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.
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