the HAES® files: Musings on Bridge Building

by Health At Every Size® Blog

by Dana Schuster, MS

In my role as a HAES advocate in the Health and Fitness realm and as an active volunteer with ASDAH, I often find myself trying to “bridge” with professionals and advocates from related disciplines. As I attempt to look for both common ground and be cognizant of points of divergence, I have become aware of an all too common, and seemingly “blind” entrenchment in weight-based thinking on the part of health colleagues. The way in which many health professionals talk about their work leads me to believe that they give no more thought to questioning the wisdom or efficacy of using body size, weight, or BMI as a baseline determinant for health, than they give to questioning the importance of breathing.

This realization again came to me in a powerful way recently, when I attended portions of the Association of Professionals Treating Eating Disorders (APTED) conference (I was there to staff the ASDAH exhibit booth). I became acutely aware of the degree to which weight seems to be embedded as a primary goal of many “successful” interventions for eating disorder (ED) professionals and treatment facilities. In reflection, I realized that up to that point in time all of my contacts with experts in the ED world had been with those who were already members of HAES communities.

Yes, my HAES comrades from the ED realm had talked about their own frustrations with the “disconnect” they saw in their colleagues’ views of ED clients relative to their expressed views of “fat” people. But until I sat in these ED workshops and listened to the conversation among these mostly non-HAES professionals, the degree to which weight-based outcomes seem to govern both ED thinking and practice had not quite hit home.

Some of the people I listened to and met probably do not even have an inkling that there might be an alternative approach to consider, let alone know the specifics of how they could actually work from a weight-neutral perspective. The idea that their weight-based thinking might be harmful in a broader context has probably never entered their minds. And, since they work in a field that apparently sets criteria for illness and recovery largely based on the “percentage of ideal body weight” that a client achieves (a reference I heard repeatedly), I found myself working hard to discover a point of reference where one might “connect” to talk about HAES principles.

I sincerely hope that readers who do work in the ED world from a HAES perspective will speak up with your comments and ideas about walking this tightrope.  From my lay perspective, I tried to jot down some possible connection points I heard from the conference presenters that just might be worth exploring further in pursuing the compatibility of a HAES approach.  I fully acknowledge that my ideas may arise from a place of ignorance and lack of experience, or may have already been attempted by others. Of course, my eagerness to find potential bridges might also simply arise from my general tendency to look for the positive in everything.

That said, here are the ED strategies I heard presented that might provide common ground for HAES proponents to build on:

  • “Strengthening the healthy self”
  • Encouraging individuals to “feel your feelings but challenge your thoughts”
  • Focusing on the “toxic environment vs. changing the canary”
  • Facilitating an individual to “reach out to people, not to his/her eating disorder”
  • Maintaining an “agnostic view of cause” (no blame)
  • Supporting the goal of putting “adolescent development back on track”

While I am not the person to bring expertise to exploring these points in significant detail, I will take the liberty of sharing a few of my additional thoughts on a couple of the aforementioned points.

It is clear that our culture generally asserts that a “healthy” state of being is inherently tied to a specific weight range, but I heard something a little different in this statement as presented in the ED workshops. It seemed that their concept of a “healthy self” was a broader and wiser notion – one that was about the positive and nurturing part of every person that knows s/he is a worthwhile individual who deserves to be taken care of. Is this not exactly the same concept that allows us to adopt HAES practices in our weight-obsessed world?

There is no doubt that the HAES model also encourages people to “challenge their thoughts” in much the same categories that the ED world seems to: food, restriction and dieting; body image and the glorification of thinness; perfectionism; self-esteem and nurturing. While the nuances and boundaries that each perspective presents may be different and need explorative discussion, it seems that the basic categories of concern do provide common ground that we share, and hence create a platform on which we might build together.

Lastly, I imagine most would agree that the toxicity of our environment around food, eating, and body image is likely to be a major point of commonality.  Again, the specifics may well be somewhat divergent, but if the HAES and ED communities made a concerted effort to come together to brainstorm how we can together challenge our current poisonous culture, both groups could end up moving forward in a way that supported our mutual goals.

I look forward to an ongoing exploration of this topic with all of you who are willing to share your insights, ideas, and concerns. Perhaps we will find this discussion will lead us closer to a way of building bridges so that we might maximize our ability to successfully and broadly infuse HAES thinking into a wide range of health disciplines.

Suggested Resources:

(1) Dr, Deb Burgard, The War on Obesity: The Eating Disorders Community at a Crossroads (Presentation at Eating Disorder Recovery Support, Inc. Conference 2012).

(2) Dr. Deah Schwartz, Some thoughts about Health At Every Size (HAES) (blog post)

(3) Dianne Neumark-Sztainer et al., Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents (American Journal of Preventative Medicine article)

5 Comments to “the HAES® files: Musings on Bridge Building”

  1. It’s troubling to me that the ED treatment community is so rooted in weight, but I think part of the reason – at least here in Ontario, anyway – has to do with the politics of the healthcare system and not just the individual biases and beliefs of the treatment providers.

    Our healthcare system is set up in such a way that individuals cannot access specialized treatment services unless they meet strict clinical criteria for AN or BN. If someone doesn’t purge at least twice a week for 3 months, then s/he doesn’t meet the criteria for being “sick enough” to warrant help. It sounds crass but essentially, one must be very ill before one can be considered eligible for care.

    At the same time, hospitals (here) are under tremendous pressure to maintain balanced operating budgets and often focus on turning over beds so that they can discharge patients quickly and admit the next person on the wait list. They focus on the re-feeding, the weight re-gain and the medical stabilization aspects, not the psychiatric, behavioural and psychosocial rehabilitation aspects. Many of our paediatric ED programs are no longer run by psychiatrists but by paediatricians for this precise reason.

  2. I am in the US. I am obese but I run 3-5 times a week. I try to eat healthy but I don’t forbid myself the occasional cookie or piece of birthday cake. My youngest son recently went to the doctor for his check up. He was nearly five at the check up. He is 51 inches tall which is off the charts for his age. His weight is also off the charts and would be slightly overweight for an 7 year old boy at his height. But the doctor kept going on and on about how my son should weigh about 40lbs at his age. So compared to other normal almost 5 year old boys my son is incredibly obese. My son is also incredibly tall compared to almost 5 year old boys. It makes me sad because my son knew exactly what the doctor was saying and it made us both feel really bad.

    • Amy, I am so sorry that you and your son are being treated this way. If your doctor must evaluate your son’s health based upon his growth chart, then the doctor needs to be savy enough to interpret the data correctly. When using a growth curve, we look for deviations, changes from HIS curve, not changes from the population’s curve. As his mother you would be the best one to evaluate his ‘health’ as you would know about his eating, physical activity and social/emotional well being. If your doctor is not willing to discuss these aspects, you may want to consider looking for a new doctor. I also hope that any of these weight/size discussions are being had without your son present. A child does not need to be burdened by this. The Best to you and yours.

  3. Dana, thank you so much for writing this article. I have been using HAES (R) in my work as an Eating Disorder Dietitian for year. I cannot see any other way to do effective work on ED recovery. One of the most challeging things for a client with an ED is to let go of weight as a defining factor. What is amazingly useful in treatment is not focusing on weight, instead focusing on health. Now ‘health’ may mean different things for differnt people. It may be having a heart rate in a range so you are not at risk for dying, it may mean getting your period routinely, having your electrolytes normalized, being able to eat enough to have the energy to focus on school, work or do activities, being able to eat enough to stablilize blood glucose levels and brain size and function, being able to eat a wide variety of foods in different settings without freaking out, being able to appreciate one’s body regardless of size/shape.

    I think part of the disconnect comes from what Amy mentioned above. Weight is used so frequently as the end all/be all to determine need for treatment. This is such a dis-service to clients who have all the symptoms of Anorexia, Bulimia or ED NOS, but are not ‘thin enough’. Often because the ‘world’ sees them as ‘normal weight’ or fat, the client doesn’t think they are as sick as they are. Many times these clients really need the advanced/higher levels of care, but do not get access due to insurance denial.

    Additionally, there is also a lot of research that uses weight restoration to define recovery or as a data point to measure. Weight is very cheap and easy to do. However, we usually get what we pay for. I wish researchers could get more creative in what is evaluated. I think some of the metal health research that focuses on improved cognition and mood is a worthwhile start.

    I have had clients actually say that their care providers as hypocritical as they tell the client that “it’s not about weight, we just want you to be healthy”, followed by ” you gained/lost — #s”, which is followed by ” you are doing better or you need to do better”. I tell these clients they are right, these professionals are hypocrites. But what are we going to do to focus on what is best for you to take care of yourself.

    I also think fear is another big driving force for practioners. If the practitioner ‘let’s go of weight’ as important to focus on, will they be setting the client up to ‘believe’ that it’s ok to continue with the ED behaviors. I think practioners need to ‘get brave’ and try to focus on the behaviours. It is a bit harder to do this type of work, versus focusing on the wt numbers, but I have found it to be a much more effective and valuable way of treating ED clients.

    Just my 2,3 or 4 cents!

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