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

by Health At Every Size® Blog

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 HAESSM approach. 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.

17 Comments to “the HAES files: hypocrisy of obesity war exposed; the HAES peace movement makes inroads”

  1. Linda, you kick a$$. And LOL about the “Aromatrim” stuff!

    Just one li’l thing:

    When confronted with data showing pursuit of weight loss to be effective

    Shouldn’t that be “ineffective”?

  2. I wish I could have been there.

    Also, I’m so glad to see that this wonderful blog has been added to “Notes from the Fatosphere.” I think it’s of great interest to a lot of people who read the feed.

  3. Brava, Linda. That was a tremendously satisfying blog post to read, particularly in your conclusion.

  4. Ah Linda, you are definately a mentor to me as I watch and learn from all you do. I thank you for that and for sharing these insights and paving the way for peope like myself to help others realise that the merry-go-round of dieting isn’t their only option.

  5. slow clap building to a full on fist pump. thank you Linda for all you do.

  6. Thanks for sharing this summary of the debate! I’m so excited to hear how the HAES message is spreading. I’m especially looking forward to your debate with Dr. Scharma!

  7. thx all. Meowser – thanks for catching that typo. I’ve asked ASDAH if they could correct it.

  8. Great post, great work.

    One question: where is the Bacon-Sharma debate going to take place? I would just love to go!

  9. I was thinking about doing a post on HAES. I admit that I have always wondered how literally the term is intended. My thoughts as of lately have been, what about people who are underweight? Does HAES apply to them as well? And what about someone who is 900 lbs? A person can only weigh so much before their body and muscles can’t support and carry their weight around and mobility becomes an issue, and once mobility decreases then how healthy can one be?

  10. Wow. Someone really thinks it’s a good idea to go around with a little vial of vomit smell to inhibit eating? I know plenty of places in any large city where you can find plenty of that smell (and other, to boot!) for free. Maybe I’ll market a map.

    Naaah, I’d rather people eat enough to satisfy themselves and feel good.

    You know, kiss and make up is a concept that has many uses in this world… but it doesn’t work in every case. There are times when two concepts are just diametrically opposed and all the goodwill in the world can’t make the opposition go away. One can treat people on the other side with respect, but disagreement in concept is not the same thing as disrespect toward an individual.

  11. Hey Ashley – HAES doesn’t contend that everyone is at the weight that is healthiest or best for them. It supports people in adopting good health behaviors, regardless of where they are on the weight spectrum. So as an example, if mobility is a problem, HAES recommends addressing issues of mobility directly. This might take the form of strengthening exercises, for example. Learn more about HAES by checking out the ASDAH website (www.sizediversityandhealth.org), my book (www.haesbook.com), my personal website (www.lindabacon.org), the HAES Community Resources (www.haescommunity.org), and tons of other places you can find linked through those or by conducting web searches.

  12. oops.. this is where I intended to put my original response

    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

  13. To NewMe – details about the Bacon Sharma debate aren’t nailed down yet, but it will take place in Canada. Follow me on social media to learn about my doings or check the speaking link now and then. Links on my website: http://www.lindabacon.org.

  14. Fantastic post- just bought a CD of the debate and I plan on listening to it with my local fatties group. The fact that this debate even happened is a huge step forward regardless of how people perceived the debate itself. We have a toe in the door and we can run with that!

  15. Linda, I just read this and I love it!! I am so grateful to pioneers like you who pave the way for sanity and a loving approach to our bodies and our lives. Congratulations on getting HAES on the map!

  16. I’ve actually always had the same question as Ashley. The greatest resistance to HAES is simply that every size isn’t healthy. I think the part of my brain that’s still moderately disordered and therefore can’t accept HAES likes to say that fat isn’t healthy. And then when I read this line:

    “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.”

    I stopped. And read it again. And again. My health model still revolves around weight.

    Obesity isn’t healthy. Neither is starving, binge eating, purging, overexercising and flat out refusing to exercise. The HAES approach does seem at the very least kinder than most of what we hear from medical professionals, nutritionists, and society at large.

    • I’m not sure I really understood what you are trying to say here. But when you say “Obesity isn’t healthy. Neither is starving, binge eating, purging…” notice that there is a big difference in these: “Obesity” is a physical attribute, while the rest of the stuff you mentioned are behaviors. One thing that comes to mind is that we can change behaviors – which may or may not result in weight change – but we don’t have any evidence of a successful method to change weight directly, at least not in any sustained way for the majority of people – and we know that prescribing it results in a lot of damage. That plays into why we encourage a focus on supporting behavior change, as oppose to a physical attribute. Also, I don’t feel comfortable with the statement “Obesity isn’t healthy” anyway – there are plenty of people living long healthy lives in “obese” bodies. We also know that “obese” people live longer than “non-obese” people with a wide range of diseases. There are other issues that seem to play a much bigger role in defining health.

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