A sociological critique of the Health at Every Size movement

The Health at Every Size (HAES) movement has become a popular alternative to the dominant scientific discourse on obesity, particularly among fat activists and the fat acceptance movement as well as some nutritionists eager to avoid an over-emphasis on body weight in their work with clients. First developed by American psychotherapist and nutritionist Linda Bacon (2010), the main argument of HAES is that good health and physical fitness can be achieved regardless of body size. As such, the approach agrees with the assertions made by many other obesity sceptics that fatness does not necessarily cause ill-health and premature mortality and that losing weight may not improve health status (see here for my previous post on the contentions of obesity sceptics).

A central plank of the HAES approach is that weight loss by means of continual dieting attempts and punishing exercise regimens should not be the main goal of those seeking to live a healthier life. Instead of attempting to follow the rigid guidelines of medical advice on losing weight and focusing exclusively on this objective, individuals should instead follow their bodies’ intuitive lead in choosing their diet and exercise activities. They should learn the instinctive hunger and fullness cues of their bodies and eat accordingly, whether or not following these cues lead to weight loss. For example, in an information sheet about HAES (2008) Bacon notes that ‘We all have internal systems designed to keep us healthy – and at a healthy weight. Support your body in naturally finding its appropriate weight by honouring its signals of hunger, fullness and appetite’.  In a YouTube video she claims that as long as ‘you stop fighting yourself, achieving and maintaining the weight that is right for you is effortless – your body does the job for you’.

A further integral part of the HAES philosophy, and one that bespeaks Bacon’s other training as a psychotherapist, is that people should accept their bodies’ size and weight, and learn to love themselves. The ‘Health at Every Size promise’ is that ‘You can feel better about yourself. You can feel loved, accepted, and vital – and you can improve your health – regardless of whether you lose weight’ (Bacon, 2010: 2, emphasis in the original).

For someone reading the HAES manifesto as put forward by Bacon and others, it all seems so simple: love yourself and others will love you; trust your body’s instincts and good health will follow. The HAES philosophy appears to be eminently laudable, avoiding the kinds of fat stigmatisation and victim-blaming that are so pervasive in medical, public health and popular discussions of body weight (Lupton, 2012). Yet I would argue that there are elements of the HAES discourse that should be held up to critical examination. It is time to challenge its assumptions and to identify the inconsistencies and the brand of rigid thinking that underpin HAES, just as critics have done in relation to scientific anti-obesity discourse.

In her writings on HAES, Bacon constantly refers to the body’s natural ‘set-point’ which ensures that too much weight is not gained if one makes sure to follow one’s body’s cues. References to ‘turning over control to your body’ assumes that the body is a natural entity that has its own wisdom independent of where it is sited or what experiences it has gone through.

While I agree with and support the major principles of accepting a range of body sizes and shapes and that everyone, regardless of their size and shape should seek a lifestyle that is both pleasurable and healthy, as a sociologist, I tend to approach the words ‘natural’, ‘instinctive’ or ‘internal cues’ with suspicion. From a sociological perspective, the ways in which we understand, view, represent and live our bodies are always sited within cultural and social contexts. The body is viewed as a complex interplay of biology, society and culture, in which it is extremely difficult to extricate one element from the other.

I also find the continual position of ‘your body’ as a separate entity from ‘you’ in HAES discourse problematic. This discourse reproduces the classic Cartesian duality of the mind/self as separate from the body/flesh and turns it on its head. Instead of the rational mind positioned as superior to the fleshly body, here the body is represented as ‘wise’ and all-knowing, to which the mind/self should relinquish control. Yet as theorists such as Merleau-Ponty have argued, we cannot separate ‘self’ from ‘body’: we always and inevitably experience the world as embodied selves.

Take the concept of ‘internal cues’ for example. The HAES literature suggests that such cues are natural, instinctive, biologically determined and therefore appropriate to follow. But if nothing else, the sociology of the body and indeed, the sociology of food and eating (Lupton, 1996) have shown us motivations can never be fully or purely ‘internal’. They are experienced via social and cultural lens, including our own life experiences and our siting within the particular cultural context into which we were born and grew up. Bacon acknowledges this to some extent when she compares French with American attitudes to food and eating practices in a brief section in the book, but does not extend this idea to the rest of her argument. She also acknowledges the emotional dimensions of eating and food cravings. Here again, however, Bacon positions these embodied sensations as individual rather than as social products, and as separate from, rather than an integral part of, the self: elements, indeed, of the ‘inauthentic body’ which one should not obey. So which sensations of our bodies should we listen to? Which are the most ‘wise’ and ‘authentic’ and on what basis should we make these judgements?

Another important aspect of HAES that requires more critical examination is the concept that we should accept our bodies whatever our size and the assumption that this will lead to better self-esteem, a goal in itself. But such attempts to improve self-esteem from within fail to recognise the continuing fat prejudice and loathing that continues to exist within our society. Bacon argues that HAES will ‘give you the tools … to live in a body you love’ (2010: 5). But this is similar to asserting that prejudice, discrimination and stigma based on such features as a person’s ethnicity or race, or their age, can be dealt with by ‘loving yourself’. Such an approach attempts to change individuals’ behaviours rather than wider societal attitudes, and the problem therefore remains personal (Murray, 2008). Whatever one’s own attitude about one’s body, the external societal meanings will remain unchanged, and prejudice, discrimination and stigmatisation will continue to exist. Fat people themselves, however, hard they try, may struggle to accept their body size in such a punitive social environment. Their inability to ‘love themselves’ may well become yet another source of shame and guilt.

References

Linda Bacon (2010) Health at Every Size: the Surprising Truth About Your Weight. Dallas: Benbella Books.

Deborah Lupton (1996) Food, the Body and the Self. London: Sage.

Deborah Lupton (2012) Fat. London: Routledge.

Samantha Murray (2008) The ‘Fat’ Female Body. Houndmills: Palgrave Macmillan.

18 thoughts on “A sociological critique of the Health at Every Size movement

  1. I share your skepticism about the salience of internal cues. After a lifetime of exposure to culture and to food advertising, using supposed internal ques to determine what to eat seems impractical. Why not use nutrition science as a guide to food choice? While studies may contradict each other, the choice of a Mediterranean pattern of diet seems likely to support good health for people of all sizes.

  2. Thanks for this Deborah, a very well put argument. For me the very idea of ‘self acceptance’ is problematic, regardless who claims it. My research focuses on using psychoanalysis (via Lacan) as a way of critiquing the social. My focus has been the weight-loss industry (see ref below). For me a person is always in a state of flux between accepting and rejecting their ‘self’ via their interactions with society. So for instance I suffer with significant weight anxiety (regardless of my ‘real’ embodiment) at times I manage to accept my body and feel (relatively) comfortable and at other times I reject it in favour of trying to change my body to meet the norm (see: http://othersideofweightloss.org/2012/09/24/on-mental-health/ for instance). What Lacan and others of this lineage recognise is that people are split, fractured if you like, and that’s fine. This of course would require all ‘weight related’ movements to allow people the space to follow their desire, for some this means hunting for the miracle pill, others training for the next ultra-marathon. Very few (if any) of us are simply content with our bodies. Thanks again!

    Dickson, A. (2011). The Jouissance of the Lard(er): Gender, desire and anxiety in the weight loss industry Culture & Organization, 17(4), 313-328.

    • Thank you for your comments, Andrew. Your work looks very interesting. I think it is important to acknowledge ambivalence/the split self, as you say, rather than posit a unified self or attempt to achieve this.

  3. This is a marvelous post, and I agree with each and every point.

    I do wonder about the possible tension between the needs of political consciousness and the significance of critique. That is, given how pervasive and corrosive fat stigma is, it is IMO so critical from a political standpoint to have a vibrant, active, organized social movement (or set of movements) promoting acceptance and protesting stigma and oppression.

    I entirely agree that a measure of that vibrancy is the extent to which friendly critiques are acknowledged and engaged, but at least in the U.S., fat stigma is so common and so devastating that I find myself grasping eagerly at any movements and groups which promote less harmful messaging.

    Hope this makes some sense.

    • Thank you, Daniel. You are right, it is critically important that fat stigma and discrimination are challenged and subverted. HAES has provided one way of doing this, together with many other fat activist and fat acceptance efforts and groups. But there are logical inconsistencies in its approach (at least as it it outlined by Linda Bacon) and too much of a focus on the individual. Acknowledgement of this would help the movement/philosophy and its methods progress to the next stage. As I noted in my response to Jennifer, some practitioners are already starting to do this, but this is not immediately apparent from the material on HAES that is freely available on the web, for example.

  4. Dear Deborah,

    Thank you kindly for this post. I enjoyed reading it.

    I too have been thinking about critical perspectives of HAES for some time, even though I feel a certain affinity to some aspects of HAES, or more specifically, what HAES could be.

    Regardless, I think this conversation (and others) is a necessary one in which the HAES folk must engage. For me, the HAES literature has lacked a healthy dose (pun intended) of self-reflexivity and self-criticality. I think this has left several gaps, some of which you identify above, in the HAES movement. However, I think it is important that HAES means different things to different people and so the criticism you note above and the ones I will add below apply more or less to different iterations of HAES offered by different authors.

    To add to what you said, I think the lack of an overt commitment to social justice has allowed HAES to drift into language and messaging that verges on healthism undergirded by a neoliberal focus on the individual. Whether intended or not, this has also resulted in a HAES movement that echos the language of the diet/food product industries and a libertarian approach to one’s “lifestyle choices” (ie. freedom means eating whatever I want whenever I want). Although, in some respects, the motivation and sentiment behind the assertion that “I should be able to eat whatever I want whenever I want” is different when coming from the HAES folk and the libertarian folk, it sounds remarkably similar and perhaps indicates some potential points of convergence.

    Although HAES has been trademarked by ASDAH, it does not take much marketing prowess to represent products/services/companies as being HAES-friendly without infringing on the trademark. I have been seeing several advertisements that have taken up HAES language, specifically with reference to size and acceptance. Similarly, there has been a lot of cudos flying about for various women’s clothing designers and women’s magazines who are featuring “plus” sized models. I put “plus” in scare quotes because the women were hardly plus sized and were still white and were in all other ways typical of the stereotypically desirable woman. The fact that plus sized models are featured in magazines seems to satisfy the desired outcomes of (some of) the HAES movement. That is, that women of all sizes are valued by themselves and by others. Using fat women to sell things is not at all satisfactory for me. And I am not saying that it is satisfactory for any others who count themselves among the HAES community. However, without an explicitly political (feminist, political economic, anti-racist, anti-colonial etc.) current, it seems that fat models in Ralph Lauren advertisements (http://www.huffingtonpost.com/2012/09/19/robyn-lawley-plus-size-ralph-lauren-model_n_1897703.html) equals a win for HAES.

    This is not to throw the HAES baby, a movement that I would say is still in its infancy, out with the bath water, but rather to say that the HAES community needs to be open to having these types of self-reflexive conversations. In addition, I believe strongly that the HAES movement needs to take up an explicitly political framing of “obesity”, bodies, and health.

    • Thank you for your comments, Jennifer. I agree that HAES needs to go beyond the individualistic focus to political engagement. There are definitely some HAES supporters and practitioners in countries like the UK, Australia and Canada who are working towards this, as was evident from the recent Critical Dietetics conference held in Sydney this month (my post was developed from the keynote address I gave there). And I also agree with your point about libertarians and fat activists sometimes sharing a similar approach, and I actually comment on this my ‘Fat’ book. I think fat activists and fat acceptance politics need to be very careful not to appear to support the purely money-grasping libertarian approach, which is all about economic self-interest and not at all about contributing to people’s health and wellbeing.

  5. Thanks for your post Deborah, it’s great to see Health at Every Size® (HAES) gaining ground in terms of enjoying critical engagement.

    As with the other commentators we agree there’s plenty of room to improve and expand HAES theory and practice and look forward to diverse voices joining the conversation. We also have some comments and clarifications to share.

    We agree that in much of the HAES literature to date, including the examples you cite, the fact that HAES is a progressive movement that embraces a social justice agenda gets subsumed under talk of strategies for furthering self-care which (mis)represents HAES as chiefly having a lifestylist focus. We’re aware anecdotally of views that HAES is ultimately about health and health behaviours, something deemed self-evident from the name; but it’s not a view shared by all and we welcome your assumption that social justice concerns are central to the HAES project.

    Many people come across HAES because they have food and weight concerns, and this point of entry is strongly reflected in Linda’s popular writing you selected to critique. In writing for an academic audience you’ll note more criticality. Nevertheless we agree that as it stands talk of health and food choices does give a skewed view of the HAES philosophy and we’re encouraged that the tendency to individualise has been recognized and problematized by the movement. So healthism was on the table at ASDAH 2011, for example, and public messages and writing are starting to catch up. It’s really heartening that a comment made in a HAES teleconference last week ‘ If we limit Health At Every Size to just changing health behaviors, I think we do it a great disservice, because I think HAES activism extends far beyond that. . . With HAES, because we can bring in social determinants of health, we can encourage people to think critically about our understandings of health”
 was selected by the organiser as one of 10 top takeaway messages.

    We also agree that the body/mind split isn’t a useful concept anywhere in health and are pleased that HAES writing is catching up on conceptualising ways of knowing that include embodied knowledge. For instance a HAES course facilitator handbook we’re collaborating on notes:

    “Explain that HAES thinking values both body and brain knowledge. In westernized science and education we are conventionally taught to split body/mind and focus on knowing intellectually at the expense of the body. We are used to using these words as if they describe two unconnected parts of us. But in fact we can’t separate body and mind – if the mind isn’t in the body where is it? Both ways of knowing are linked and have their place; in the course we focus on highlighting body knowledge to redress the balance – but not at the expense of cognitive knowing.”

    It’s a bit trickier to see how these ideas could be clearly communicated on a YouTube video introducing HAES.

    Have you come across Laura McKibben’s food pyramid? It’s a great example of how nutritional knowledge gets used by HAES advocates, reflecting the (limited) role of cognitive dietary knowledge in health, and accurately portraying the contribution of health behaviours to wellbeing http://www.food-for-thought-pyramid.com/articles/pyramidsample.pdf

    We wonder about your assumptions around internal cues. It seems to us that there’s some faulty logic here. We don’t see how to describe body signals as natural, instinctive and biological, or emotions as residing in the body, is also to say these signals are devoid of contextual influence. And in the book you critique there’s talk of helping people to relate to food in ways that meet nutritional, emotional, cultural and psychological needs. This strikes us as a pretty contextualised approach. Let us give another example from the Facilitator handbook. Say we’re discussing wellbeing related to activity or fitness. The person who comes home tired after work and relies entirely on body signals is probably more likely to have a cup of tea and put their feet up than say go for a run. It seems to me that someone using body signals along with the knowledge that they feel so much more alert for a 20 min run and so will end up feeling they’ve had an evening, and also sleep better, is on to something more useful. This relational perspective is integral to a HAES philosophy, it’s being articulated more explicitly in recent theorizing and I’ll (Linda) make more of it in the next edition of my book.

    Similarly, while the phrase ‘turning over control to your body’ clearly doesn’t capture other ways of knowing, we don’t think it decontextualizes the body or denies a life course either. For instance, pointing out the impact of dieting on weight gain inscribes us as interdependent situated bodies. We agree relationality is important, and expand on this when we explain set-point in the facilitator handbook:

    “Explain the concept of set point. This describes how someone is programmed through their genetic make-up and metabolic inheritance (experiences that affect groups and that continue to be passed on through generations) and by in utero experiences to be a certain weight as an adult. The set-point at any given time is a function of the person in their environment.

    So, your current weight is a reflection of your set-point and the fact that you have particular food preferences, exercise habits, dieting history, medication needs, stress levels, employment status, level of well-being and experiences of discrimination etc. It is a measure of your body in relationship to your past, life course events and your present environment. The concept of viewing ourselves in relationship is central to a HAES philosophy.”

    Of course you’re right that key tenets of HAES are intuitive eating and self-acceptance. But it’s not true that the book says ‘individuals should instead follow their bodies’ intuitive lead in choosing their diet and exercise activities. They should learn the instinctive hunger and fullness cues of their bodies and eat accordingly’ or that in HAES “we should accept our bodies whatever our size”. It’s not the strategies, it’s the ‘should’ that we want to pick up on. We are fully committed to helping people move towards size acceptance if they want to and at the same time feel strongly that there has to be room for ambivalence, challenge and contradiction. In fact, one of the ways we frame the underlying project of HAES is that at its most fundamental level it seeks to challenge the logic of domination. Improved health and wellbeing becomes a likely side effect, not the raison d’etre of HAES interventions. We engage with this in practice by highlighting the binary thinking epitomised in diet mentality dichotomies of good/bad, healthy/unhealthy and then all the should, oughts and have tos that go along with this. Meaningfully challenging fat stigma necessitates challenging [the thinking behind] all forms of stigma.

    We also have some trouble with the point you make about self-esteem. If we’ve understood correctly, you’re saying that by encouraging somebody towards self-acceptance we must necessarily be ignoring the realities and impact of fat prejudice and the need for societal change? It seems unlikely this is really your position. We’re not sure it would even be possible to address self-acceptance without attention to politics or the fact of the personal being the political being the physiological from a HAES perspective. Helping people learn ways to protect themselves from sizist insults and nurture self-worth recognizes that societal discrimination has real embodied impacts. The message is that the onus is firmly on society to change and meanwhile there are ways we can look after ourselves. You’ll be aware of the studies on body image that show that changing how we feel about ourselves can improve our sense of wellbeing; we do think there’s merit in this. Within this, we’re confused as to why moving towards self-acceptance requires a unified body? As we understand self-acceptance, it means teaching that we all have innate human worth –whether we’re dieting, size accepting, prioritizing health or not – and we can’t follow the logic that takes this to a fragmented corporeality?

    You write: “Whatever one’s own attitude about one’s body, the external societal meanings will remain unchanged, and prejudice, discrimination and stigmatisation will continue to exist.”

    Stonewall was possible because people from the queer community changed their attitude about their bodies, and with that their sense of entitlement to be who they are. External homophobic societal meanings still exist, but there have also been shifts. So, we’re not suggesting anyone is obliged to change their attitudes to their bodies to alter society, but we do support a relational view of embodiment that finds links between personal attitudes and social change.

    We agree with your last sentence that it’s really important that HAES doesn’t just become something else to fail at, hence the commitment to spaces that hold ambiguity, difficult emotions, conflicting desires re dieting and so on without judgment. But we wouldn’t confine these struggles, or the relevance of a HAES approach, to fat people as you’ve done.

    Lastly, just to say special thanks to Daniel Goldberg for his post. We certainly acknowledge the need for more scholarship, diverse voices, and critical writing in HAES. We also acknowledge that much of the scholarship available to date has been achieved outside of academia or against institutional mores and with real life costs. It’s good to have this human element and context acknowledged.

    I’ve (Linda) worked to make HAES info available outside of academia because I think there’s benefit at the moment in having one site I/we can direct people to with personal, press, professional queries. What became clear as we were writing a response was that on the points where we agreed with you it highlighted the need for clearer and fuller explanations. On the points where we disagreed there was still scope for expanded theorising. Oh to have the time! We hope that more involvement from academics will continue to strengthen praxis and vibrancy and seek to build meaningful community development responses to transformation.

    On a final note, I’d also like to correct your opening: I (Linda) did not initially develop HAES. HAES practice was developed by a community of fat activists, researchers and practitioners some 30 years ago. However, I am proud to participate in the vibrant community developing on the powerful foundation that was established before I came into the picture.

    Lucy Aphramor and Linda Bacon

    • Thank you for your response, Lucy and Linda. I am glad that as two well-known proponents of HAES you are willing to take on board others’ comments on the movement and the practice of HAES and I welcome your comments and clarifications.

      To start with, thank you for clarifying that Linda did not initially develop HAES. It must be said, Linda, that your name and face are definitely dominant in any cursory Google search of the topic of HAES because of your book, website and other output, so it is easy to conflate HAES with you and your definitions of it. And you are right, I was focusing on these more popular texts rather than the academic literature you have published, as I was interested in the ‘public face’ of HAES and what the casual observer may make of it.

      As a sociologist my post was essentially seeking to undertake a discourse analysis of HAES to identify its dominant assumptions concerning concepts of health, selfhood and the body. I have been publishing this kind of work for many years now, particularly in relation to medicine and public health topics (and focus on discourses of anti-obesity science and public health in relation to fat embodiment on my book ‘Fat’ that has just been published). This analysis can be a useful way of challenging assumptions, although simply identifying them is not in itself a critique. The critique comes into looking at the ways in which assumptions might disadvantage or stigmatise certain individuals or certain groups or deny them justice or freedom, and how social change should come about to address this. I am glad that you note that recent HAES discussions have begun to go beyond the individualistic neoliberal approach, championing the self-responsible subject, to an examination of the social determinants of health.

      I would still stand by my problematising of ‘internal cues’ and how they are represented in HAES. I continue to see difficulties with how to distinguish between the ‘natural’ and the ‘instinctive’ against the ‘acculturated’, as from my perspective these elements are inextricably intertwined. Yes of course we all experience sensations of need from our bodies that must eventually be satisfied – hunger, thirst, elimination of body wastes. But how we interpret these sensations, what we do about them and where, are all culturally shaped and surrounded with a myriad of social and cultural prescriptions and proscriptions. How we interpret our hunger and how we then go on to act upon it, in particular, is an incredibly complex social phenomenon, as sociologists, anthropologists and historians of food and eating practices have demonstrated. Some of these sociocultural influences are relatively easy to identify: others are habitual, adopted by our bodies on a pre-reflexive basis and thus very difficult to identify as socially-constructed (Bourdieu’s work on the habitus is instructive here).

      My point about self-acceptance as it is advocated in HAES is that this again can become a very individualised endeavour, involving ‘work on the self’, that in itself does not lead to social change. Yes, being able to accept one’s appearance may make a person feel happier. But it will not protect that person from the kinds of entrenched societal discrimination to which fat people are routinely exposed (such as discrimination in employment), whether or not they feel fine about their body size. I agree that a first step in social change is to challenge stigmatising cultural norms such as fat hatred, homophobia, sexism, racism etc. But social change will not occur unless a focus on the self moves to a focus on society and collective action.

      It is also important to recognise the potential for ambivalence and ambiguity in this kind of discourse about self-acceptance. We are not unitary selves, and do experience ambivalence and conflicts that we must acknowledge and come to terms with. Self-acceptance may not always be achievable, however hard we try. Samantha Murray’s book to which I referred in my post makes some excellent arguments in relation this kind of discourse in fat activism more generally, writing from the perspective of a fat woman who finds herself ambivalent about fat acceptance. I commend this book to you if you haven’t already read it.

      I can see from your response that you are both open to new ways of interpreting and using HAES and I look forward to seeing where HAES goes from here.

  6. I read this post with interest, and thought twice about posting a comment as I am not schooled in the kind of sociological discourse used above. But in words of three syllables or less (or maybe 4), I don’t see how it is possible to stand up to societal stigma until you yourself believe that you do not deserve to be stigmatised. As long as we are unable to accept ourselves, why would we expect anybody else to.

    I am relatively new to the HAES philosophy but have embraced it wholeheartedly, and credit it with nothing less than giving me my life back. I have taken this new life and am using it to champion for change on both a personal (if such a route is chosen) and societal level. I would not have had this voice, or the sense that I was entitled to use it, before learning to accept myself.

    • And an afterthought, with apologies for the double posting. Whilst the eminently more qualified than myself Drs Bacon and Aphramor discuss above the role of the HAES movement in social justice terms, my understanding has always been, with credit to the inimitable Ragen Chastain, that Health At Every Size principles encompass an individual approach to health. Should an individual, of any size, wish to improve their health, adoption of these principles is one way to do so, and one which proponents of HAES believe is likely to produce better results than going on another diet. Nevertheless, it is a matter of personal choice. In contrast, the Size Acceptance movement seeks lack of discrimination based on size. This is aimed at society as a whole, and it is a civil rights issue. It is non-optional. HAES and SA are not the same thing.

  7. Great discussion, everyone! Just wanted to say thank you, Deborah, for the thoughtful analysis and also confirm Lucy and Linda’s perspective that many of us have been formulating this model for decades (and thank them for trying to broaden the discussion and for all their tireless dedication to explaining the HAES model).

    I hope you might want to see some of that range of time and voices – and holding that wider-ranging discourse (messy as it is in a grassroots, not-always-academia-based movement) a little more loosely. The early (70’s and 80’s) roots in the San Francisco Bay Area, for example, include members of the Fat Underground like Lynn McAfee, progressive healthcare providers working for community health like Pat Lyons, members of the fat dykes’ community, performers and artists like Fat Lip Readers’ Theater, the Making Waves swim, my own dance classes called We Dance, Rozella Canty-Letsome’s fitness classes, Lisa Tealer and Dana Schuster’s “Women of Substance” gym, Alice Ansfield’s “Radiance” Magazine and on and on. Many of us have been meeting three or four times a year since the early 90’s(?) to support each others’ work in a melding of activists, artists, fitness instructors, therapists, nurses, dieticians, physicians, psychologists, eating disorder specialists, researchers, and so on. I remember the arguments about calling it “Health at Any Size” vs “Health at Every Size,” and what I sometimes wish we had settled on, “Health for All Sizes” (Kelly Bliss’s suggestion).

    And that isn’t even every influence in the Bay Area, and that isn’t every influence in the US, and that isn’t every influence in the world. Google is going to give you mostly links to what has been online – mostly just the most recent decade.

    I sometimes have to remind people that HAES is a model that challenges using weight as a proxy for health. It is not a new set of rules about how to confer moral approval, perpetuate healthism, or select who is a “good fatty” and who is not. Some of the impetus for the model comes from healthcare providers talking to other healthcare providers about what, if not BMI, is a better focus. A great deal of my work has not just been with individual people coming to me as a psychologist, but also been aimed at changing the structural problem of medical and psychological practice using weight as a proxy for health. In that respect HAES is not just an individual-level intervention, it is meant to address the health threat to people of all sizes of these toxic practices, unequal access to everything that supports peoples’ health, and the health risks of stigma, bullying, discrimination, and the moral freighting of health itself.

    If you have any great ideas about how to keep this work from being reduced to, “listen to your hunger and your weight will be fine,” I would love to hear it. I just don’t think there is any way to keep a big messy bunch of voices from being appropriated by the weight cycling industry and a sound-bite driven media. But I would hope that people who study us will try to widen the frame to include more of the story and its roots in broader social justice movements. I couldn’t agree with you more that real change has to address structural problems – so please don’t dismiss all those voices and all that history in your portrayal of the model. Thanks, again, for the discussion!

    • Thank you for your comments, Deb. It’s great to see more detail about the antecedents of HAES. I know that Charlotte Cooper has published a time-line of the fat activism/fat acceptance movement (put together with others, including yourself), which is also very helpful in siting the movement and demonstrating how far back it goes. This time-line, which I just had a look at, places the emergence of what would become HAES at 1997. Maybe it’s time for someone to write a history of HAES – or is there one already?

      • Charlotte’s timeline is fantastic. Barb Bruno also collected a timeline for the National Association for Fat Acceptance’s newsletters. Over the years, various scholars have interviewed people for dissertations and documentaries and so one hopes some of this will get preserved somehow! Lynn McAfee is still sitting in on FDA meetings to this day – she is a great interview. The Council on Size and Weight Discrimination probably has some amazing historical documents, as does NAAFA. There was an article in Ms. magazine in – 1986? Carol Sternhell, “We’ll always be fat, but fat can be fit,” that turned into the opportunity for the book Pat and I wrote – “Great Shape” – published in 1988. Even though that was a self-help book, what we said was that fat people have no more moral obligation to exercise than anyone else, AND that fat people had a RIGHT to access physical activity like anyone else. We also said, the way people exercise in this culture leaves us all hating it, and that is because of the connection to the pursuit of weight loss, among other things. I started BodyPositive.com in 1996, and the webring “Health at Any Size” in 1999, the list “Show Me the Data” in 2001, and the HAES Special Interest Group (with Ellen Shuman, current president of the Binge Eating Disorder Association) within the Academy for Eating Disorders. Before it was called HAES, some of it went by the term “non-diet” movement/model – I was working in groups with that all the way back in the early 80’s. Some folks used a book called “One Bowl,” (still available published in later editions) and Geneen Roth’s books were probably the first big popular self-help version of “intuitive eating.” The intuitive eating thread was always problematic due in part to the assumption that weight loss would follow. But in the debate between “listen to an expert who will tell you portion sizes” vs. “you have the wisdom about hunger and fullness from the moment you were born,” I still find the latter more reliable, though I agree with you that our body sensations are not happening in a vacuum. People working with eating disorders and people working with size acceptance (I was part of both groups) were converging on the pursuit of weight loss as a big problem. But going all the way back to the late 70s, all those (explicitly not weight-loss-focused) physical activity spaces for fat people were sites of resistance and one thread of (what would become) HAES in action. Many of us were directly involved with second wave feminism, women’s health care, understanding health as a social justice issue. Sorry, I am rambling now but hope maybe there are some breadcrumbs here for further investigation. Thank you again for the discussion!

  8. This is a great post and a pleasure to read. I particularly liked the identification of the Cartesian dualism mistake. I like Wittgenstein’s treatment of this error with regards to personal, subjective experiences of pain. I believe that it is these kind of errors that lead to these philosophical and consequentially social issues that you discuss. In this case I think it comes from the way we believe that ‘you’ stands in relation to ‘your feelings’. When a fat person says ‘I am in pain’ he is not saying *this* fat person is in pain, he is not making a statement *about* a person. But in believing so, we come to a dualist point of view, which may lead us to believe we can change one without the other. In the same way we believe we can change ‘your’ body size without affecting ‘you’, and so we can also do the opposite.

    You quote Bacon as saying ‘give you tools… to live in a body you love’. This is exactly that error. I don’t *live* in my body – I can’t doubt what my ‘my body’ experiences. I don’t ‘listen’ to my body telling me what it experiences. Saying ‘I experience pain’ is no more a statement about someone that groaning is.

    I think there is also an error in Bacon’s reasoning about dieting versus following your body’s natural impulses. The argument assumes that one is an unnatural, forced method of losing weight and the other does not necessarily require will and will lead to a healthy equilibrium naturally. Someone may have good reasons to pursue either method – certain facts or beliefs give reasons to do so. Bacon appears to be claiming that epistemic reasons such as medical advice and evidence aren’t sufficient reasons but that feelings are (plus her advice of course). But these feelings are strongly affected by external psychological manipulation and social and cultural cues, not to mention physiological problems.

    I agree that the overweight and obese should not be stigmatised, we should not punish them simply for their BMI. However, intervening in society to reduce obesity not only increases the health of the population, it can reduce socioeconomic health inequalities. What people in lower socioeconomic classes eat and do only accounts for some of the differences in health between them and their more well off counterparts. Just saying that it is a case of responding to your body’s natural instincts and you will be better is wrong as it ignores external factors that operate on a larger scale. As a society we have a responsibility to everyone in it and movements such as HAES, I believe, undermine that.

  9. Sam, you write “However, intervening in society to reduce obesity not only increases the health of the population, it can reduce socioeconomic health inequalities.” If anyone has any shred of evidence for this I would like to see it. The pursuit of weight loss, the weight cycling industry, the focus on fat bodies needing to change – it leads to more stigma, more wasted time and money, more despair, more disordered eating. You can’t say people should not be stigmatized and then add to the forces that make their bodies wrong.

    Why is the health argument made on the backs of fat people? Most progressive people get it that there are structural inequalities that must be solved regardless of weight. What possible value is there in singling out someone’s body size for the argument that people should have access to high-quality food or medical care? Do only fat people need that? Are there no thin people in those communities who need that?

    Some people are willing to admit that it’s expedient to trade on the hatred of fat people because the public doesn’t care about health disparities. “That’s where the money is.” “Governments listen to that argument.” “Here’s how to alter your grant proposal to make it about obesity.”

    Too many progressive people are falling for the distraction of “fighting obesity” and not getting it that the “war on obesity” has shifted millions of dollars away from other social and health programs. Another problem is that even helpful (albeit woefully inadequate) interventions like bringing back recess, having activities that are accessible to people at a wide range of weights, getting better food to people, etc., that are tied to changing weight are doomed to lose funding and interest when people’s weights don’t change. It’s a parallel on the social level to what happens with trying to lose weight on an individual level.

    I was intrigued by your sentence, Sam: “Bacon appears to be claiming that epistemic reasons such as medical advice and evidence aren’t sufficient reasons but that feelings are (plus her advice of course).” In fact, we are looking at the medical evidence and seeing that it is often ignored in the service of weight bias and prejudice. I am not claiming that science is free from bias but rather that even the science that the weight loss advice is based on does not support the pursuit of weight loss, and is ignored.

    But it is the last clause that is quite right – the HAES model contributes an argument that seeks to influence the discourse around weight and bodies, one that competes with the “try to lose weight” and “your weight means you are Unhealthy, Morally worthless, a Drain on society,” etc. Even as we are directing people to ask themselves about their own experience of hunger or stigma or health, we of course are adding to the social and cultural milieu in which they will be conducting those investigations. There is a tension there that I think this discussion is trying to get at – how to help people focus their attention inward to the guidance there, a kind of prescription, even as we are questioning the “expert” advice. I think we see the women’s health movement influences there.

  10. Pingback: La basse cour de la poule pondeuse » News Réfléchir » Le poids : et alors ?

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