I first came across the Health at Every Size movement almost eight months ago, while in an anthropology class at the University of Alberta. My professor assigned Rothblum and Solovay’s The Fat Studies Reader as a required textbook, which immediately caught my attention; I had of course heard of gender studies, race studies, and queer studies, but fat studies? What, I wondered, could be said about fatness? Flipping through its pages, I found—amongst such titles as ‘Part-Time Fatso’ and ‘Jiggle in My Walk: The Iconic Power of the Big-Butt in American Pop Culture’—Deb Burgard’s article, ‘What is Health at Every Size?’ I did a double take—Health at Every Size? The name itself seemed to contradict every fat-is-unhealthy message I’d ever heard from friends, doctors, and politicians who ‘fight’ the ‘War on Obesity.’ These messages are so pervasive in our culture that they are accepted by most as unquestionable, as beyond repute, as so obvious that they don’t even need to be said—and yet they are said. They are insisted upon over, and over, and over again. Why?
This is perhaps the central question of fat studies. Why has fat been socially constructed as unhealthy, unattractive, and even immoral? And perhaps more importantly, how do these beliefs affect people’s lives?
Until eight months ago, these were questions that I honestly never considered. At 5 foot 8 inches and 145-ish pounds, my weight has never really been a major source of concern. Even after I graduated high school, gained the seemingly inevitable freshman 15 (or, in my case, 20) and my family doctor told me to lose weight with such contempt that I cried on the drive home, it still never occurred to me to question fat-hatred and anti-fat discrimination. I, like most thin people, suffered from—dare I say it?—‘the skinny girl’s burden.’ That is, because fat-discrimination does not directly affect my daily life, I never really thought about how it affects others. However, this anthropology class forced me to step back and carefully reconsider health and its relationship to body size. Over the next few months, I became an adherent to HAES, and here’s why:
1. It makes sense.
The HAES model acknowledges a simple truth: bodies are not 100% under our control. If body size was entirely determined by diet and exercise, everyone who ate healthily and remained active would be slender, and everyone who does not would be larger. This is obviously not the case. We all know people who cannot attain the ‘ideal’ body no matter how hard they try, and others who are thin despite high caloric intakes and gross inactivity. Ah, genetic variability. Unfortunately, many of us seem to forget, ignore, or actively combat our genes, as the overwhelming social pressure to be thin leads millions of dieters to adopt extreme measures to lose weight. This is not a good idea. Numerous studies have shown that yo-yo dieting is actually more harmful to one’s health than maintaining a steady, larger BMI. HAES recognizes this and rejects weight loss as its central goal. Instead, it advocates healthy lifestyles—staying active, eating well, and taking care of ourselves on a daily basis. In HAES, a ‘healthy’ weight is not numerically calculated with pounds and inches, but is understood to be the weight that results from healthy behaviours, and varies enormously from person to person.
2. It advocates social justice.
However, as Burgard points out, the scope of HAES is not limited to physical health, but also includes emotional and spiritual well-being. This is due, in part, to the movement’s historical roots. Fat advocacy is often traced back to the 1969 foundation of the National Association to Advance Fat Acceptance (NAAFA), which was the first of many organizations to recognize body size diversity and challenge anti-fat stereotypes. These groups not only questioned the health benefits of dieting (is a ‘starved fat person’ really as healthy as an ‘always-thin person’?), they also questioned the supposed health detriments of fat, suggesting that anti-fat stigma may have a greater negative impact on one’s health than fat itself.
This, to me, is a very provocative argument. Consider last week’s story of the ObGyn doctor who called his patient fat and unhealthy without conducting any tests or asking any questions about her lifestyle. What if she came in to his office not for a routine exam, but with a specific complaint? Would he follow due diligence and conduct all necessary tests to make an accurate diagnosis, or would he assume that her weight must be the cause of her discomfort? Sadly, studies have shown that this is often the case; anti-fat discrimination is rampant in clinical settings, and leads to fat patients often receiving sub-par health care. Such discrimination also discourages larger patients from seeking medical attention in the future—why expose oneself to such pain and humiliation unless it’s absolutely necessary?
HAES also considers how fat stigma affects health outside of the doctor’s office. Larger bodies have higher levels of un- and underemployment than thinner bodies, earn lower wages for equal work, and consequently are more likely to have lower socioeconomic statuses. This creates a vicious cycle, as lower income levels reduce access to high-nutrient foods and safe physical activities. So while HAES encourages individuals to eat their veggies and hit the gym, the movement also recognizes that this is not always possible for everyone, and aims to combat social barriers to health.
3. It applies to everyone.
Like last week’s blogger, I can’t stand it when people accuse HAES to be an excuse to be fat. HAES is a weight-neutral health paradigm. It doesn’t care what you weigh, only whether or not you can and do live healthily. It does not only apply to larger bodies, but ‘skinny-fat’ bodies as well—it applies to me.
Here is a brief history of my body. I was always a slender child, but I became quite athletic in junior high, when I started to dance at least 2 hours a day. After high school graduation, I quit ballet, discovered beer, and reached my weight zenith around age 20. I did eventually lose 15 pounds, resuming my 145 pound average, but not because I dieted or exercised, but simply because I moved out of undergraduate residence and stopped eating excessive amounts of poutine. With the exception of several short-lived bouts of fitness-mania, I had been almost completely inactive for 7 years. Although I was thin, I was not healthy. In March, however, I actually sought out the gym in my apartment building, and starting going 4-5 times a week. In May, I registered in ballet classes at my university. I started cooking more. Although I’m not sure I made the connection at the time, I think my exposure to fat studies and HAES seeped into my subconscious and motivated me to become active again. And although I haven’t lost any noticeable weight, I do feel a lot better!
Me (on the right) during my first year of university.
Now, to those ‘skinny-fat’ people who argue that HAES is an excuse to stay fat, I would counter that, for you, the biomedical model of weight and health is an excuse to stay inactive. It’s all a matter of perspective. Doctors, friends, parents and politicians who equate thinness with health are not doing thin people any favours; in fact, thinness may function as a kind of veil concealing ill health. Health concerns should not therefore focus exclusively on large bodies, because a) many fat people are healthy, and b) many thin people are not. We all need to be encouraged to pursue health, regardless of size and without the impediment of judgement and discrimination.
As a fat chick I have to say I haven’t been real open to the whole HAES thing. I’ve followed a few of the HAES blogs and I have to say I’m not a huge fan. Pardon the pun. It’s like a good fatty/bad fatty game. It’s fat people who are trying to convince everyone they are just as healthy as skinny people when in reality they are playing the exact same shame game. Oh, ok, you can dance/exercise/do splits/whatever at that size so I’m supposed to know it’s ok to show you some respect. Forget that. I don’t care if you sit on your fluffy ass and eat Cheetos and cupcakes all day everyone deserves to be treated decently.
Yes, there’s a lot of stigma about weight, yes, you do indeed get substandard medical care if you’re fat. Been there had that. But trying to convince them we are all good fatties who eat our vegetables is not the answer. Shaming the shamers is the answer. You don’t get to half ass treat someone because they are something you dislike. How many times are drug addicts treated to that same behavior? Maybe not as often because drug addiction is hide-able to a degree but if they knew they’d be just as scummy about treating those people bad, because that’s how shamers are.
I also disagree with the bottom line premise that you can have *real* health at any size. Having been huge (and after a 120 pound loss still am) I can tell you that although I was active and even began eating well I was not/am not healthy. There comes a point where it’s just not possible to be both big and truly healthy and it’s hard to admit that on some level. I think HAES is somewhat a balm for the fat. Maybe some of us need it, and if it gets them off the couch great, but it’s not truth. You don’t have to be rail thin to be healthy but you do have to be a size your heart can handle or you are genuinely kidding yourself.
There are people who will happily take any excuse for their mistakes. You can’t pick them out of a crowd by their size however. Not many sensible people will argue that they are healthy if they can’t walk a mile, no matter how much they weigh. Obesity researchers like Arya Sharma write about the dangers of focusing on weight loss, and the wisdom of counseling weight maintenance and good health. I think this is more when HAES is about.
If you are not healthy and you know you are not healthy – then do what you need to do to change that. But don’t kid yourself into thinking losing the weight is the one and only fix. It isn’t. It’s the attitude shift that makes you a healthier and hopefully happier person.
I ran across this Salon.com article on Holley Mangold (Olympic weightlifter) and thought of these HAES posts. I don’t think anyone can argue that this woman just doesn’t work out enough, or hard enough.
At my gym, I routinely see trainers put overweight women through fast-paced programs with light weights and emphasis on the cardio – lots of step-ups, swinging of kettlebells, then up to the treadmill – obviously geared towards fat loss. It always kind of looks like hazing to me. If I were a trainer, I think I’d want to get these women under barbells, pushing some weight and hopefully feeling kick-ass. As Mangold shows, there are some positive aspects of larger size (strength, power). I like the idea of emphasizing getting stronger, rather than smaller.
Thanks Terra. I agree with what you say about training women who are new to fitness, and have seen experienced trainers do a good job, focusing on weights as well as cardio, among other things. However, a few trainers have told me that many female clients demand fat loss results and want them rather quickly, and do not see as much immediate benefit from lifting weights. This is foolish. I think some trainers deliver hardcore bootcamp style programs in order to give their clients what they want and to keep them motivated.
@Anne Did you actually read what you were responding to? After 120 pound loss I think I know *exactly* what needs to be fixed, and yes, it’s only the weight. The bottom line is about weight. I’ve always been a fantastic person in all the ways that matter to me, but the bottom line is physical. I can also walk a mile, I don’t feel that’s an acceptable measure of health. And why are you assuming I share your values that happiness is a goal? That’s awful presumptive for someone just reading someone’s comment on a blog. Sharma can kiss my weight losing butt. Focusing on losing it is exactly how it gets done. It’s not dangerous, it’s necessary – and if that’s what those people think we can chalk that up to another reason I could care less what they have to say.
@Terra I agree completely. But trainers are all about making sure a client comes back first and not pissing off the insurance people second. Putting the fat people under heavy weights is not one I’ve seen them do. One reason I don’t use one myself.
If groups like HAES are contesting the notion that skinny = health, by that same standard, how do they justify the notion that the marginally and morbidly obese are healthy? Seems to me that they, too, are correlating health to one’s size.
I have trained several women in the past, all 50+, and, with the exception of one woman, to varying degrees, overweight. Here’s my experience, anecdotal as it may be. People are lazy, they actually do not want to work their way to health if it’s deemed too heavy, too sweaty, too hard. People will cling to every excuse imaginable not to make the necessary adjustments to attain health. And, to boot, none of them sought readily available medical care to determine whether they were healthy, or unhealthy, from the get-go.
Are members of HAES, unlike my small sample group, just that much more uniquely proactive about their health? What’s the definition of ‘health’, anyways?
Last anecdote. I was out last week with one of my girls and we ran into her g/f, who would qualify as ‘morbidly obese’ – and screw BMI, she was very fat by anyone’s standards. She was decrying her lack of physical activity, her weight gain, and my friend’s response was, ‘as long as you’re happy’. Her response is tantamount to what HAES preaches. I call bullshit on that.
I really appreciate this comment Hewon. I have not done much personal training myself, but have heard from other trainers that clients can make 1,000 excuses to over-eat and avoid physical effort of any kind.
Whether a person is lazy is not the issue. The issue is whether or not shame is a good motivator. It is not. That is what HAES is fighting. Many people seem to feel comfortable deciding what fat people should do or not do. Do you walk around lecturing smokers? Do you go to bars and try to convince the heavy drinkers to start taking taxis?
“If groups like HAES are contesting the notion that skinny = health, by that same standard, how do they justify the notion that the marginally and morbidly obese are healthy?”
I’m not an expert on HAES, but I don’t think they’re contesting the notion that skinny = health. I think they’re contesting the notion that all skinny people are healthy and all fat people are unhealthy.
As an inactive, binge-eating-disorder suffering size 22, I was definitely unhealthy. I took steps to change that and became an active, mostly-eating-well size 14. My physical endurance, mobility, and lab tests were all excellent. I was healthy by every measure except BMI.
I’ve since dropped another 3 dress sizes solely because I wanted to be thinner. My physical health has in no way improved from that further weight loss.
Thanks for all of these comments. I agree that HAES is primarily trying to unlink assumed relationships between health and size. I also agree that getting skinner won’t necessarily make someone healthier. However, I insist that challenging workouts will make people healthier (though not necessarily any smaller or bigger).
I also wanted to respond to a previous statement in which dieting was equated with starving. Good nutrition has nothing whatsoever to do with a lack of food. Eating well means eating the right food, including lots of protein, in smaller amounts throughout the day. When I leaned out for my figure show I was never hungry; I am rarely hungry now. I sometimes want to eat cake or cookies but have a protein pancake instead. Those are the sort of nutritional decisions I make on a regular basis; I have no idea what other people do. Still, I think that the HAES principal of eating what you want to eat and doing so with pleasure will likely make almost anyone fat (regardless of ‘genetics’)—mostly because over-consumption is a key facet of western culture. Even people who think that they are eating reasonably are actually over-eating, showing little restraint, because we are continually encouraged to eat massive amounts of unhealthy food by the fast food industry among many other sources. In other words, I think that most people underestimate the amount of food they eat—thereby regularly over-eating—and overestimate the amount of exercise they do because our cultural standards are so feakin’ low on both issues.
Great article! While I’ve never been obese, I’ve had periods of time in my life in the past when I was heavy, & as an adult I’ve been slim, so I know how it feels to be both. And one thing that I CAN’T STAND is naturally thin people that are slim only out of luck that act like a.)somehow they have more discipline & are overall better than heavy people and the absolute most annoying of all, b.) naturally thin people that have never worked at it a day in their lives that go around acting as though they do. I see this constantly on Youtube with beauty gurus, they’ll do a ‘my diet and fitness routine’ video, & it’ll be very obvious that they have no clue what they’re talking about, & are just repeating certain buzzwords like ‘Trader Joe’s’ or ‘Gluten Free’, or saying whatever just so coincidentally was just on Dr. Oz that very week.Or saying common sense things like ‘I drink water instead of soda!’ like it’s some huge revelation, because they really don’t have anything genuine to say, being they probably don’t even do that. Or maybe go on a hike with friends twice a year & act like they work out. It’s just ridiculous. I liked what you said at the end, how if they say it’s an excuse to say fat, tell them it’s no more that than an excuse for them to stay inactive. Which they would never admit to anyway, but whatever.