the HAES® files: A Move Toward the Dark Side?

by Health At Every Size® Blog

by Dr. Jenny Copeland 

“It is better to light a candle, than curse the darkness.”

In this movement, it often appears that we should choose between the two sides of a dichotomy. We must either uphold the HAES principles in their purist form or reside among the fringes of the community, isolated. The decision often feels “either / or,” leaving those who wish to proceed with a choice between belonging and exclusion.

We have among us professionals who have chosen the difficult path of existing within weight-loss centric environments, implicitly participating in the pursuit of weight loss to varying degrees. Rather than choosing the exclusion from this company, which accompanies genuine honesty in these cases, many choose instead to remain silent. To exist in this manner, as a solitary candle within the darkness, is hard. And until very recently, I was one of these professionals.

I am the psychologist on a bariatric surgery team. I perform pre-surgical psychological evaluations, provide psychological treatment as needed, and run a local support group for those pursuing or who have received weight loss surgery. The team I am a part of is made of respectful and compassionate providers – professionals who are not only aware of weight stigma dynamics but are also willing to learn more about them. I am proud to be a part of a team where my judgment is respected and patients have the relieving experience of being treated as a person – not a problem.

The most fascinating, enjoyable, and challenging aspect of my job is introducing individuals in this process to the HAES principles – especially intuitive eating and body respect. These are deeply ingrained in my philosophy, however, and not sharing them is not an option for me. That means from Day 1, my patients are exposed to this approach. Their recommended reading list includes The Fat Chick Works Out, Intuitive Eating, Embody, The Diet Survivors’ Handbook, and Health At Every Size. We talk about not waiting for life to start until after their surgery by learning to recognize the agency they have in their own bodies in the present, shifting from shame and blame to respect and acceptance. For some, the message simply does not resonate for them; they are not ready. They may even be convinced I am off my rocker: of course their weight is a problem and of course they are to blame for it, what could I possibly be thinking by implying otherwise?

The pieces all fall into place for others. And for them, amazing things have happened. One individual noticed recently that not only had she not been binge eating Halloween candy this season, but she had not even purchased a single bag. Another patient encountered feeding difficulties after a series of complications from the surgery. While I was frantically consulting with every expert I could think of and was suggested to me, she progressed from severe anxiety and pain with eating to consuming foods again. All on her own. How did she accomplish that, you ask? Two words: intuitive eating. She discovered “The Body Warrior Pledge” in Beautiful You prior to obtaining surgery and worked to change her inner dialogue to one of acceptance. With a little encouragement, she was able to rely on these principles while struggling in order to continue moving towards health and well-being. How would life be different for patients had they not been exposed to a body positive perspective? What is the result for patients who are only exposed to the HAES principles far after their surgery or, worse yet, who have never had that opportunity?

Research supports that the internalized experience of weight stigma has a tangible impact on an individual’s physical and emotional health. When people accept these stereotypes and prejudices as true, they experience corresponding increases in depressive symptoms, recurrent binge eating behaviors, increased caloric intake, decreased engagement in physical activity, increased cortisol reactivity, poorer weight loss outcomes when engaged in such treatment approaches, and higher HbA1C. Although there is little to no research on levels of internalized weight stigma in bariatric surgery patients relative to other patient populations, I would posit these individuals have significantly higher levels given their choice of intervention to “solve” the “problem” of their weight. We know that for the overall health and well-being of such individuals, internalized weight stigma cannot continue to go unnoticed. What, then, is the solution?

One of the most important facets of the philosophy we espouse is that these principles are valuable for any person, any body, of any shape or size. Should that mean those who are pursuing or have obtained weight loss surgery cannot benefit from them? I do not believe so. I believe we meet these individuals where they are in their level of body hatred, whether they choose an intervention we disagree with or not. It is for this reason I choose to participate in the bariatric surgery process, fully aware of the controversy and potential hypocrisy of such actions in our community. This decision is not for everyone: it can be unsettling and at times, outright disturbing for one who knows the perils of the pursuit of weight loss. Others may choose to work from the outside to dismantle this industry in the future.

I believe this overlooks the well-being of those who pursue bariatric surgery in the here and now. Although I may disagree with their choice, I will not undermine their agency and I do not have the power to change their minds. By the time I meet them, the majority of the individuals I work with are highly invested in this treatment option. Rather, by introducing the HAES principles these patients have the opportunity of full awareness of their options. If they choose to proceed with surgery, they are doing so with greater capacity for their health and well-being than they would otherwise have. The Health At Every Size® approach can be the candle, providing illumination and freedom that would otherwise, not be present. To me, that is worth it.

8 Responses to “the HAES® files: A Move Toward the Dark Side?”

  1. Hi Jenny. You are very brave. I hope you have the support of your supervisors, if they even have a clue what you are talking about. I like how you are trying to respect people’s choices while offering them alternatives. In my private practice, several people have opted for WLS, even after thorough research. What has been hard for me is watching the people who are very satisfied with it, seem to have an easy time of it, and it actually lasts over the long run. It has made me a little more humble. At the same time, I’ve treated many WLS survivors who are flooded with rage, grief, anxiety–all the feelings they were using food to hold back and now don’t have food as an option. It is very difficult to watch and see people through. Carry on! You are an inspiration.

  2. Yes! Yes! Yes! A million times YES!

    Whether a person engages in practices we agree with or not, their stigma experience is real and supporting their ability to learn to care for themselves, to embrace HAES, is equally as important (arguably, more). Meeting a person where they are is the most effective way to plant the seeds of change.

    The various philosophies about what a person can and should do with their body may be at odds, but the people within those communities who work to support the individual (who has a personal right to make any choice they want with their body) and who work toward preventing stigma in general should not be demonized. We must ALL talk and find the common ground where our efforts overlap and we can stop poor treatment and bad behavior.

    Very brave Jenny! Well written!

  3. Jenny, thanks for “coming out” around your excellent work 🙂 I, too, try to keep my focus on body autonomy when working with people who are making choices that concern me – and this applies to other things not just WLS. And I also wonder about the level of internalized stigma people opting for surgery have relative to other fat people. It would be interesting to see some research on that. Please continue to write and share about your experiences working amongst bariatric professionals and organizations; you are not alone in doing this work and we need to learn from you.

  4. I know it is heretical to say this in the Fat Acceptance community, but I’ve said it before (and been soundly chastised for it) and will say it again.

    I don’t exactly long to be thinner. I don’t actually care that much about my body size. But I do very much long to experience what life would be like in a non-stigmatized body. And if there were a safe way to get to have that experience, I would, even if it meant altering my body. Note the emphasis on “safe.” If I thought bariatric surgery were safe, I’d have it in a heartbeat, even if I knew that the weight was likely to be regained in 5 years. It would still give me a few good years of living in a non-stigmatized body, just for the experience of it.

    I have dieted many times, including medically supervised starvation (VLCD) diets (400 cal/day) and including a “Biggest Loser” style residential treatment program (the only differences from the TV show were that I paid $1000 bucks/week for it – 20 years ago when $1000 bucks went a lot further – and there was no chance of getting “voted out” — as long as I kept paying I could stay). Some of those times I became temporarily thinner — and I DO still remember -vaguely – what it was like to be treated like a “normal person” instead of like a fat person. I long to have that experience again.

    So call me heretical. I don’t care. I’m getting older and I won’t live forever. For most of my life I held out hope that either I would eventually find the “willpower,” or else medical science would find some treatment, that would allow me to have a body that was treated like that of a “normal person” by others.

    Now I have lost that hope. And learning to live comfortably with the fact that regardless of what I eventually die of, or how long I live before that happens, my death will be deemed a “preventable” result of my “obesity” and therefore, my own fault – and/or my own “choice” — that is my current challenge, one that I’d really just as soon not have to grapple with. I’d much rather be spending my mental and emotional energy on World Peace.

  5. Jenny, I just had an interesting project come across my radar – it is an attempt that Utah therapists are making to come to some points of agreement about what to do to help people with distressing same-sex attraction (DSSA) – people who, in Utah, are often raised in the LDS church. It is not the same situation, of course, and yet the openness to understanding all the complexities is leading to some interesting discussions here http://www.reconciliationandgrowth.com/

    I have always found the sexual-orientation-change-efforts (SOCE) issue to be an interesting contrast to the prescription of weight loss issue, but that is because I live 50 years later than the times when it was just as much a foregone conclusion that people should try to be heterosexual as that higher weight people should try to be thin.

    I really see this as an issue of responses to oppression, where there is really no right or wrong answer for an individual who is struggling to live as best as they can. I am not going to criticize the decision but I am also not going to criticize the way others who are members of the oppressed community might have feelings about it. My criticism is for the industries that create/add to the oppression and then make a profit selling an supposed individual solution to it.

    Whatever you can do as a healthcare provider to increase the informed consent, self-knowledge, sense of alternative choices, realism about the options, and empowement of your clients is good. Too many of us forget that we have an arsenal of tools for helping people with depression, social rejection, hopelessness, desperation, etc., that have nothing to do with weight, and we need more tools that are designed to support people who are living with oppression. For me, that has meant doing activism that seeks to end the oppression that makes my clients’ lives and health worse.

  6. All commenters were “on the money” but I found rg’s comment especially poignant–nobody active in size acceptance should try to make someone with her opinions feel chastised. My attitude toward those who have sought to avoid oppression by trying (again!) to lose weight, is to try to be supportive, to recognize that it is their body, not mine, that they are trying to change, and that they have to live with the results every day. I am always saddened when someone feels that the only way they can deal with an oppressive fatphobic society is to make themselves smaller–but even the most avowed SA activists can have a bad week and feel beaten down by the constant nibbling away at their self-esteem by that society.

    I only get angry when someone succeeds (usually temporarily) at losing weight by whatever method, and tries to convince everyone within earshot how wonderful their method is.

    • Well, I should say that for a lot of my life I also held out hope that some day my body would not be stigmatized for being fat, not would anybody else’s. In fact I devoted a fair amount of time and energy toward making that come to pass. I still hope that will be true some day, but the likelihood of that happening within my lifetime is growing less and less, in part because I’m getting older and we’re not any closer yet.

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