The Evidence for HAES

Written by Naima Sullivan MS, RD, LDN

Edited by Sarah Criscuolo MS, RD, LDN, CSN, CPT

At Karuna, we embrace a Health at Every Size (HAES) approach to nutrition and wellness. We are a non-diet and weight inclusive practice, which means that we do not promote restrictive diets and that we accept and honor people of all body shapes and sizes. But, what exactly is the HAES approach, and is it really an evidence-based way to manage health?

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Some background…

Weight bias and discrimination are pervasive in our society, with profound consequences for individual and public health. Studies consistently demonstrate the detrimental effects of weight stigma on mental and physical well-being. Size discrimination exacerbates health disparities, leading to poorer health outcomes among individuals in larger bodies (Tylka et al., 2014; Hunger & Major, 2015; Phelan et al., 2015).

Moreover, the perpetuation of diet culture and weight bias is damaging to people of all sizes and contributes to the alarming rates of body dissatisfaction and anxiety, eating disorders, and disordered eating behaviors (Westby et al., 2021; Vartanian & Porter, 2016; Hunger, 2020). People in larger bodies are often blamed for their size and health status, but research consistently shows that social determinants of health have a more significant impact on overall health than weight and individual behaviors (Braverman et al., 2010; Marmot et al., 2008).

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Let’s put this into context…

Contrary to common belief, lower weight is not synonymous with better health. Studies examining the association between BMI and mortality consistently show that there is increased risk for mortality at both extremes of the BMI spectrum. However, compared to so-called “normal weight,” overweight is associated with lower risk for mortality and the lower end of obesity does not correlate with additional risk (Flegal et al., 2013. Flegal et al., 2005).

Despite pervasive cultural narratives, many studies fail to demonstrate that weight loss interventions result in significantly improved health outcomes (Mann et al., 2007; Tylka et al., 2014; Bacon et al., 2005, Tomiyama et al., 2013; Gaesser, 1999). There is also nuance that is missed when discussing health risks associated with higher BMI. Cardiorespiratory fitness and physical activity, for example, have a protective effect against mortality related to type 2 diabetes and cardiovascular disease associated with higher BMI (Wei et al., 2000; Gaesser, 2010; Wei et al., 1999).

Weight loss interventions prove largely ineffective, with failure rates of up to 95% in the long term (Gaesser, 2000; Mann et al., 2007; Lowe et al., 2013; Hall et al., 2018). Dieting is predictive of weight gain and this can perpetuate a pattern of weight cycling that is associated with numerous negative health effects, including increased risk of cardiovascular disease and metabolic disturbances (Lantz et al., 2010; Montani et al., 2015; O’Hara & Taylor, 2018). Even in adolescents, the strongest predictors of weight gain are dieting and unhealthy weight control behaviors (Field et al., 2003; Neumark-Sztainer et al., 2012).

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So, what is HAES?

The Health at Every Size (HAES) framework, developed by the Association of Size Diversity and Health, is an alternative to the weight-centered healthcare model. Grounded in five core principles, the HAES framework prioritizes health equity, endeavors to end harmful weight discrimination, and advocates for improved access to quality, respectful healthcare for individuals of all sizes. These principles can be applied to the way we approach health and well-being as a society, in communities, and as individuals.

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Health at Every Size Principles:

1. Weight Inclusivity: HAES recognizes that people of all body sizes deserve respect and equitable treatment in all aspects of society.
2. Health Enhancement: HAES encourages sustainable health-promoting practices, focusing on behaviors that enhance physical, social, and emotional well-being rather than weight loss.
3. Respectful Care: HAES advocates for compassionate, non-stigmatizing healthcare that addresses individuals’ needs holistically, without emphasizing weight as a primary indicator of health.
4. Eating for Well-being: Rejecting restrictive diets, HAES promotes intuitive eating, attunement to the body’s hunger and satiety cues, and awareness of how different eating patterns can impact the way one’s body feels and functions.
5. Life-Enhancing Movement: Encouraging enjoyable physical activity that prioritizes pleasure and function over calorie expenditure, HAES supports individuals in finding joyful ways to move their bodies.

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What evidence is there to support HAES practices?

Numerous studies highlight the efficacy of weight-inclusive interventions in improving major health outcomes, cardiovascular risk factors, and psychological well-being (Bacon & Aphramor, 2011; Tomiyama et al., 2018; Mensinger et al., 2016; Tylka at al., 2014). Research consistently demonstrates the benefits of physical activity to mental and physical health and overall quality of life, independent of weight (Bacon & Aphramor, 2011; Matheson et al., 2012; Swift et al., 2014). Adopting self-regulated and attuned eating practices has been associated with improved health outcomes, enhanced body satisfaction, and improved mental health (Tylka et al., 2014; Herbert et al., 2018; Schaefer & Magnuson, 2014; Hazzard et al., 2022). Promisingly, the physical and mental benefits achieved through weight-inclusive approaches can be sustained long-term.

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Putting it all together…

The HAES framework offers a scientifically supported alternative to the prevailing weight-centric approach to health. At Karuna, our work is informed by the clear evidence that weight bias is harmful and that weight-centered care can be ineffective in the long term and harmful to physical and mental well-being.

Wherever you are in your health and wellness journey, your Karuna dietitian will take into consideration the many aspects of your life that impact your health and well-being, including the effects of diet culture and weight bias. We are part of a network of weight inclusive providers who share our belief that people of all sizes deserve inclusive and respectful care. Use the link below to schedule an intake today!

If you are a provider interested in learning more about the HAES approach or would like to collaborate with us, we would love to hear from you!

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Resources:

• American Association of Size Diversity and Health:
  https://asdah.org/health-at-every-size-haes-approach/
• What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift: https://journals.sagepub.com/doi/10.1177/2158244018772888
• The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss:
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132299/
• HAES Healthsheets: https://haeshealthsheets.com/