My first exposure to the Health at Every Size® (HAES®) Principles more than a decade ago was a pivotal moment in my personal and professional life. Since then, I’ve come to realize that not only do many people not understand what HAES actually means (hint: it doesn’t mean that everyone can be healthy at any size), but that there were some issues with the version of the principles that helped change my trajectory away from pursuing intentional weight loss and promoting it in others.

These principles, which were very thoughtfully revised with a lot of community input, for the first time brings HAES® back to what it was always intended to be about: access to bias-free healthcare for bodies of all sizes.

The roots of HAES® begin with the fat acceptance movement of the late 1960s and early 1970s, which was entwined with other social justice movements fighting forms of oppression such as racism, sexism, agism, classism, etc. In the words of activist Johnnie Tillmon, spoken in 1972:

“I’m a woman. I’m a Black woman. I’m a poor woman. I’m a fat woman. I’m a middle-aged woman. And I’m on welfare. In this country, if you’re any one of those things you count less as a human being. If you’re all of those things, you don’t count at all. Except as a statistic.”

Unfortunately, some of the anti-diet books that started to come out in the 1980s focused less on the weight-based oppression stemming from fatphobia (or anti-fatness, since the “phobia” part implies that fatphobia is a mental illness) and more on the fact that repeat dieting can lead to weight gain over time — coupled with the idea that the reason we should stop dieting is so that we don’t become fat. That itself is an example of anti-fatness.

The first emergence of HAES®

It was in the 1990s that early versions of what would become known as Health at Every Size® started to emerge, blending elements of the non-diet approach and size acceptance.

The Association for Size Diversity and Health (ASDAH) released the first version of the Health at Every Size® Principles in 2003. They were:

  • Accepting and respecting the diversity of body shapes and sizes.
  • Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional and intellectual aspects.
  • Promoting all aspects of health and well-being for people of all sizes.
  • Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite and pleasure.
  • Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercises that is focused on a goal of weight loss.

Health at Every Size® became popularized when researcher Lindo Bacon published the book by that same name in 2008. Unfortunately, this led to many, many people thinking that Bacon “invented” HAES, which is not true.

In 2011-12, ASDAH filed the trademark for Health at Every Size® and HAES® because of concern about co-opting by weight loss companies. Indeed, in spite of the trademark, there are many health clinics that claim to be HAES®-aligned yet offer weight loss.

Revised (and slightly improved) HAES® Principles

In 2013 ASDAH revised the Health at Every Size® Principles. You’ll notice that this version places more focus on weight stigma and other systemic inequities, but what really picks up steam in the mainstream are the last two parts (eating and movement), with some self-acceptance thrown in:

  • Weight Inclusivity. Accept and respect the diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  • Health Enhancement. Support policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to physical, economic, social, spiritual, emotional and other needs.
  • Respectful Care. Acknowledge our biases, and work to end weight discrimination, weight stigma and weight bias. Provide information and services from an understanding that socioeconomic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  • Eating for Well-Being. Promoting flexible, individualized eating based on hunger, satiety, nutritional needs and pleasure, than any externally regulated eating plan focused on weight control.
  • Life-Enhancing Movement. Support physical activities that allow people of all sizes, abilities and interests to engage in enjoyable movement, to the degree that they choose.

Unfortunately, how HAES® was interpreted varied widely — in ways that were often contradictory — among health professionals who were working within the traditional model of healthcare that puts a focus on weight loss.

It also really put the focus on HEALTH, which often was interpreted as “It’s sort of OK if you’re fat, as long as you’re healthy and you’re actively pursuing health.” Many fat people ended up in a position of feeling that they had to “perform” health.

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The big shake-up

By the end of the 2010s, things were coming to a head. For years, ASDAH and the “HAES® movement” had largely been steered by white women with at least relative thin privilege.

Even though the 2013 principles gave a nod to the fact that weight stigma is generally amplified in people who are “othered” in additional ways — based on socioeconomic status, race, gender, sexual orientation, age, and other identities — they were still a far cry from the origins of the fat acceptance movement.

I remember blithely attending the 2018 ASDAH conference (my first) and being hit head-on with the reality of the above two paragraphs. There were a lot of heated discussions, but they were discussions that needed to happen because they helped catalyze some real change.

In 2020, ASDAH refocused its efforts to be led by those most impacted by anti-fat bias. To be perfectly blunt, this did not sit well with some HAES-aligned providers who are in fact the least impacted by anti-fat bias (white, thin or small fat, educated).

I admit that during this time I was sometimes worried about saying the “wrong thing,” but I took that as an opportunity to listen and learn. This was true a million times over when I had just started working with Lindo Bacon as a ghostwriter on a revision of the book “Health at Every Size,” and everything blew up. I nearly had a panic attack before I wrote this Instagram post.

But I listened, and learned, wrote this Instagram post, then listened and learned some more.

The road to the new revisions

Over the past year-plus, ASDAH worked on a third revision of the HAES® Principles. As ASDAH leaders explained in a virtual meeting last month, the current revision was prompted by deep concerns that HAES® was being positioned as a social justice movement (which it actually is not), and that there is inherent healthism and ableism in positioning eating and movement as principles.

Also, as I alluded to above, the first two versions of the principles were the work of people who were (mostly) white, (mostly) thin or small fat, and (mostly) health professionals or academics.

And, this is KEY: the people most impacted by medical anti-fat bias did not find HAES® helpful for accessing compassionate healthcare.

Why? Because even if Superfat+ and fat BIPOC people followed those principles — engaging in joyful movement, ditching dieting and finding acceptance — they still found themselves in the position of not being able to access life-saving medical procedures because they were “too fat.”

This new revision is grounded in liberation and informed by community input. One aspect was also aiming to be clear on what HAES® and ASDAH are and are not (or can’t be).

  • ASDAH is the largest organized group of health professionals who care about providing care for fat people, but it’s not the only group addressing anti-fat bias in society or healthcare.
  • HAES® is not a self-help program,* but it is an orientation to health and healthcare that encompasses many approaches and practices.

*(Through this process, ASDAH leaders learned that there has been a proliferation of private practice dietitians and therapists offering the self-help version of HAES®. I fell into that trap for a while, I admit. Also, there are not NEARLY enough doctors and medical clinicians offering HAES®-aligned care.)

New HAES® Principles

Of course, many people of all sizes want to include food and movement in how they care for themselves, but the newly revised HAES® Principles include that in a way that emphasizes evidence-based, informed consent and personal autonomy, while avoiding the healthism trap.

  • Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum.
  • Wellbeing, care, and healing are resources that are both collective and deeply personal.
  • Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind.
  • Health is a sociopolitical construct that reflects the values of society.

Framework of Care for healthcare providers

Alongside the 2024 revisions to the HAES® Principles, ASDAH developed something new — a Health at Every Size® Framework of Care. This framework is intended to serve as a roadmap for healthcare providers to become HAES®-aligned. The core elements are:

  1. Grounding in liberatory frameworks (Health at Every Size® is not a liberatory framework or social justice movement in and of itself, but rather aims to align with other movements in order to further the journey towards liberation for all.)
  2. Patient Bodily Autonomy
  3. Informed Consent (provided without bias and with a focus on patient autonomy)
  4. Compassionate Care
  5. Critical analysis, application, and execution of research and medical recommendations related to weight
  6. Skills and equipment to provide compassionate and comprehensive care for fat people’s bodies
  7. Provider Roles and Responsibilities (includes applying ethical and liberatory frameworks)
  8. Tools that support wellbeing and healing without contributing to oppression
  9. Addressing Your Anti-Fat Bias
  10. Addressing Systemic Anti-Fat Bias

Each of these elements is equally important (#1 is not more important than #10), and if even one of them is missing, HAES®-aligned care is not possible. Healthcare providers need to seek ongoing learning to stay up to date and to continue to provide HAES®-aligned care.

Unfortunately, I’ve encountered providers who think they’re HAES®-aligned, but their mindset is stuck back in the early iterations of HAES®, which again, focuses more on the eating, movement and self-acceptance pieces. This makes it really easy for these providers to think that recommending intentional weight loss can be HAES®-aligned.

Carrie Dennett, MPH, RDN, is a Pacific Northwest-based registered dietitian nutritionist, freelance writer, intuitive eating counselor, author, and speaker. Her superpowers include busting nutrition myths and empowering women to feel better in their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute individualized nutrition or medical advice.

Seeking 1-on-1 nutrition counseling? Carrie offers a 6-month Food & Body program (intuitive eating, body image, mindfulness, self-compassion) and a 4-month IBS management program (low-FODMAP diet coaching with an emphasis on increasing food freedom). Visit the links to learn more and book a free intro call to see if the program is a good fit, and if we’re a good fit!

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