From time to time the Health At Every Size® Blog will be sharing HAES Matters “roundtable” posts with our readers. The questions that appear in the HAES Matters posts are based on questions generated by participants at ASDAH’s 2011 Educational Conference. The participants were asked to list the most common questions they heard with respect to health, weight, dieting, and the Health At Every Size approach to promoting wellness. We have compiled responses from some of ASDAH’s HAES experts to these commonly asked questions. We hope you will comment below with your own questions, answers, and reflections on these HAES matters.
Q: Isn’t fat unhealthy?
A: Fall Ferguson
Fat is neither healthy nor unhealthy. Being fat has been correlated with some health conditions, but its role in causing disease is highly exaggerated. Our health is based on a combination of genetics, environment, lifestyle, and certain intangibles such as attitude and sheer luck.
What the data do clearly show is that many people are both fat and healthy. Population studies in a number of countries have shown that all-cause mortality associated with “overweight” as defined by the BMI is lower than all-cause mortality associated with a BMI “normal weight.” Moreover, merely removing adipose tissue via liposuction has no effect on health whatsoever. This all suggests that we need to look for other causes than adipose tissue for the health conditions that tend to be blamed on “obesity.” A HAES® approach focuses on how we eat, how we move, and how we feel about ourselves, rather than on how fat we are. Our goal is the same as that of traditional approaches: to improve health. We simply maintain that this is best accomplished by a focus on health-promoting behaviors and attitudes rather than a focus on body size.
A: Deb Burgard
It is true that extremes of weight in a large population of people are associated with more health problems – whether we are talking about the very thin or the very fat. However, the strength of those associations diminishes greatly when we correct for economic resources, physical activity, social support, weight cycling, access to good medical care, exposure to stigma, etc. What this tells us is that these other factors are more important if we care about health, rather than making everyone’s weight conform to some mythical “ideal.”
Even without correcting for those factors, there are healthy “overweight” and “obese” people at every age. In fact, if we look at metabolic health risk factors and outright disease, trying to use BMI as a stand-in for “health” is inaccurate way too often to be useful: it identifies 51% of the “healthy” people as unhealthy, and overlooks 18% of the unhealthy people (Wildman et al., Archives of Internal Medicine, 2008). Medicine by “BMI-profiling” wastes money screening and medicating people who are healthy, and overlooking people who are not until their conditions are more expensive to treat.
The other obvious problem with trying to make people healthier by changing their weight, is that most people who pursue weight loss end up weight cycling; they will often be fatter than where they started and their fat tissue will often be redistributed to areas of their body – like the abdomen – that seem to be associated most strongly with health problems. This is not to say that big-bellied bodies are any less precious than small-bellied bodies – but it is to say, if health professionals are trying to make people healthier, it makes no sense to prescribe weight loss. People who regain weight – i.e., almost everyone, feel discouraged and embarrassed and are more likely to avoid the practices that might actually make them healthier – even without weight loss – because those practices are “what you do to lose weight,” rather than “what you do to care for the body you have right now.”
A: Sandy Andresen
Not in and of itself. There are no body parts that are inherently unhealthy. Fat has been unfairly categorized for decades as a cancer that disrupts and disables the body’s normal functioning. This is simply not the case. In fact, being fat can be protective of health and longevity in some types of cancer.
A: Deb Lemire
Fat is a necessary component of a healthy body. And healthy bodies come in all shapes and sizes. The size of one’s body is not the best indicator of an individual’s state of health. Metabolic and cardiovascular measurements will always give a more accurate health picture.
Q: What’s wrong with wanting to be thinner?
A: Sandy Andresen
Many people conflate being “thinner” with getting a good job, being successful in their relationships, being better looking, and being lovable. This mixed message contributes to fat stigma and supports a contention that fat is inherently bad and unhealthy. It is important to separate out what one hopes to get more of, in their life, by being thinner and try to work on those important goals, separate from weight loss.
A: Deb Lemire
Nothing. We live in a culture that makes it difficult to NOT want to be thinner. After all if we are thinner we will be happier, healthier, get that cute guy/girl, live happily ever after, right? If we look closely we find that what we really want is to belong and to be loved. And the best place to start is with our own selves. Accepting and loving ourselves is what really brings the happy ending. The HAES model allows room for that.
A: Fall Ferguson
For most people, wanting to be thinner than they are is like wanting to be taller or wanting to be a dolphin. You can wear high heels or learn how to swim really well, but at the end of the day you are still short and still human. Body size is a complex phenomenon that results from many factors, including genetics, environment, and health condition. Attempts to control body size tend to fail in the long-term (more than 2-5 years), at least in part because our metabolism responds to dieting by slowing down, resulting in long-term weight gain rather than weight loss.
Q: I used to be fat and I’m not anymore; I’m so much happier and healthier now. Can’t anyone lose weight if they really try?
A: Deb Burgard
HAES proponents are not against weight loss, and understand that many people are not currently at their heaviest weight. However, the approach does not recommend the pursuit of weight loss, as those practices are objectively more harmful for the majority of people, who experience weight cycling and are psychologically and physically at greater risk after trying to lose weight.
A: Fall Ferguson
It is always great to hear when someone feels happier and healthier. However, it would not be appropriate to generalize from one person’s experience to say that everyone can lose weight. Few people who lose weight keep it off permanently. Diets not only don’t work for most people, they often cause harm. Dieting is a known risk factor for eating disorders as well as conditions such as metabolic syndrome and gallbladder problems. Perhaps even worse is that by recommending diets, we are setting people up for failure, and people tend to blame themselves when their diets fail. Most dieters engage in a cycle of shame and blame, a source of needless anguish. When we take a Health At Every Size® approach—when we eat mindfully, move joyfully, and accept and take care of our bodies no matter what size we are—we are setting ourselves up not for pain and anguish but for living well in a sustainable manner.
A: Deb Lemire
By taking care of ourselves we can be happier and healthier. Sometimes that caretaking results in weight loss, sometimes it doesn’t. And ultimately it doesn’t matter. Health, not weight, should be the priority.
Q: Aren’t fat people less happy and poorer than people who weigh less? Shouldn’t we be encouraging people to lose weight so they can be happier and make more money?
A: Lindo Bacon
I was shopping with an African-American friend (I’m Caucasian), and it was obvious to the two of us that the shopkeeper was distrustfully watching my friend. Clearly, this was about racism. I could have suggested that my friend bleach her skin to escape this in the future, but I don’t think this would have been helpful. Instead, I acknowledged that racism isn’t okay and she didn’t deserve that treatment. This analogy is apropos. Weight bias is real and it isn’t okay, but we shouldn’t blame the victim and expect them to be the one to change in order to escape the oppression. Instead, I’d prefer to support people in understanding that the problem is the cultural body discrimination – not their bodies. And support them in developing the skills to manage oppression, such as building more community.
A: Deb Lemire
Well, like they say, money can’t buy happiness, so I don’t know that “less happy and poorer” or “more happy and richer” necessarily go hand in hand. I would love to say that weight has nothing to do with how much money you have, it certainly shouldn’t. But there have been some significant studies that show the bias against larger bodies has led to discrimination in employment, housing and access to resources. It isn’t the weight itself, but the stigma associated with a larger body size that can have an impact on socio-economic status as well as a person’s happiness.
A: Dana Schuster
HAES living encourages people to treat themselves and others without judgment, and to honor and respect the wonderful diversity of body sizes that make up our world. Any associations between being fatter and poorer are related to lack of access to resources and societal discrimination, and should be challenged head-on.
A: Fall Ferguson
There is nothing inherent about being fat that makes one unhappy or poor. This is like blaming the members of any other minority for the disparities in their situation; it’s simply not fair. Accepting and learning to love and care for our bodies at every size is a better way to a happy life than the blame and shame and physical risks of weight cycling. And, to the extent that our society pays thin people more, or doesn’t hire people because they are fat, that is a social problem that can negatively affect health. We need to work to address the weight stigma that currently exists in all aspects of our society.