Health at Every Size – this man’s take

Today I’m going to talk about Health at Every Size and what this means to me. I’m going to mention the word diet a few times along the way. Right now so that there is no confusion, I want you to interpret the word ‘diet’ as meaning “what someone (or something for that matter) eats” not “the restriction of food intake to try to lose weight”. All animals have a diet, like squirrels live on a diet of nuts and berries (or so cartoons taught me). Humans live on a varied diet depending on which region of the world they live in and how plentiful different types of food are (or conversely, what little food is available).

What is Health at Every Size? Wikipedia lists these three components:

  1. Self-Acceptance: Affirmation and reinforcement of human beauty and worth irrespective of differences in weight, physical size and shape.
  2. Physical Activity: Support for increasing social, pleasure-based movement for enjoyment and enhanced quality of life.
  3. Normalized Eating: Support for discarding externally-imposed rules and regimens for eating and attaining a more peaceful relationship with food by relearning to eat in response to physiological hunger and fullness cues.

The first one is what the fat acceptance movement is all about. Learning to become comfortable within your body and accepting who you are RIGHT NOW! Not in three weeks time, or in a couple of years or “when I’ve lost 10 kilos/pounds/<insert unit of measure here>” but just as you are. I think this is something that we should all be looking to achieve. I’m sure there are skinny people who don’t accept themselves either!

The second component is physical activity. It should be activity that you enjoy and that you do to enhance your life, not because someone says you have to do it to be a better person. Many people (me included) enjoy walking or running or jogging or cycling. Some dance and jump about, or play team sports. It’s about moving to have fun and enhance your life.

The final component involves diet. Eating food in an intuitive way and trying to determine what works for you. If you feel sick after eating a packet of chips, then you probably need to reconsider that. Does fried food give you the shits (literally)? Then perhaps abstain. Do you come out in a rash when you try and eat a salad? Don’t bother!

It isn’t “thou shalt eat 1200 calories a day, spread over 6 meals exactly 3 hours apart” like I’ve seen some at work do. It means eat when your body wants you to or needs you to. Eat what you think your body wants you to, and listen to the outcome. Work out what works for you and what doesn’t work.

Due to reflux, I don’t have chocolate, coffee, tea, tomatoes, too much oil or fat and some other things. I feel sick if I have them. I might lose weight because I’m not eating these things, but perhaps I’ll substitute them with other foods that will mean I maintain my weight. The goal is to eat as much nutrient rich food as my body requires, and it takes time to work out your own body cues.

Something that I feel that the Health at Every Size movement is trying to promote (as well as the fat acceptance movement) is that just because I’m fat doesn’t mean I should be treated differently. Therefore when I go to a doctor, the doctor should treat me for my symptoms/illness and not just go “lose weight, fatty”. It also means that when you go to your doctor and they suggest a treatment option that doesn’t work for you (like weight loss surgery) that you tell them this. 

If the treatment your doctor is suggesting is proven to work for the illness in question, you should consider it carefully and probably latch onto it for all it is worth. I’m not a doctor so I’m not providing medical advice. If doctors provide the same treatment options to you as to a thin person, that’s all we can ask for.

I think it is important to remember that everyone is different, so some things will work for you and some won’t. Crap happens.

What I don’t get is this: a doctor tables treatment options for an illness such as weight loss or a change in diet or move physical activity where the same options would be suggested to others that aren’t considered fat. I think sometimes as fat people we get triggered as soon as the “weight loss” flag is waved. Perhaps the issue is the “weight loss” tag has a stigma.

I guess my point is that sometimes when you are unwell, your doctor is going to say “you need to change what you are eating’ or “you need to get some more physical activity” in order to get better. As long as it isn’t “ok, so since you are fat you are sick” but “you are sick and the best treatment options are…”, I have no issue with that.

The fat acceptance movement is not the Heath at Every Size movement. Many people who consider themselves part of the fat acceptance movement do not subscribe to the three components I’ve outlined above. The common ground we share is that first one; accepting yourself as you are.

Anyway, that’s probably quite enough for now. I would be very interested to hear your thoughts on the issue.

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  • Fantine

    You know, I don't mind if a doctor tells me that certain dietary habits or specific exercises (or types of exercise) might help with a specific problem I am having. What bothers me is when they prescribe weight loss as a cure-all for everything, or ascribe any problem I am having to my weight.

    I once complained of dizziness due to a new blood pressure medication, and the doctor told me that fat people just have that problem sometimes because when we bend over our bellies press against our knees and cut off the blood flow. Yeah, so the fact that this dizziness only occurs when I am taking this medication, that's because of the fat? Right, that makes perfect sense. This is just one example of the kind of fat-blaming that drives me up the wall.

    It does me no good for my doctor to tell me that my fat is causing a particular problem, since I tried for most of my life to lose weight and was not able to do so permanently (and he already knows this). If my fat is the sole cause of a problem and there is no treatment for it, then they need to make that clear instead of implying that the problem is entirely my fault. If the problem is caused by fat but the symptoms can be treated, then don't harp on my weight–treat the symptoms. If doctors want to recommend behavior-based treatment, they need to focus on behaviors that are modifiable, not on body size.

  • meerkat

    “It should be activity that you enjoy and that you do to enhance your life, not because someone says you have to do it to be a better person. “

    It's ironic because the only reason I would want to take up a physical-activity hobby is because HAES bloggers keep saying I should. (But I can't do it the way they describe it because I absolutely loathe things like jogging and dancing and–ughhh–team sports.)

  • Hidi

    I think Health at Every Size is exactly what it says: Health at Every Size. Health is not about your body shape and size; it is about internal health. For example, a person can be slender and diabetic. Self-love is one of the most important expression you can give yourself. Like the author said, love your self now and not where you want to be physically. The three basics things the body needs are sleep, nutrients and exercise with huge dose of love. Those needs applies to mankind. I do not care how you look, where you live, how much money you have….people have to take care of themselves; it is a necessity for survival.

    Fat people are people. NO ONE IS MORE HUMAN THAN SOMEONE ELSE.

  • dashing_but_not

    Do any non-team sports look interesting? Or any less traditional team sports, like laser tag? Have any 'adventure sports' looked interesting? I certainly don't think anyone should be pressured into taking up a physical activity they hate, but I think that the general focus on a small subset of sports and physical hobbies that are considered 'acceptable' can be distracting from the massive variety that's available.

    If you just find physical activity bores the hell out of you, or you just plain hate it, no one has the right to tell you to take something up against your nature or inclinations. It's just that, personally, I felt like I hated physical activity for ages just due to the fact that I was presented with options that didn't appeal to me at all, and the stuff that I did like I was discouraged from because it 'wasn't very good for weight loss'. As if I cared, I just wanted to have fun!

  • meerkat

    No. I've played paintball, and it *sounds* very fun, but apparently I suck at it so much that I just lurk around and don't get to do anything, which is not fun at all (and I can't tell who is on my team because they insist on losing their armbands). I have also done tai chi, and it was not fun at all because I was extremely bad at it. Soccer enthusiasts tell me you're just supposed to get good at it (soccer, in this case) and then it will be fun, but how long would it take for me to get good enough for it to be fun? I'm supposed to suffer through it based on the hope that someday it might become fun? It may not be that I hate sports themselves so much as I hate doing things that I am hopelessly terrible at and have no propensity for whatsoever. I hate both competitiveness (most “real” sports) and pointlessness (going for walks to look at the scenery I have seen a million times which is ugly anyway; exception for cherry blossom season).

    I have enjoyed in the past: Dance Dance Revolution (but you have to go all the way to the game center to do that, and lately I have found it more frustrating than enjoyable, and doing it often enough to actually improve my skill level is a serious chore), tennis and volleyball and badminton (but only when I was a little kid so that people gave me really easy shots and did not play competitively at all, I have tried tennis and badminton since and it was not remotely fun in the least because I can't even hit the ball/birdie), tag (again as a kid, so I didn't feel silly and there was a large enough group of kids that I was lost in the crowd and it didn't matter so much that I completely sucked), swimming (when I was young enough to not worry about how I looked, and also my family went to the beach a lot; not so convenient any more, and I don't have the guts to show off my legs anyway). The only way I will actually *want* to do one of those things is if I'm already at the game center watching people do DDR at a level I can do *and* it is not very crowded (the humiliation factor) *and* I am in the mood, and no one ever suggests going to the game center any more because I complained so much about how I suck at DDR when I did not have fun. I do get some level of walking in my daily routine, so I don't feel the urge to go out and do something (actually, this applied even when I was more sedentary due to having a car, because I was busy all day with schoolwork and didn't have surplus energy even when the only exercise I got was walking between classes) unless I have a long vacation, and it will be “going to the used book store” or “trying out a new restaurant” or something, which do not count as “exercise” (and going to a restaurant especially doesn't count because they sell food; although maybe the used book store ought to count because big bags of books are totally heavy and I lug them back on foot; actually, rearranging bookshelves is a pretty good workout too when you have enough books). Just necessary walking is enough to meet the “half hour a day” minimum requirement that I saw in some article, but it's not going to get my heart rate up or anything, and I don't do it because it feels good, I do it because places I need to go are not located inside the train station. Also, when there is an escalator, I take it! I am a horrible person. (And breathing hard from exertion embarrasses me, because look at the stupid fatty getting out of breath from only two flights of stairs, if only she got any exercise ever she would be thin and run up and down ten flights of stairs with ease. Okay, I can probably do two flights without visible effect if I'm not carrying anything, but I am almost always carrying stuff.) It doesn't help that I hate getting sweaty and having to change clothes. (Oh yeah, add that to the DDR requirements: I must be going home directly after the game center so I can take a shower and not fester in disgusting sweaty clothes while running errands. My skin does not thank me if I ignore this rule.)

    So the problem is that this disqualifies me from HAES, and I can't do HAES because HAES says to do it because it feels good (or here, it brings pleasure and enhances your life), not because someone told you to do it, and it just *doesn't* feel good and I *hate* it (with extremely rare and somewhat unpredictable exceptions that I cannot recreate, or attempt to recreate without making myself miserable).

    I might fail less at #2 if I were better at #1, but physical-activity hobbies (a less repellent phrase than “exercise”) tend to require you to be conscious of your body, and that also makes me depressed. I try and blame society for being so hateful toward bodies like mine instead of blaming my body, but it goes against messages I have internalized about not blaming other people for your problems. (I hate those messages too, because they tend to imply that everything wrong is my fault, I am the single cause of all my problems, etc. but that doesn't mean I can just dismiss them, because they're not made of concentrated wrong, they just go too far in one direction [because nuance does not make a good soundbite].)

  • audreydc1983

    I'm much better at #1 than I used to be!
    #2…well, being in the Marines didn't make exercise fun…it was a chore, something I HAD to do, because I was ordered to do so. Kinda sucks the fun out of that, dontcha think? I have found that I enjoy walking my dog; mainly to see his exuberance and joy in just…being outside. Energizes me quite a bit. I sing and dance (when no one's looking, heehee) occasionally. I LOVE the stability ball. It made me feel stupid and uncoordinated at first, but with a little bit of practice, your muscles “relearn” how to stabilize you correctly. I have back problems and knee problems, so the type of exercise that I can do is limited…I have to be creative. Weight lifting is really fun for me, but I usually stick to upper body, due to the knee issues.(Shallow squats, no weights, with a stability ball against the wall work best for me for lower body: )
    #3 – Having gone on a gluten-free diet a month ago, I am still learning how much, and when to eat. I rely on my body for these cues, not the time, or how much I “should” be eating. Going Gluten-Free has improved my sleep patterns vastly, and I have more energy and vitality to boot! It IS harder to eat out at a restaurant, but I think…would I rather go back to the way I was? Tired all the time? No thanks. Goodbye, Gluten.
    Oh, I almost forgot…Hi Nick, I'm a BIG fan of your blog! (pun not intended…or wait – maybe it was :D )

  • dashing_but_not

    If you hate it all, you hate it all. More power to you. I just can't stand that fat people are presented with such a limited range of options when it comes to physical activity, and if they don't like that small number of options, then apparently it's too bad.

    You've clearly tried a bunch of stuff and it hasn't appealed to you, so why on earth would you keep doing it? For me, I was able to find something I like because I found a sport I enjoyed watching, so my interest to continue was already there when I started doing it. As I think we all know, a LOT of skinny people don't do any kind of physical activity at all, so it's pretty obvious that anyone who finds a physical-activity hobby they like has probably just gotten lucky.

    BTW, paintball and laser tag are quite different. Paintball tends to force you to play very defensively due to one-shot-and-you're-out rules. Laser tag doesn't work that way for most game types, so you can rush in and get shot a bunch of times, and then just return to base to respawn or whatever. I dunno, I just figured that if you thought paintbull *sounds* fun, but it seemed to bar you from participating, then laser tag has a much gentler learning curve. If you're a Brisbanite, Battlefield LIVE is awesome fun. I don't recommend Laser Force, as the kids who play there have the benefit of being shorter than the cover. You will never want to charge a group of children more in your life than you will when playing at Laser Force.

    Wow, that was a massive aside.

    Whether you ever want to take up any physical-activity hobby or not, it doesn't matter. I and anyone else should assume that you are a worthwhile and awesome person, completely deserving of the basic respect that should be afforded to any other human being. Just don't let the disrespect of ignorant bastards ever stop you from doing something you might like.

  • meerkat

    Cool, I will seriously consider trying laser tag if the opportunity ever presents itself, and your perspective on the issue is very helpful :)

  • Frances

    You can buy Dance Dance Revolution to play at home:

    Also, Islamic swimwear is an option if you're not comfortable showing your legs, though they can be expensive. I know that My Cozzie has at least one option without a veil that goes up to a US20/Aus24 ( Other brands out there are Burqini and Veilkini, though I'm not sure if they offer swimwear without a veil.

    I'm not saying this to pressure you to exercise, just to give you some options.

    If you don't enjoy exercise, that doesn't make you a horrible person at all and HAES isn't a competition that you can be 'disqualified' from. It's your life and you should not be coerced to do something that makes you miserable.

  • Frances

    I think those three components are a great overview of HAES. The best thorough explanation of HAES I've seen is on the Fat Nutritionist:

    I'm pretty good at (1). Not perfect, but I'm pretty good. I've got arse pride, thigh pride, and I've reconciled with my upper arms, back rolls and slight double chin. The last hurdle is my belly. I love it, but I don't love it in tight clothes. It's not very jiggly; rather it sticks out so I get self-conscious whenever I wear a dress or something that's tight all over. Hopefully I'll conquer this too and rock full body spandex like Ms Ditto.

    I've achieved (2) through dancing. God, I love it. The sluttier the better. Reggaeton is my absolute favourite, closely followed by samba. I've become one of those people who gets crabby if I have to miss my weekly dance class.

    I'm pretty good at (3). I can usually pick exactly what food I feel like. But sometimes I deliberately ignore fullness cues because my food is way too tasty, or I feel like being stupidly full. I like the feeling of it.

  • meerkat

    I used to have a good DDR dancepad at home, but it is unfortunately not feasible to get another right now. I do have the soft mat for the Wii, but it doesn't have the practice options I liked on DDR Max 2. That's an interesting idea about the swim suit, would not have occurred to me. Thanks!

  • PerryAu

    Great article on Fat Acceptance and Health at All Sizes, please let me know if there is any Group in Australia to join.

  • skinnyemmie

    Nick, I really actually like the way you lay out what HAES means to you. The entire HAES debate has been a tough one for me, because some who say they are HAES advocates have criticized my blog since it revolves around weight loss. What really frustrates me about that is that I 100% agree with all the principles at HAES. No doubt.
    The problem people have had is that my “diet” (also as I define, my way of eating to sustain life) is one that some people see as a fad (a low carbohydrate lifestyle). Am I doing it to lose weight? Yes, I don't hide that fact. But the reasons behind me choosing this diet as a way of life is because it eliminates my sugar spikes, sluggishness, water retention and general lethargy. Just as you eat what you do because of reflux.

    I'm lucky that I have a doctor who has seen me at my lowest (215) and my highest (460). He never pushes me about it and for that I am incredibly grateful.

    Thanks again for this post. I'm so glad I came across it.

  • amplecurves

    This is my first introduction to Health At Every Size, and so I want to thank you for sharing it! It seems very, refreshingly, reasonable. I feel like I've got a ways to go when it comes to incorporating more movement into my life and listening to my body more about how food makes it feel; all the same, I really really appreciate this way of framing the issue of how to be healthy and how to set healthy goals at the same time as being wholly accepting, non-shaming and non-blaming, of my body. Because I refuse to go back to seeing myself as disgusting, for feeling guilt and shame over my body. AND I sincerely care about being healthy. It's nice to see there's a larger community out there that acknowledges that these two stances are not mutually exclusive and in fact are a cohesive road toward both physical and mental health.

  • Lori

    If the treatment your doctor is suggesting is proven to work for the illness in question, you should consider it carefully and probably latch onto it for all it is worth. I'm not a doctor so I'm not providing medical advice. If doctors provide the same treatment options to you as to a thin person, that's all we can ask for.

    Thanks for this post, and I think you make an especially good point here. As somebody who is on the smaller end of the fat spectrum and has been fortunate to not be lectured or shamed by doctors, I've been a bit surprised at how violently some people seem to react against HAES, because the idea that changing what/how you eat or how much exercise you get can affect how you feel and is something you might want to pay attention to seems pretty noncontroversial to me. I can certainly understand how, when these changes are put in the context of weight loss, they are off-putting and offensive. But, there are plenty of times when these changes really would be recommended to anybody.

    I have panic disorder, and getting daily aerobic exercise is one of the treatments recommended to everybody who has it, not just the fat ones. And, it really does make me feel better. My OB, however, has recently advised me to temporarily cut down on the amount of physical activity I was getting, because it was exacerbating the sciatica that's been bothering me. Her suggestion was very sound, and I do feel better. I have horrible, horrible acid reflux when I'm pregnant, and I do need to watch what and how I eat, and I'm very open to suggestions from my doctor. (One that's working very well for me right now is drinking most of my fluids with food, and just sipping between meals. For some reason it's fluids–even water–that tend to bother me the most.)

    I think a lot of it probably has to do with having a positive, trusting relationship with a doctor. If, the first time I went in to see my OB, she had told me to limit fatty foods, I probably would not have had a good reaction. However, given that I know her and trust her, and know that she is extremely size-neutral in her care and has ever made an issue out of my weight in a negative way at all, when I tell her my reflux is really acting up and she says, among other suggestions, to limit fatty foods, I know she's not telling me that because I'm fat and she assumes I stuff my face with fried food all day, but because it's the advice she'd give to anybody with the same complaint. If she tells me that doing some stretching when I wake up and before I go to bed will help with my lower back pain, I know it's not because she thinks I don't move all day, but because these are things that have been shown to help people of any size with the same problem.

    But, again, I think having a relationship of trust and acceptance with a doctor is really important, otherwise it's very hard to determine if the advice is coming because of assumptions being made about the lifestyle of fat people or because it's simply an effective, common treatment for a given condition. And I do think to some degree–probably to some significant degree–the burden does have to be on the doctor to establish that sort of trusting, respectful relationship with fat patients, if they want their advice to be taken as therapeutic rather than judgmental, given how many fat people have had such terrible experiences with the medical community.

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