the HAES® files: Healthier At Every Size

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

My friend and colleague Bill Fabrey (founder of NAAFA and current Board Member of ASDAH) recently used the phrase Healthier At Every Size in an email thread. I started thinking about how, maybe, just maybe, a weight-neutral, health-focused approach is really always a Healthier At Every Size approach. Thinking about “healthier” versus “health” inspired me to return to my ongoing exploration of how we define health … hence this blog post.

No Such Thing as Perfect Health

Have you ever noticed how the phrase “in perfect health”—whether used in a news report or in conversation—is almost always followed by the information that the supposedly perfectly healthy person had a fatal heart attack or contracted a deadly disease? And let’s face it, people who promise you perfect health are almost always trying to sell you something. Because (IMO) no responsible health care practitioner would ever guarantee perfect health, for one simple reason: it doesn’t exist.

We have this illusion in our culture that there is a holy grail of health, a magic bullet, some special recipe of behaviors and metrics that means one has achieved health (cue the trumpets and angel voices). I believe health is an idea, not a thing. And if health is an idea, how we think about it and the language we use to talk about it really matter.

Framed negatively, health can be a commodity to be bought and sold or a status that serves to create a hierarchy of judgment around various physiological states or around certain health behaviors that are deemed culturally acceptable or unacceptable.

Framed positively, health may function as a resource we can draw upon or a process for identifying and working towards wellbeing and functionality of mind, body, spirit, and community, regardless of the challenges each of us faces in life.

Health as Capacity

Another way of thinking about health is as a capacity or, if you will, a skill-set. Jon Robison and Karen Carrier, in their excellent treatise on holistic health promotion, suggest a dynamic vision of health: “Health can be redefined as the manner in which we live well despite our inescapable illnesses, disabilities, and trauma” (p. 171). To that which is inescapable, I might also add socioeconomic inequities, bias, stigma, environmental toxins, and other circumstances that can affect our health. So there are all these difficulties that we face, and the question is how are we going to handle them? I have written previously about the theory of salutogenesis, which suggests that our primary goal as health professionals should be to facilitate our clients’ and patients’ “general resistance resources” that promote a “sense of coherence.” Research shows that those with a more robust sense of coherence tend to live better and longer.

Make no mistake: I believe that we should collectively focus our public health efforts on eliminating the bias and stigma, socioeconomic disparities, cultural pathologies (e.g., the thin ideal or our overstressed workplaces), and environmental conditions that negatively affect our health. But the question remains, while these pressures are being exerted on the collective level, how we should be framing health when we work with individuals? When we reframe health as a capacity, our focus shifts from how to achieve the holy grail of perfect health to how to build one’s capacity for joy, vitality, and well-being in the face of all these challenges.

“Empowerment” Starts to Take Shape

The literature of health promotion is replete with references to “empowerment,” but this concept often remains elusively vague. In part, it seems to me, this elusiveness may be traced to our desire to define health as a “state of complete physical, mental and social well-being” (the World Health Organization’s oft-quoted definition).

How in the world can I (as a health educator) empower someone to achieve that level of perfection? The answer is I can’t, because as noted above, such perfection doesn’t exist. But when we reframe health as a capacity—as a set of behaviors, attitudes, and beliefs that we can cultivate to support our ability to thrive—then the abstract concept of “empowerment” morphs into a tangible strategy.

So a better question is, how can we empower people to live well despite the inescapable difficulties we all face? One important thing that we can do as health professionals is to recognize that we neither can nor should attempt to control how our clients and patients define “health” or how they choose to cultivate that capacity for living well. What we can do is facilitate and support that cultivation. For many of us, this means reframing for ourselves how we do our work. As William Benda M.D. writes in his chapter in Consciousness and Healing (p. 37):

If I realize and accept that the patient is the ultimate master of his or her body, mind, and soul, and am willing to relinquish control, the outcome is a sense of empowerment worthy of the word.

The HAES® principles as articulated by ASDAH are completely consistent with this view of empowerment. The beauty of how the HAES principles work is that they accommodate a variety of approaches to health promotion and health care. I am presenting my view here, and I recognize that others may differ as to how to define health. To me, a HAES approach is not about achieving and maintaining some elusive state of perfect health. It’s about setting aside our limited and limiting views of health and affirming our right—at every size—to develop our capacity to live well.

5 Comments to “the HAES® files: Healthier At Every Size”

  1. Well said! I recall the email thread that led me to use the phrase “Healthier at Every Size”. It had to do with the conversation that HAES® advocates often have with people who say something like “do you seriously expect me to believe that someone can be healthy if they are fat like my sister, who weighs 500 pounds? She can hardly breathe…etc.” To me, even their sister has some choices that are consistent with HAES tenets. First, even at her weight, giving up dieting or other “heroic” measures to lose weight is the first step. Most 500 pound people have spent a lifetime ratcheting up their weight to what is it today, through dieting. Second, there are lots of things any of us, even 500 pound people, can do to be healthier. But typically, very large people have often given up seeking those things because there is no guarantee of weight loss, and they may even suffer from what Canadian researchers Polivy and Herman called the “what the hell” syndrome–“I’m going to die young anyway, so what’s the use?” Another variation of that is: “No potential partner will look at me until I lose 350 pounds, which is an unattainable goal, so why bother looking for a partner?”

    And, taking off my HAES hat for a moment and putting on my anti-size-discrimination hat, someone’s harsh treatment in society due to the size of their body is wrong, even if they aren’t so healthy, for whatever reason! As a simple test, ask yourself whether you feel empathy toward someone who has developed lung cancer, even though you know they smoked all their life despite the risks. I do feel such empathy.

  2. I’ve had success with long-term weight loss precisely because I never went on a diet. Instead I worked with an RD for two years. The focus was on health, not weight (at her direction, not mine; I was often frustrated by how little she wanted to focus on weight.) Over time I became aware of things like whole grains, saturated fat, and also the benefits and limits of exercise.

    I am one of the “lucky” ones because I had the money to spend on health care and organic food. I also live in a city where I can exercise year-round in (relatively) safe neighborhoods. My nutritionist’s current rates are $110 an hour. I doubt many health insurance plans would cover that. (Mine didn’t.) I notice how high my grocery bill is when I shop exclusively off Dr. Weil’s food pyramid. I can’t afford to be *that* healthy.

    One small sign of progress I saw recently: in an episode of “Perfect Couples” a character was encouraged to improve his eating habits. The focus was strictly on health, not weight. I don’t remember a single comment about his needing to lose weight even though the actor might be considered “slightly overweight” by show biz standards.

  3. I am reblogging this post because it fits in my belief system; health isn’t about size or shape or marathon running. I see thin people eating poorly and larger people eating properly; is one healthier than the other? I have seen larger sized people accomplish IronMan Triathlon and fitter looking bystanders saying “I could NEVER accomplish that”.
    Health begins as a state of mind; not a size or standard.
    I have lost just shy of 100lbs in a matter of 1 1/2 year and have kept it off for the past 1 1/2 year strickly because I didn’t look at it as dieting; I began to understand how to fuel my body properly, added movement into my daily life and changed the way I viewed myself.
    Thank you for the post. Melodie

  4. Reblogged this on Your Turn Women and commented:
    I found this blog post to be thought provoking and within a belief system I have. I hope you enjoy it!

  5. How wonderful it is to know that we are all responsible for ourselves in mind, body and Spirit. Noone has the right to control us in any area of our lives unless we unhealthfully allow them to. I read a great book in college (1986) called “Stigma” that adressed all types of false perceptions plus predjudices along with discussing the oppressiveness exuded if not encouraged by our brainwashing society’s dysfunctional (primarily male dominated) grid and standards. It’s so awful that our society is still bound by the things that perpetuate negativity, shame and hatred pertaining to the Divinely Created human form.

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