HAES
Health at Every Size
By Frances O’Neil, RD, MSW, CDE
Founder Dr. Linda Bacon


Earned her doctorate in physiology, specializing in
weight regulation, from the University of California,
Davis.
graduate degrees in:
– psychology, specializing in eating disorders and body image
– kinesiology, specializing in exercise metabolism

Currently
– nutrition professor in the Biology Department at City College of
San Francisco
– serves as an associate nutritionist at the University of California,
Davis.
– private consulting practice, advising on strategies for
implementing Health at Every Size.
Could being fat be the
preferred state for the
human body?
Weight Loss, the Challenge

Programmed to store excess calories as fat
– Has allowed us to survive catastrophic events throughout
history.
– Will having extra fat on our bodies allow us to survive the
challenge of old age?
– Are we fighting a losing and unethical battle, ie. taking away
ones right to choose what is the right size for them, how to live
their lives, etc. and instead simply providing a means by which
some people profit?

consider the effort put forth to maintain your weight.
– Is it stressful?
– Are we designed to handle that kind of chronic stress?
Weight Loss, the Challenge con’t

According to highlights from a symposium, “Your
Brain Can Help You Eat Better,”
– The more we think about food, the more we want it
– Some people have less dopamine receptors in their
brain requiring more food to give them pleasure
– For some people, they choose foods with known
higher calories levels because they think it will taste
better
– The more food decisions a person has to make per
day, the less self-regulation they have.
Weight loss, the Challenge—Con’t
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According to the article, “Time to Abandon the
Notion of Personal Choice in Dietary Counseling
of Obesity,” JADA, Aug 2011
– access to highly palatable foods makes one extremely
vulnerable to overeating
– Life stress and other factors can easily disrupt
inhibitory control
– For many, instant gratification has far greater
influence than a future goal of weight loss
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Of all the conditions that we treat, weight loss is
the most challenging—agree?
It could be said that weight loss enjoys
special immunity from accepted
standards in clinical practice and
publishing ethics.
Standards for Treatment of Weight
Loss

Are there any? Should there be?
– It seems that anything goes.
– There are no guidelines as to what is safe
and acceptable.
– Is the practitioner required to tell a patient if
they are overweight or obese and if so, what
exactly do they tell them?
– What is the protocol for an overweight or
obese person.

Ethics Regarding Weight and
Treatment of the Overweight and
Obese
Are there any? Should there be?
– Are we continuing to promote the stigma and
therefore creating a barrier to the solution?

AIDS vs. Obesity
– The AIDS community has been very effective
at destigmatizing AIDS and as a result have
been able to harness massive resources to
effectively treat it.
– Why can’t we do the same for obesity?
Who Benefits From The Pursuit of
Thinness?

The U.S. weight loss industry
– $58.6 billion annually.

The bariatric industry
– According to the consumer guide to bariatric
surgery,
 average cost for the gastric bypass procedure-$18,000 to $35,000
 gastric banding--$17,000 to $30,000.
HAES’ Mission

To take the focus off of weight and place
it on health (health promotion)
– Weight is not a determinant of health
– People can be healthy at any size other than
at the extremes
– Make recommendations that are weight
neutral
 Weight is not a behavior
 not an appropriate target for behavior
modification.
Assumptions made About
Weight
Adiposity poses significant
mortality risk
obesity is associated with increased risk for
many diseases, causation is less wellestablished.
 studies rarely acknowledge

– fitness, activity, nutrient intake, weight cycling or
socioeconomic status
– When studies do control for these factors, increased
risk of disease disappears or is significantly reduced

Weight cycling results in increased inflammation,
which increases risk for many obesity-associated
diseases
Con’t

According to the Center for Disease
Control
– "even severe obesity failed to show up as a
statistically significant mortality risk
– overweight people live slightly longer than
people of 'healthy weight
Con’t
obesity may be an early symptom of
diabetes as opposed to its primary
underlying cause.
 visceral fat, the fat in our organs, that is
more highly associated with disease, can’t
be measured
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The pursuit of weight loss is a
practical and positive goal
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Placing excessive value on weight loss creates anxiety
about weight.
– Evidence from the eating disorder literature indicates an
emphasis on weight control can promote eating disordered
behaviors.
– Stress itself alters metabolism independent of a person's lifestyle
habits
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Focus on weight stigmatizes and results in discrimination
against fat individuals.
– Extensive research indicates that stigmatizing fat demotivates.
– Adults who face weight stigmatization and discrimination report
consuming increased quantities of food, avoiding exercise, and
postponing or avoiding medical care (for fear of experiencing
stigmatization)
The only way for overweight and
obese people to improve health is to
lose weight
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most health indicators can be improved
through changing health behaviors,
regardless of whether weight is lost
– Aerobic training resulted in improved insulin
sensitivity and blood lipids even in individuals
who gained body fat during the study
Obesity-related costs place a large
burden on the economy
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estimate fails to account for:
– physical activity, nutrient intake, history of weight
cycling, degree of discrimination, access to (quality)
medical care, etc. that could be contributing to
disease
– socioeconomic class, weight tracks closely with
obesity
– as well as eating disorders, diet attempts, weight
cycling, reduced self-esteem, depression, and
discrimination as a result of stigmatization.
Con’t
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Because BMI is considered a risk factor for
many diseases, obese persons are
automatically relegated to greater testing
and treatment
Con’t
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a study which examined the "healthy obese" and the
"unhealthy normal weight" populations found:
– a substantial proportion of the overweight and obese population,
at every age, who were healthy and a substantial proportion of
the "normal weight" group who were unhealthy.
– BMI profiling overlooks 16.3 million "normal weight" individuals
who are not healthy and identifies 55.4 million overweight and
obese people who are not ill as being in need of treatment
– this could mean that
 31 percent of the population is mis-identified when BMI is used as
a proxy for health.
Con’t

2009 study published in the American
Journal of Public Health examined how
often a group of people with similar
backgrounds and health reported feeling
sick over a 30-day period
– Results indicated that body image had a much
bigger impact on health than body size
Weight loss will prolong life

One study looked at post abdominal
liposuction patients
– Participants lost an average of 10.5 kgs but
saw no improvements in obesity-associated
metabolic abnormalities
– Note that liposuction removes subcutaneous
fat and not visceral fat
Con’t

people who lose small amounts of weight
generally get as much health benefit from
the intervention as those who lose larger
amounts.
Anyone who is determined can lose weight
and keep it off through appropriate diet and
exercise
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The Woman’s Health Initiative
– 20,000 plus women
 maintained a low-fat diet, reducing their calorie
intake by 360 calories per day
 significantly increased their activity.
 After almost eight years:
– there was a loss of only 0.1 kg
– average waist circumference, which is a measure of
abdominal fat, had increased (0.3 cm)
Con’t
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National Institutes of Health
– "one third to two thirds of the weight that is
lost is regained within one year and almost all
is regained within five years.“
– More recent review finds one-third to twothirds of dieters regain more weight than was
lost on their diets
"if shame were effective
motivation, there wouldn't be
many fat people."
HAES’ Approach
Encourage body acceptance as opposed to
weight loss or weight maintenance
 Encourage reliance on internal regulatory
processes, such as hunger and satiety, as
opposed to encouraging dietary restriction
 Encourage being active as opposed to
encouraging structured exercise.
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