Health at Every Size®, weight neutral care, and the non-diet approach

What Is Health at Every Size® (HAES®)?

HAES is a health framework that promotes wellbeing without focusing on weight loss. It is a holistic, inclusive approach to health that promotes respect, dignity, and access to care for people of all body shapes and sizes. The HAES approach is weight neutral, which means it does not use weight or BMI to measure health, but rather takes into account the broad range of factors that influence health and wellbeing.

HAES challenges the idea that weight is the primary indicator of health and instead it’s core principles are:

• Weight Inclusivity: accepting and respecting the diversity of body shapes and sizes.

• Health Enhancement: supporting and advocating for health policies that improve access to information and services and acknowledging that health is multi-faceted.

• Respectful Care: acknowledging and actively working towards ending weight discrimination, weight stigma and weight bias.

• Eating for Wellbeing: promoting flexible eating based on nutritional needs, hunger, satiety, appetite and pleasure, rather than eating that is focused on the goal of weight control.

• Life-enhancing Movement: promoting physical activities that are enjoyable, rather than exercise that is focused on the goal of weight control.

Adopting weight neutral care as opposed to a weight centric approach, recognises that:

• Health is influenced by many factors (e.g., genetics, environment, trauma).

• Weight loss is not always achievable, sustainable or beneficial.

• People of all sizes deserve respectful, evidence-based care.

• Dieting often leads to weight cycling, which can harm physical and mental health.

The Non-Diet Approach is a health and nutrition philosophy that rejects diet culture and aligns with the principles of Health at Every Size (HAES®) and is often used in weight-neutral care. It focuses on:

• Body respect: Respecting body diversity, reducing body shame, and promoting self-compassion.

• Intuitive eating: Attunement to hunger, fullness, and satisfaction cues, and moving away from restrictive dieting and food rules.

• Nutrition for wellbeing: Focusing on nutritional adequacy, variety, and enjoyment of food, without moral judgment around foods being ‘good’ or ‘bad’.

• Joyful movement: Encouraging physical activity for pleasure, not punishment.

• Mental and emotional wellbeing: Prioritising psychological health over weight outcomes.

Why These Approaches Matter

Traditional weight-centric or weight focused models can lead to:

• Weight cycling or yo-yoing in weight leading to higher risk of poor health outcomes e.g. increased risk of type 2 diabetes, cardiovascular disease and increased cardiometabolic markers (blood pressure, cholesterol, triglycerides), osteoporotic fractures, loss of muscle tissue, hypertension, chronic inflammation, some forms of cancer (Kakinami et al, 2020; Zou et al, 2020; Rhee, 2017; Lissner et al, 1991; Rzehak et al, 2007; Nilsson, 2008; Guagnano et al, 2000; Strohacker & McFarlin, 2010; Thompson & McTiernan, 2011), as well as increased mortality rates (Nilsson, 2008; Lissner et al, 1991; Rzehak et al, 2007; Park et al, 2018)

• Disordered eating (Field et al, 2004; Osborn et al, 2011)

• Psychological and emotional distress (Olsen et al, 2012)

• Weight bias and weight stigma in healthcare leading to not receiving adequate healthcare (Phelan et al, 2015; Puhl & Heuer, 2009), avoidance of healthcare altogether (Lee & Pause, 2016; Tylka et al, 2014; Puhl & Heuer, 2009; Phelan et al, 2015), or increased mortality rates (Sutin et al, 2016)

In contrast, HAES®, weight-neutral, and non-diet approaches have been shown to:

• Improve physiological measures e.g. blood pressure, cholesterol, triglycerides (Bacon & Aphramor, 2011; Bacon et al, 2005; Bacon et al, 2002)

• Decrease body dissatisfaction and encourage self-compassion and self esteem (Bacon & Aphramor, 2011; Baco n et al, 2002)

• Reduce disordered eating behaviours (Tylka & Wilcox, 2006; Bacon & Aphramor, 2011; Bacon et al, 2005; Bacon et al, 2002)

• Decrease depression and improve psychological wellbeing (Bacon & Aphramor, 2011; Bacon et al, 2005; Bacon et al, 2002)

• Lead to increased sustainable, enjoyable self-care behaviours such as movement (Homan & Tylka, 2014)

• Show no adverse outcomes (Bacon & Aphramor, 2011)

If you are seeking a health professional that uses the HAES approach, then go to the verified provider directory on the Size Inclusive Health Australia website at: https://www.sizeinclusivehealth.org.au/find-a-provider/?tab=2

If you are a health professional and would like to receive training in the Non Diet Approach, then go to http://www.healthnotdiets.com/

Health at Every Size ® and HAES ® are Registered Trademarks of The Association for Size Diversity and Health (ASDAH).

Helpful Resources:

• https://www.sizeinclusivehealth.org.au/

• https://asdah.org/

• http://www.healthnotdiets.com/

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