the HAES® files: History of the Health At Every Size® Movement—The Mid- to Late 1990s (Part 4)

by Health At Every Size® Blog

by Barbara Altman Bruno, PhD, LCSW

In response to requests from our readers, the Health At Every Size Blog is honored to reprint Barbara Altman Bruno’s history of the HAES movement. Most of the installments of this history have been previously published in ASDAH member newsletters. This post is Part Four in a series.

The mid to later 1990s found increasing pressure from pro-weight-loss groups against the fledgling anti-diet, pro-health forces. The American Obesity Association (AOA) formed in 1995, thanks mostly to generous funding from the drug industry, which then used Everett Koop’s false and misrepresented figure of 300,000 deaths/year from obesity in order to get FDA approval for Redux (a weight-loss drug which had already been found in Europe to be dangerous-to-lethal). Other vested interests were those wanting health insurance mandated to pay doctors who worked with weight loss and weight-loss surgery, and various diet programs and producers, many of which had already been discredited by the US Congress and the Federal Trade Commission. Although the AOA claimed to be an advocacy group for fat people, they had only one member1. By calling obesity a disease, rather than a body size, daily, lifelong medication could be advocated. NutriSystem and Jenny Craig started employing physicians to prescribe fen-phen.

Meanwhile, several real advocacy groups for fat people and/or against the diet industry, including the Association for the Health Enrichment of Large People (AHELP), came together. In October 1996, the AOA held a so-called “consensus conference” with “Shape Up America!” the purpose of which was to establish guidelines for treating the “disease of obesity” and get mandated health insurance coverage.  AHELP members including Debbi Kauffmann and Barbara Altman Bruno were joined by several NAAFA members including Lynn Meletiche, and AHELP founder Joe McVoy, Lynn McAfee of the Council on Size & Weight Discrimination, Glenn Gaesser, and NAAFA executive director Sally Smith, in denouncing the sham.

Several books appeared which supported the ideas of both physical and mental health at larger sizes.  Exercise physiologist Glenn Gaesser’s Big Fat Lies dispelled many of the weight-equals-health notions that had been fostered. He described “metabolic fitness,” which in particular addresses how the body is able to produce and respond to insulin. He advocated that people of any size keep active for about 20 minutes per day, and commented that without losing any weight, most people could ameliorate Type 2 diabetes solely through eating and movement. Ironically, although he strongly opposed dieting, his publisher required him to include some sort of eating plan in order to get the book published. Gaesser’s work on fitness was supported by that of Steven Blair, of the Cooper Institute for Aerobics Research (fitness, rather than body size, determined longevity, and weight loss was correlated with higher mortality from heart disease), and Ralph Paffenbarger and I-Min Lee, of the Harvard Alumni Study (active men whose weight cycling seemed to have a much greater risk of death than people whose weight stayed stable). Another exercise physiologist, Wayne Miller, would go on to become co-editor with Jon Robison of the Journal of Health at Every Size, which succeeded the Healthy Weight Journal.

Therapist and educator Cheri Erdman’s two books, Nothing to Lose: A Guide to Sane Living in a Larger Body and Live Large!: Ideas, Affirmations & Actions for Sane Living in a Larger Body were published in 1995 and 1997, respectively. Erdman describes the “spiral of acceptance,” the process of coming to accept one’s body as it is. She co-created a support program, Abundia, offering an annual weekend retreat for larger women.

Another author, mental health researcher and therapist Carol Johnson, created her esteem-building program, Largely Positive, several years before her book, Self-Esteem Comes in all Sizes: How to Be Happy and Healthy at Your Natural Weight, was published in 1995.

Barbara Altman Bruno, a clinical social worker and educator, wrote Well Being columns in Dimensions magazine starting in 1995, while physician Moe Lerner wrote a health column called “Heretic Physician.” Bruno published Worth Your Weight: What You Can Do About a Weight Problem in 1996. Like Erdman and Johnson, she supported people in building their health, mental health, and self-esteem, and she provided “eating lessons” (now known as intuitive eating), starting in the mid-1980s. Bruno, who was also NAAFA’s Mental Health Advisor, wrote Guidelines for Therapists Who Treat Fat Clients (co-written again with David Garner and twice more with Deb Burgard). In 1999, she and psychologist-educator Michael Loewy published “Weight Problems and Solutions” in Current Thinking and Research in Brief Therapy, vol. 3.

Dietitian Linda Benjamin Bobroff presided over a session on Moving Away from Diets at an American Dietetic Association conference in Orlando during the mid-1990s.

In 1995, the Society for Nutrition Education recognized the Weight Realities Division, a group of nutrition professionals supporting a Health At Every Size approach. Members of the division included Joanne Ikeda, Ellen Parham, Michelle Grodner, Adrienne White, and Francie Berg. In 2002, joined by Jennifer Buechner, Anne McPherson, and others, this group published a HAES-oriented resource list at http://www.sne.org/weightrealitiesdivision.htm. They also published guidelines for childhood obesity programs. In 1998, Ikeda wrote If My Child Is Overweight, What Should I Do about It? In 1999, nutritionists Karin Kratina, Dayle Hayes, and Nancy King published Moving Away from Diets: New Ways to Heal Eating Problems & Exercise Resistance.

Also in 1995, W. Charisse Goodman’s book, The Invisible Woman: Confronting Weight Prejudice in America, pointed out that “Weight prejudice supports a greed which cloaks itself in a hypocritical concern for health, much as the racist philosophy of the ‘natural order of things’ once supported the American slave trade”(p. 32). She also likened weight prejudice to sexism and anti-Semitism.

(Originally Published in the ASDAH August, 2010 newsletter, edited April, 2012 and August 2013)

Footnotes:
1. Johanes, L and Stechlow, S. “Dire warnings about obesity rely on slippery statistic,” in The Wall Street Journal, 2/9/98.

2. The ongoing Nurses Health Study presented a number of publishing biases. Being neither randomized nor controlled, it surveyed mostly-white female nurses in 11 states. Weight was self-reported by mailed-in questionnaires. Even more unfortunate, the data in its 1995 report applied to only a small subgroup of the nurses studied. Deaths in this subgroup, which was used to rationalize the NHLBI guidelines, totaled only 11 percent of total deaths and only 4 percent of the sample in follow-up. Even so, the adjusted relative risk of 1.2 for mortality for BMIs of 25 to 26 was not statistically significant. Racial and gender comparisons could not be fairly made since 98 percent of the nurses were white and nearly all were women.  However, unlike most other studies, which found lowest risk at a BMI of around 24 to 30, the Nurses Study reported higher risks at a BMI as low as 23. This was apparently the desired result. (Healthy Weight Network)

bruno_barbaraBarbara Altman Bruno, Ph.D., LCSW, is a clinical social worker,  size acceptance activist, and HAES pioneer.  She has presented at clinical conferences, appeared in television, radio, magazines, newspapers, and demonstrations, and has written many articles, including well-being columns for larger people, guidelines for therapists who treat fat clients, a brief history of HAES, and a book, Worth Your Weight (what you CAN do about a weight problem).  She is former co-chair of education for ASDAH and is on NAAFA’s Advisory Board.

5 Responses to “the HAES® files: History of the Health At Every Size® Movement—The Mid- to Late 1990s (Part 4)”

  1. It is obvious from this remarkable history that the weight loss industry (including diet companies, pharmaceuticals, and bariatric physicians) will stop at nothing to keep the industry alive and profitable, under the guise (and now and then, good intentions) of helping fat people.

    They’re still at it, but its up to those of us in the movements supporting size acceptance and HAES® to keep them on their toes (and be a badly-needed source of information and inspiration to people who no longer trust the industry to tell the truth.)

  2. A few additions…about presenting 3 times at the American Dietetic Association (ADA) regarding HAES in the 90s, and writing the first chapter written for a professional diet manual on HAES, though not getting invited back after that!!!!……

    Karin Kratina, PhD, RD, LDN

    I think the first time HAES concepts were presented at ADA was when I presented with Dayle Hayes, MS, RD and Nancy King, MS, RD, CDE and Karen Carrier (a leader in the field back then) at American Dietetic Association’s 77th Annual Meeting in Orlando, FL in October 1994. The title was “Women, Weight and Hunger: Shifting Paradigms and New Frontiers. We introduced the HAES paradigm to a standing room only audience of over 5000, with monitors posted at the doors so no one else could come in.

    We were hopeful that ADA would pay attention to this overwhelming interest and provide more HAES presentations. The next year we presented a 4-hr preconference workshop at their 78th Annual Meeting in Chicago, IL in October 1995. Title: “If Diets don’t Work, What Can A Nutrition Professional Do?” Again, standing room only with people turned away. In spite of that, future proposals were refused and it was years before HAES was discussed again at the ADA meetings.

    HAES was introduced to The Florida Dietetic Association Annual Meeting in Palm Beach Gardens, July 1996. My talk was “When is ‘Overweight’ a Health Risk factor?”

    In 1996, we three (Kratina KM, King NL, Hayes D.) wrote Moving Away From Diets: New Ways to Heal Eating Problems and Exercise Resistance. This was the first book (?) written for health care professionals outlining how to implement a “nondiet” persective, but was short on HAES research.

    The very next month, I attended The Association For Health Enhancement of Large Persons conference in Mountain View, VA (November 1996). I spoke about how to quit dieting and begin “Hunger Work: Reconnecting to the Joy of Physically Connected Eating.” But the MOST important presentation was Glenn Gaesser’s Big Fat Lies!!! You could hear a pin drop as we were amazed at the collection of research Glenn presented about the lies of obesity research. I can still remember how thrilled I was, how thrilled everyone was to have this new resource (and wished I’d had access to it when writing our book.

    Glenn Gaesser and I introduced the HAES concepts to the eating disorders world at the Eighth Annual Renfrew Center Foundation Conference in Philadelphia, PA in November 1998 when we presented “Pathology or Biology: Dealing With ‘I Feel Fat’ and Related Issues.”

    I introduced HAES concepts to the Virginia Dietetic Association Annual Meeting in Charlottesville, VA, in March, 1999. Title: “Moving Away From Diets: New Ways to Heal Eating Problems.”

    I co-chaired the Sixteenth Annual SCAN Symposium held in Cincinnati, OH in March, 1999. We were able to bring in such illustrious speakers as Marilyn Wann, Pat Lyons, Joann Ikeda, and Glenn Gaesser to introduce size acceptance and HAES to dietitians.

    We FINALLY got HAES back into ADA at the American Dietetic Association 82nd Annual Meeting in Atlanta, GA in October, 1999. I put together and led a panel discussion with John Foreyt, PhD and Rebecca Reeves, MS, RD on the one side and Glenn Gaesser, PhD and Dayle Hayes, MS, RD on the other. Because ADA was so resistant to anything that might hint of negativity in regards the diet industry, we had to call it “Dieting and Nondieting: What are the Common Grounds” just to get it accepted!!!!!!

    In 2000, Glenn Gaesser and I did a series of full day workshops on the east coast exploring and implementing HAES concepts.

    In 2003, I updated and expanded Moving Away From Diets: New Ways to Heal Eating Problems and Exercise Resistance. Added were a chapter on HAES related research written by Glenn Gaesser, and a HAES overview written by Jon Robison and myself. To my knowledge, this was the first book written about HAES implementation, calling it HAES, for the professional.

    In 2005, I wrote a chapter for the Handbook of Medical Nutrition Therapy: The Florida Diet Manual titled New Interventions for Eating and Weight Problems: Health At Every Size. (Tallahassee, FL: Florida Dietetic Association, Inc.) I believe this is the first addition to any diet manual in the US about HAES. I don’t think they knew what they would be getting when I proposed it, and I’m not sure they were pleased, but were committed to printing it once I turned it in. I did feel a bit sneaky about it.

    Interestingly, I had been an invited author to write their chapter on eating disorders 3 years in a row. (Kratina KM, Albers, MM. Eating Disorders. In: Handbook of Medical Nutrition Therapy: The Florida Diet Manual. Tallahassee, FL: Florida Dietetic Association, Inc. 2005.) But after writing that chapter on HAES, I was not invited back. Hmmmm.

  3. Karin, you were and are a pioneer who is an inspiration to all of us, and so are many of the other names you mentioned.

    I remember meeting you at the AHELP conference in Virginia–I think it was at a resort called Smith Mountain Lake, where the film “Dirty Dancing” had been shot, and how impressed I was with your presentation–Dr. Gaesser’s too.

    A common thread in the events you describe is how much of an uphill battle HAES® can be to sell. We all know how heavily invested in the older weight-related models most healthcare professionals are, not to mention lay persons. Old beliefs die hard! Nonetheless, there is an important and growing audience for HAES, thank goodness!

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