the HAES files: promoting health or peddling weight loss?

by Health At Every Size® Blog

by Deb Burgard, PhD

My challenge – to health care providers, family, fitness and nutrition experts, school officials, our own government and public health agencies – basically, anyone who will listen – is to have the courage to make the argument for health without doing it on the backs of fat people.

It is obvious that creating environments that support human health is not an “obesity prevention” project. Do thin adults and children not deserve access to good nutrition, safe places and abundant opportunities to be physically active, freedom from bullying, teasing, violence, and discrimination? Whatever is good for human bodies is good for all human bodies, not only fat ones.

What is it that distorts the promotion of health into weight loss marketing?

Money is an obvious answer. The weight loss industry is extremely lucrative, and the grant money is flowing to researchers who can spin their projects as “obesity” related. Even people who believe in the Health At Every SizeSM approach are sometimes ambivalent about leaving behind the promise of weight loss, worried that weight loss is the “hook” that makes many people a customer for therapy, nutrition advice, fitness advice, etc.

But I suspect it is more than money. I suspect that many people just don’t believe that it is motivating to try to feel as healthy (energetic, rested, with less pain, more mobility, skilled, respected, and cared for) as possible. They don’t believe people will invest in the practices that support health if they are not doing it to lose weight.

Notice I say “as possible” – because health is not a binary good. It is dynamic, changing every day, changing over our lifetimes. But health feels good. More health feels better than less health. People deserve environments that allow them to be as healthy as they can at any given time. And, in these days of rampant healthism, it needs to be said that whatever degree of health they have does not equate with their moral worth.

I see every day that people are motivated to feel better, that they invest time and effort to do so. But the nearly universal pathway people use to do this is to try to lose weight, because they are told and they believe – despite their own experiences – that weight loss will deliver all those features of health: energy, mobility, respect and care from others. And then what happens? In the vast majority of cases, they are unable to sustain weight loss. The benefits they sought are fleeting or unattainable. So everyone walks away thinking, “well, you/I must not be motivated enough.”

 But what if the fruitless pursuit of weight loss was eliminated from this process? What if the focus could be on creating environments that support the practices that support the health of people of all sizes? What if our science investigated what those environments look like, and what approaches help people invest in those practices – and sustain them – even when they are challenging? What if our policy science investigated what sorts of laws and services support people making such investments?

I think we would see science confirming that discrimination and stigma harm health; that removing barriers to access to medical care, play opportunities, and nutritious food promotes health; and that helping people feel empowered and effective (as opposed to demoralized and re-stigmatized from weight regain) at whatever size, keeps us motivated to continue.

So I challenge us all to see the peddling of weight loss, in whatever guise, as a morally bankrupt act. Make it clear that causing more weight cycling and disordered eating is against the principle to “do no harm.” Tell the people who only have good intentions to take those good intentions and come up with 2-5 years of outcome data that shows sustained weight loss and sustained health outcomes for the majority of people before they inflict their intervention on the public. I challenge us all to demand this minimal standard of proof of value before anyone spends a single dime on weight loss, and before any one of us recommends a weight loss intervention.

Saying no to the pursuit of weight loss is only part of the challenge, though. The other more joyful challenge is to take the effort and ingenuity and hopes we are all capable of, and invest in our well-being right now. Do something for your body every day, and do something for everyone else’s bodies with your activism every day. Let’s prove the cynics wrong.

4 Comments to “the HAES files: promoting health or peddling weight loss?”

  1. This is a brilliant challenge to all of us to get real, finally, about telling the emperor that he has no clothes on. Health for all, intentional weight loss for none! (Except when it is incidental to improving health–I do believe that some people are above their natural setpoint weights for a multiplicity of reasons that are unhealthy in and of themselves, with a rise in weight a side effect.)

    Nature seems to resist our trying to reset our weight setpoints, but nature may not resist our trying to live healthier lives–with some physical activity, more nutritious foods that taste good, cutting out drugs, alcohol abuse and smoking, developing a positive attitude about life, perhaps doing yoga and meditation, and learning to accept yourself as you are. All those changes usually improve people’s health, whether or not they lose weight. The minute you make weight loss the goal, you are setting yourself up for temporary weight loss, weight cycling, and disordered eating. That’s too high a price to pay.

  2. Really interesting post.

    From a policy standpoint, one of the things I find most frustrating is that there are very few metrics for measuring outcomes. BMI is appealing because it’s relatively cheap & easy to track (so let’s set aside the fact that it’s seriously flawed as a measure of actual health outcomes).

    The upshot is you have interventions (aimed especially at kids) that are potentially really positive — encouraging activity & a healthy diet etc. — but it seems the only yardstick available for measuring whether the initiative is successful is BMI. And all the positive gains fall by the wayside: the initiative is deemed a failure because it didn’t make people thin.

    So my question/challenge is — how can we come up with metrics that are more meaningful and useful? and how can we get them out there so more scientists & policy makers are focusing on the right thing?

    • Thanks, Bluefish, we have actually done quite a bit of thinking about this. Metrics reflect how the “problem” is conceptualized, and what we value. In this case, we might ask, do we value thinness? Uniformity of body size?

      As you note, if you want to measure health, BMI is a terrible proxy. Someone recently equated it with the guy searching around the lamppost for his watch because that’s where the light is. But most kids’ health metrics – like cholesterol and blood pressure and so on – are fine. People might say, so we need BMI to predict who will have problems in the future. But again, BMI is a terrible proxy for future health problems too.

      Since I am psychologist I tend to measure feelings and attitudes and behaviors, and so what I care about is how the kids feel – about themselves, their bodies, life. How they make decisions about eating and playing and whether they are learning that their bodies are their partners in helping them make decisions or whether they are being taught that their bodies are a source of shame and stigma. From working with adults, I can see that there are certain skills that some people learn that allow them to optimize their health for a given environmental circumstance (and of course improving environments is just as important). They appreciate their flawed bodies and make efforts to practice what makes them feel as good as they can, in a flexible, non-obsessive, non-judgmental way. I think we should be studying them more!

  3. Does ‘doing something for my body’ include getting a sunburn? ’cause that’s about all I did today. Wandered over here from Well Rounded Mama’s blog. Congrats on the new digs and am looking forward to your posts!

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