the HAES files: from unaware to advocate

by Health At Every Size® Blog

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-HAESSM 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.

13 Comments to “the HAES files: from unaware to advocate”

  1. Great article describing the awakening process to Health-At-Every-Size®

  2. This article is very enlightening.The continuum of HAES acceptance you have presented here is very useful. As a novice, I have made some effort to explain or advocate the HAES point of view, mostly online, though this is a very new activism so I tend to tread lightly.

    Despite that, I’ve experienced some venom from the ‘lose weight at all costs’ camp. They can be relentless, and can be very quick to call you a ‘quitter.’ I have also shopped for health insurance recently with a very anti-obesity agent. I didn’t breathe HAES-hate upon him, but tried to educate him to the complexity of morbidity/mortality due to BMI. I also tried to sensitize him to the fact that if 66% of the population is ‘overweight’ according to BMI tables, that those millions aren’t all at equal health risk–perhaps it’s time to look at this group and stratify it further based upon health behaviors. He had a hard time being convinced that you can be ‘obese’ while exercising and eating for health.

    Thank you for this article. It will help me explain myself a little better to various people I encounter in life, though I suspect some people will continue to hear HAES language as a threat to their way of life. I am mostly vegan, and always vegetarian, and have found that my mere presence, particularly if sharing a meal together with people who enjoy meat, eggs and dairy, can be construed as a challenge to some. HAES can be very threatening to some restricted eaters, and people profiting from the weight loss industry.

  3. This is the best analysis of the topic I have ever read. To describe HAES(SM) acceptance, or lack thereof, as a continuum, and to break it down into significant types is a stroke of genius. This is refreshing, because there are many people on both sides of an issue (any issue) who believe that if you are not 100% on their side, you must be against them.

    I also liked Dr. May’s inclusion of bullies as a force to be reckoned with, and her suggestions about how to deal with it. I believe that many activists waste hundreds of hours trying to argue with the bullies, to no avail. Their time could be better spent.

  4. Thank you Camerin and Bill! I hoped this would spark some thought and discussion. It is easy to get so close to an issue we’re passionate about and forget that others are at different places. Let’s focus on increasing awareness and providing accessible information to bring them up to speed.

  5. Wonderful post. Dr. May, I’m curious where you see yourself on this continuum, and whether it has changed at all since you wrote your book? I ask because you do talk in your book about how weighing weekly to monthly works best for most people, which doesn’t sound weight neutral to me. You did also talk about not focusing on the numbers if it bothers you, but it sounds as if you recommended weighing for most people? Of course, maybe I’m reading too much into it. :)

  6. Thanks for your question Renee. I am definitely a HAES advocate, but I originally started to write this post to tell how I got to this point. I won’t tell the whole story here (maybe I will write that post after all!) but as you probably know, I’m a physician in an obesity focused medical environment, but as a former yoyo dieter, I don’t recommend weighing. The vast majority of our Am I Hungry? Workshop facilitators do not do “weigh ins” either, except occasionally as part of data collection at the beginning and end of a program when required.

    Renee, I am still on this journey and have noticed a significant “HAES evolution” in my own writing and teaching over the last 12 years (which is what initially inspired me to post about this). I advocate for the HAES principles every chance I get. Though I suppose it can be misinterpreted by the more radical among us (not meant to be derogatory), I am more than willing to speak the language the medical and diet community understands when needed to get my foot in the door or bridge the gap so I can get this message heard! Heck, I even blog for CalorieCount.com because that is where some of the people who need this message most hang out. Why do we waste so much time just preaching to the choir instead of hitting the streets?

    I’m curious about your question though. I am assuming that you are referring to the first edition (hardcover) of Eat What You Love, Love What You Eat. In Chapter 9: Diets Don’t Work, there is a two page section called Don’t Measure Your Self-Worth. As you may know, most of my work is with chronic dieters, most of whom, as that section opens with, “allow a number on your bathroom scale determine your mood or ruin your morning.” It is definitely an anti-weighing section, written to DECREASE frequent weighing and counteract the junk that the medical community keeps preaching about weighing oneself every day based on the Weight Control Registry data.

    I’ve pasted the whole two page spread here. This is an example of one of the ways I try to bridge the gulf between where most people are and where we are taking them.

    Strategies: Don’t Measure Your Self-Worth

    Do you allow a number on your bathroom scale to determine your mood or ruin your morning? Many of the people I work with have discovered that weighing themselves sometimes backfires. Have you ever said to yourself. . .
    • I did so well this week, I deserve a treat!
    • I was so good, but I still didn’t lose any weight. I might as well eat.
    • I don’t have to weigh in until next week so I’ll splurge now and make up for it later.
    • I was terrible this week, but I still lost weight. I guess I don’t need to be as careful as I thought.
    • I lost only half a pound. It wasn’t worth it.

    Your weight is simply a measure of the weight of your tissues (which includes your bones, muscle, and fat) and substances that are just passing through (like water, food, and waste). Your weight can fluctuate dramatically depending on your hormones, when you last ate, and other factors—none of which have anything to do with your value as a person or the long-term benefits of the changes you are making.

    In fact, you probably won’t see significant changes in your weight from day to day, or perhaps even after some weeks. Further, when you exercise, you’ll build muscle and lose fat, so although the numbers may not change, your body composition, metabolism, and health are improving. If you’re depending on a needle on a scale to tell you how you’re doing, you may feel discouraged and tempted to give up even though great things are going on inside.

    Take the Weight Off Your Shoulders

    This time, focus on the process, not the outcome.
    • Be honest about how the numbers affect you. If knowing your weight tends to backfire, put your scale under the sink or out in the garage. You can decline to be weighed at your doctor’s office or ask that they record it without telling you the number.
    • Decide how often you need to weigh yourself. Some people prefer to be weighed only when they go to the doctor, but for most people once a week or even once a month is a good interval.
    • You never need to weigh yourself more than once a day; if you do, you’re playing games by measuring meaningless physiological fluctuations.
    • Let go of old benchmarks. You may never again reach your wrestling weight or your wedding day weight, but you can live an active lifestyle and make conscious choices that will serve you now.
    • Don’t weigh yourself to confirm what you already know. When you’ve been mindful of your choices, don’t take a chance that the scale will give you an answer you didn’t expect and derail your confidence.
    • Don’t use the scale to punish yourself. When you know you are off track, focus on the changes you’ll make rather than beating yourself up.

    No Weigh

    A man I met recently at a conference said, “I don’t need a scale; I have pants.” I smiled at the simplicity and accuracy of his method of monitoring himself. A few ounces won’t make a difference, but a few pounds will determine how comfortable he feels.

    Look for other ways to assess your health and progress.
    • Resting heart rate
    • Blood pressure
    • Cholesterol
    • Fasting blood sugar
    • Waist circumference
    • Clothing size
    • How your clothing fits and feels
    • Minutes of walking
    • Number of steps counted by a pedometer
    • Amount of weight you are able to lift
    • Quality of your food choices
    • Energy level
    • Mood
    • Stamina
    • Progress on other meaningful changes you want to make

  7. I should add though that when we submit post to other blogs or do interviews with the media, we cannot control how the message is used or heard! You KNOW I didn’t come up with this headline for the article in Health mag: http://caloriecount.about.com/blog/partners/emotional-eating-trick-staying-slim-b530629 !

  8. Sorry; it looks like I deleted the rest of comment above before I posted it (posted at 6:47 am). That article in Health mag is not weight neutral. The author (or her editor) interviewed me about emotional eating but then titled the article “The Trick to Staying Slim” – even though we were talking about eating, not weight. I’m going to assume for now that she is HAES uninformed and keep the doors open for ongoing conversation and hopefully new articles.

    However, not knowing your weight at all, is not weight neutral either – it is weight averse. To me, weight neutral means practicing behaviors that support body, mind, heart and spirit – not with the goal of losing weight. In that section of Eat What You Love, Love What You Eat, I am suggesting that if they do want to weigh themselves, they treat it as just one piece of information.

    My approach to eating, physical activity, and weight, is to increase an individual’s awareness about what they think, feel, and do; see the effect that is having on their body, mind, heart, and spirit; help them consider other options for thinking, feeling, and doing; and put them in charge of deciding what to think, feel, and do. Even though many people find their way to us because of their long frustration with their weight, through a gradual process of non-judgmental awareness, they discover that they can’t measure the transformation that occurs on a scale anyway!

  9. I like the idea of letting go of the scale. Your list of possible reactions dependent on what you see there is spot on. Using the fit of your clothes to determine if your weight is going up or down seems so natural. The French do it, so why can’t we?

  10. Dr. May: When I went to a new internist several years ago, I told him that I had avoided doctors for over 20 years because of embarrassment over weight fluctuations. I told him that I really needed to be able to see him when I was sick, regardless of whether my weight was up or down. I figured that as I get older, I couldn’t afford to hesitate on seeing a doctor if I needed one.

    I’m a well person, so going in sick hasn’t happened many times, but on those occasions my doctor hasn’t put me on the scale and lectured me like other doctors have done in the past. He does weigh me at my annual visit, though he doesn’t talk to me about it. I’m not sure this is helpful to either of us. What do you advise HAES-supporters, who have used the scale inappropriately in the past, do with respect to doctor weigh-ins, even if they are fairly neutral?

  11. Linda,

    I LOVE that you articulated your needs clearly with your doctor and I’m glad your doctor respects your clearly stated boundaries. Until (if?) the medical profession gets on board with HAES, you must advocate for yourself in this manner. It is also a perfect opportunity to educate them about HAES.

    This topic should probably be a blog post itself but let me take a stab at being brief:)

    Your weight is important for your medical record and DOES have clinical significance when used non-judgmentally and appropriately, just like other data collected at your annual complete physical or when there is a change in your health. Examples of how weight is used clinically include: signs of a thyroid problem (hyper- causes weight loss, hypo- can cause weight gain); possibility of cancer when weight loss accompanies other unexplained symptoms; side effects from medications (typically weight gain); sudden weight loss from dehydration due to illness, heat, or other causes; and fluid retention in conditions like congestive heart failure or kidney disease. In children, weights and heights are essential to document normal growth and should be collected regularly as part of their well-child care. (In a child who is larger than the average, let’s use 80 percentile as an example, normal growth would mean that they stay consistently at the 80 percentile.)

    Personally, I am no longer in my clinical practice but I also used fluctuations weights to help a patient accept that weight cycling was an issue and used that information to help them consider other options for becoming healthier.

    Most of the time, weighing isn’t the problem. It is the judgment (or sometimes the perceived judgment) that can occur. That is where advocating for yourself (and HAES), and if necessary, finding a new provider, is essential.

    My summary: Allow your health care provider to collect clinical data as needed, including weights. If the number isn’t helpful to you for any reason, tell them not to tell you. Expect respect, ask for it if you don’t automatically get it, and move on when necessary.

  12. Thanks for your response. Now that you mention various scenarios where weight fluctuations might be useful in following a health condition, it makes sense. Perhaps, I should give my doctor license to address my weight if it has bearing on a medical condition like the ones you mention above. He may not know I’m okay with that.

    I have no argument with my doctor, really. He has honored my request to ignore my weight, even when I lost weight last summer. I’m guessing he had to bite his tongue not to praise me, but the weight loss was situational and temporary (vegans don’t do well finding acceptable food on road trips through various parts of our country). I’m glad he showed restraint.

    I am happy I brought candor to my first meeting with him. I actually think he was taken aback at the thought that a patient might avoid going to see him at a time of medical necessity due to shame. How many of us have received weight lectures, while presenting with sprained wrists after a vigorous tennis game? I know I have. And, I let him know that. I think everyone who supports a HAES point of view should at least try to communicate this to their doctors. Can’t hurt; might help, and at least you know where you stand.

  13. Hey everyone!

    I just wanted to say thank you to Linda Bacon for presenting at FNCE. This was something I wanted to hear for a while, since I have had conflicting thoughts about this myself. I actually wish they had a better debater for Linda, as he seemed to be not that great of a presenter. I thought Linda was energetic, spoke with great passion and conviction, and seem to have the confidence and charisma to engage those who were un-aware of this approach ( I am one of those who were unaware of HAES). Me and my friend were discussing this during the talk and we both agreed that “you were killing him” not literally of course!

    Has anyone in this community heard of health sociologist Annemarie Jutel? I believe she has the same view as this community. She was in a debate in a book titled: Taking Sides Clashing Views on Controversial Issues in Food and Nutrition. The issue was: Is body weight a reliable measure of overall health? If she isn’t part of HAES, then I think this community should reach out to her.

    I have one more silly question for Linda if you have time to answer. When looking into the crowd, did you see a lot of angry and confused faces? Through the debate did you see people nodding their heads as a way of saying “oh, that makes sense”?

    Well, it was a pleasure to run into people who thought of health at every size. Till next time.

    Pedro Sun CSCS

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