug” and make up, however, read on for my response.)

THE DEBATE

It won’t surprise practiced HAES defenders to hear that my presentation covered evidence belying the myths around “obesity=death” and other unsupported claims. I discussed confounders and the difference between association and causation. I reviewed CDC and NIH data that undercut the agencies own advisories on BMI. And I delved into the wash of corporate money that unavoidably seeps into common beliefs, research, academic publishing, and public policy decisions in the obesity field.

Dr. Foreyt reprised familiar lists of the “health detriments due to obesity.” His response to my challenges on the data consisted, essentially, of this: Everyone knows fat is bad for you. It’s a no-brainer. When confronted with data showing pursuit of weight loss to be ineffective, he again trotted out canards drawn from Popular Wisdom. Sure it’s difficult to maintain weight loss, yet it’s always better to keep trying, he insisted illogically, even if you regain it. (Say it with me:) It’s a no-brainer.

Seems he’s right: There is a decided “brainlessness” to the arguments for an international war on fat.

STRENGTHS AND “NEEDS IMPROVEMENT”

I managed to anticipate all of Dr. Foreyt’s arguments. Rather than rebut him directly on BMI, for instance (sigh, what’s the point – he was on the government panel that lowered the BMI standards, and I can’t imagine he’ll ever publicly admit the politicking that went into this decision, in which NIH adopted guidelines favored by the diet industry in the face of evidence suggesting that raising BMIs might have made more sense. The backstory is in my book.), I took the occasion to address the relentless barrage of misinformation and understandable self-interest that can make it hard to hear and internalize the HAES message (link to excerpt).

I do hope those points were heard by many audience members. The data supporting a HAES approach are strong. It’s the ability to consider it that is the limiter.

Think about what it would take for an audience of conventional health providers to really challenge themselves. After all, they probably chose their professions because they care about health and are committed to helping people. A HAES approach suggests that what they have been doing is not only unhelpful, but actually harmful. Who wants to believe she or he has hurt people?

It would be the most natural thing in the world to resist this message.

If I had to do it over again, and of course, if I could have found more time than was available in our limited format, I would have spent more time engaging the audience on the emotions they felt as I spoke. The more public speaking I do, the more I recognize that emotional connection matters more than a thousand facts and data points.

My task next time will be to draw more on my experience as a psychotherapist and work more empathy into my presentation. Suppose I asked my listeners to consider the idea that they have hurt their clients and watch what that evokes, noting how hard it must be to stay in that emotional place. I could ask them to tune into the feelings that arise when they realize that they may not be able to deliver the fantasized weight loss, and what it must feel like to share that with clients. (Too touch-feely for an audience of professionals? Something to think about.)

If they recognize the cost to giving up the old ideas, the thinking goes, they may better understand where their own resistance comes from. And that could help them see the tremendous power they have to make substantive change in people’s lives if they face up to their resistance and adopt the HAES model.

Lastly, I am glad to say I managed my tone. I was calm and respectful throughout, something Dr. Foreyt (who is, it should be said, a generally genial man) didn’t always manage. At one point, he sneered:

Thank you, I appreciate you have published one paper, so thank you, on that. There was no weight loss in your study, but thank you.

Of course, how telling was it that he dismissed the study as a failure because there was no weight loss, when its very point – and success – was to demonstrate that health improvements can result without a focus on weight loss? That one line really exposes the hypocrisy when fat-fighters profess their concern for health, but betray an obvious focus on weight over everything else.

I do admit to taking one cheap shot, but this one was just too hard to resist…

Eating in HAES is not about monitoring your weight or counting calories or fat grams. It’s not about drinking Slimfast, vegetable juice, or carrying a plastic module that supplies a whiff of vomit to help you maintain your diet… [Audience laughs.] Oh, be nice. Don’t laugh. Dr. Foreyt has actually done research on all of these and can tell us the advantages to that whiff of vomit.

It’s true! He published research on “Aromatrim,” which apparently impressed him since he also appeared in advertisements plugging its benefits. (I assume it goes without saying that Aromatrim funded his research.)

CONFLICTS OF INTEREST (COI)

Before we leave that topic of COI, I should add this. The ADA requires that we provide a disclosure of interest. (Follow links to view John’s disclosure and mine.) In the speaking contract, the ADA specifies that “While an interest or affiliation with a corporate organization does not prevent you from making a presentation, the relationship must be made known to attendees.” The ADA even provides us with a disclosure slide as part of the template we are instructed to use.

I used no slides during the debate but voluntarily described my potential conflicts of interest in the course of my talk. (Really, I disclosed the lack thereof, since, as a matter of principle, I accept no corporate funding for my research.) Dr. Foreyt did use slides, but omitted the required COI disclosure that had been inserted by ADA staff. When this omission was brought to the attention of ADA staff after the fact by me and journalist Pattie Thomas, who is examining these issues, we received the following response from the ADA Director of Professional Development:

We will follow up directly with Dr. Foreyt regarding the lack of the disclosure slide and verbal acknowledgement at the educational session. Additionally, we have already made notes for FNCE 2012 regarding enhancing the language in the speaker agreements indicating this new mandatory slide in each speaker slide deck.

This is a major development. Perhaps audiences would hear information about weight loss differently if they know a speaker is a paid Slimfast representative?

THE RESPONSE

Q&A, Twitter and the Press

I am (the HAES community is) forever indebted to stalwart HAES backers in the ADA, who agitated to help get this debate on the map in the first place. They and other supporters also turned out in force at the event itself, which drew a crowd that easily topped 1,000.

The sizable HAES presence did more than just bolster me. It sent a powerful message of conviction and numbers to the HAES-hostile, -agnostic or merely -curious in the rest of the crowd. The 500 HAES stickers that ADA/ASDAH members Dawn Clifford and Michelle Neyman Morris brought were quickly snapped up, and it was way fun to see it on lapels all over the convention later. I’m sure it inspired many important conversations.

Also, several people amplified the HAES message in the Twittersphere. Other notable HAES advocates posted to their blogs: check out smart commentary by Marci, a dietitian, and dancer Ragen Chastain (Dances With Fat). (Great to meet the two of you personally, by the way!)

THE PAYOFF

Initially, I refused payment from the ADA for this appearance. I assumed offering a gratis appearance would make it more likely that I would get a spot, and, later, when I was pushed into a debate format, was the best way to assure my interlocutor and I approached the issues on a high professional plane, with deference only to the research. I also disliked the idea of accepting fees that come, indirectly, from the many food, diet and pharmaceutical companies that pitch their goods through the ADA; it feels like tainted money to me.

But when I learned Dr. Foreyt would be receiving $1,000 for his appearance, I renegotiated my contract for the same. (How come they offered me only $500 at first?) I will be donating my stipend to ASDAH.

“KISS AND MAKE UP”? NOT SO FAST…

One of my few regrets in this debate was the way it ended. Audience member Julie said something to this effect:

The health risks are real and undeniable. I want you to kiss and make up. Linda, stop saying the health risks of obesity are exaggerated. John, stop saying that intuitive eating doesn’t work.

Well, sorry Julie, but no can do.

Most every objection to the Health at Every Size model (that it’s “giving up;” that never-mind-the-data-we-”know”-fat-is-bad-for-your-health, that obesity impedes an active lifestyle, etc.) relies on a paradigm that the HAES approach itself rejects. The HAES model has an answer, is an answer, to every one of these concerns, but you can’t pursue a HAES approach as long as your health model revolves around weight.

There’s no question of “making up,” really, because there’s no fight. What there is is a vast and unbridgeable difference in opinion and outlook. It’s not just desirable but required of us – as professionals and thinking people – to tolerate such differences, weigh the evidence and reach our own opinions.

We don’t ask climate change researchers to “make up” with global warming deniers, do we? Should flat-Earthers have “made up” with Christopher Columbus? This is where the broad acceptance of the obesity paradigm proves so pernicious: How can we consider evidence that counters what we “know” to be true? (Copernicus’s opponents “knew” that the sun circled the Earth.) It seems to take time for evidence to build and sink in before a paradigm shift can happen. For the majority of Americans who struggle with weight and weight paranoia, change can’t happen soon enough.

I have no personal beef with Dr. Foreyt or any weight-control advocate. But that doesn’t mean our ideas are, or ever can be, compatible. A HAES perspective works when and only when we disregard weight and focus instead on attaining the best possible health.

If the goal is just to make everyone skinnier, good luck with that. But if the war on obesity’s true aim is to help all Americans achieve greater health, a HAES approach will get us there.

The HAES model is not an alternative in the arsenal against fat. It exists to disarm that arsenal. It’s a fundamental paradigm shift in the way we think about fat, disease, and our bodies. A HAES path is the only route towards a more compassionate – and healthier – culture.

Posted in LInda Bacon | 17 Comments »

October 4, 2011

the HAES files: from unaware to advocate

by healthateverysizeblog

by Michelle May, MD

I have to confess: I wasn’t always a Health At Every Size® supporter. To be clear, I was never anti-HAES^SM either, but over the years, I transitioned through a series of stages from HAES-unaware to HAES-advocate.

I was planning to write about my personal journey before I attended what I call the “great weight debate” between Linda Bacon and John Foryet at the ADA FNCE (American Dietetic Association’s Food and Nutrition Conference and Expo). Linda had submitted a proposal to present the HAES concept at FNCE but was instead asked to participate in a debate, called “The War on Obesity: A Battle Worth Fighting?”

As I listened to the debate, the follow-up questions, and the discussion in the halls and online, I heard many people express regret that the format was polarizing, appearing to pit HAES supporters against HAES non-supporters. This was disturbing to me since I don’t see people as “for” or “against” the HAES principles, but at different places in their understanding and acceptance.

So instead of sharing my personal experience, I’d like to share my observations about how those who appear to be on different sides of the HAES issue are actually in different stages. At the risk of appearing presumptuous, I’m also sharing possible recommendations as a starting place for further discussion and suggestions.

Let me emphasize: I have no official position in this movement or within any supporting organization, so these thoughts are my own. However, I believe that only through understanding where an individual (or group) is coming from—and why—can advocacy efforts be directed efficiently and effectively.

I’ve organized my observations into three broad categories: Non-Supporters, Ambivalent, and Supporters.

NON-SUPPORTERS

HAES Unaware: They haven’t heard about the HAES principles.

Recommendation: Continue positive advocacy efforts—write, speak, teach, study, and especially, live the HAES principles to reach potentially interested individuals or groups; explain what it is (and what it is not) and why it is relevant and important. Be willing to use language they understand and are likely to be interested in, such as “obesity” and “weight management.”

Uninformed Non-Supporter: They don’t really know what the HAES concept is but disagree with the concept.

Recommendation: Same as for HAES Unaware. When opportunities arise, provide accurate information through respectful dialog.

Informed Non-supporter: They understand the HAES principles, have read the literature critically, and still don’t agree.

Recommendation: Develop a more compelling case and/or communicate it in a way that makes it relevant and useful to them. Continue to conduct research and point out research bias. Use credible allies within their circle of influence to explain it in more understandable or palatable terms, such as “healthy behaviors” and “weight neutral.” Pick your battles carefully; excessive effort directed toward this group may be unproductive and perceived as antagonistic. If all else fails, encourage them to be tolerant (see below).

Tolerant Non-supporter: They are an informed non-supporter who accepts that there are other viewpoints and more than one way address an issue.

Recommendation: Agree to disagree and communicate the value and importance of fairness, equality, and compassion toward all marginalized groups.

Intolerant Non-supporter: They are an informed non-supporter who is intolerant of other viewpoints or possibilities.

Recommendation: Communicate the value and importance of fairness, equality, and compassion toward all marginalized groups.

Bullies: These individuals appear to troll the Internet, anonymously posting blatantly bullying, discriminatory, angry, cruel, and/or violent messages on blog posts, articles, and videos having anything to do with people of size.

Recommendation: Protect your web-based content by moderating comments. When you see it elsewhere, flag as inappropriate, and/or respond simply and clearly with messages like: “This is bullying”; “This is discriminatory”; “This comment underscores the need for … (restate the reason for the original post)”; or “To learn more about the Health at Every Size approach, visit the ASDAH website. Their actions usually speak for themselves so stand up to them but avoid getting into angry exchanges, since just like playground bullies, it gives them a larger platform and seems to urge them on.

AMBIVALENT

Uninvolved Non-Supporter: They are aware of the HAES principles but don’t take a position because it doesn’t affect them directly.

Recommendation: Communicate the value and importance of fairness, equality, and compassion toward all marginalized groups.

Curious: They want to understand the research and learn more about the HAES principles.

Recommendation: Same as for HAES Unaware. Avoid defensiveness; see their questions and counter-arguments as an opportunity to inform and inspire.

Halfway There: They have a reasonable understanding of the HAES principles and agree with some or most of them, but have a different experience, viewpoint, environment, or professional bias that prevents them from agreeing with all of them.

Recommendation: Recognize that this is a process; sometimes it is a radical departure from firmly held beliefs. Be open and inclusive, while remaining clear and consistent in communicating the HAES principles. Develop a more compelling case and/or communicate it in a way that makes it relevant and useful to them. Continue to conduct research and point out research bias. Use credible allies within their circle of influence to explain it in more understandable or palatable terms, such as “healthy behaviors” and “weight neutral.”

Intrigued but Doubtful: They think the HAES principles sound good in theory, but they doubt they could really work, or think that they would only work for certain people.

Recommendations: Acknowledge that while it may sound “too good to be true,” the alternative hasn’t worked for the vast majority of people. Encourage them to try it for themselves. Personal experience is the best teacher and is ultimately the most convincing of all.

Inconsistent: They understand and agree with the HAES principles and apply them completely, but only in certain circumstances. For example, they may practice them themselves, but not with their patients, or only with certain patients.

Recommendations: Respectfully address the incongruence and encourage them to try it in other groups. Again, personal experience is the best teacher.

SUPPORTERS

HAES Hopeful: They understand and agree with the HAES principles, but they don’t understand how to practically implement them in their own lives or the lives of their patients.

Recommendation: Refer to a skilled, experienced HAES-friendly clinician or program to provide them with the confidence, practical skills, and support necessary for implementing the HAES principles.

HAES Uninformed Supporter: They think they understand and agree with the HAES concept, but make fundamental, albeit unintentional, errors in their application of the principles.

Recommendation: Acknowledge the intention and respectfully correct the misunderstanding or misuse of the principles to ensure that the HAES message does not become diluted or confusing.

HAES Unaware Supporter: They’ve never heard of the HAES model but they’ve come to the same conclusion on their own and/or practice the principles instinctively.

Recommendation: Be on the lookout for these people since once informed, they are wonderful allies and can offer fresh perspective and energy.

HAES Committed: They believe in the HAES principles and consistently practice them personally and, if applicable, professionally.

Recommendation: Support them by continuing to promote the HAES principles and provide tools and research. Encourage HAES advocacy within their sphere of influence through their direct interactions, social media, local media, presentations and articles within their social and professional organizations.

HAES Advocate: They seize and seek opportunities to share HAES principles with a broader audience.

Recommendation: Continue to support their efforts by providing additional training and opportunities to spread the word (for example, giving them exposure in social media, blogs, presentations, articles, and referrals).

HAES Activist: Every movement has its outspoken “radicals” and the HAES movement is no exception. They are willing to push the envelope to further the cause. Their passion comes from their long history with the movement, their deep exploration of the topic, and/or personal experience with bullying, discrimination, or worse, dismissal.

Recommendation: Use their commitment and passion constructively. Use their credibility and leadership when direct confrontation is required. Be cautious about allowing this to be the only, or even most prominent, voice in circles where radical activism is viewed negatively, and therefore can lead to rejection of the messenger and message. Be aware that due to their visibility, the HAES cause is sometimes mistaken as their cause or their program, rather than a universal set of principles and a global movement.

The transition from HAES Unaware to HAES Advocate is a personal journey for each of us. Therefore, I believe that it is a mistake to treat all Non-supporters as Intolerant, or expect all Supporters to be Activists. Through awareness, mutual respect, sound argument, and open dialogue, together we will successfully achieve the goal of health at every size.

Posted in Michelle May | 13 Comments »

M	T	W	T	F	S	S
« Sep				Nov »
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30
31

Archives

Email Subscription

find posts