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.

Can a thin person write about fat?

In recent years a field of study that has come to be entitled ‘fat studies’ has developed, largely in response to the discourse around obesity in developed countries. Just as gays, lesbians, bisexual and transgendered people have chosen to reappropriate the once pejorative word ‘queer’ for their own purposes, attempting to reinstate it as a positive self-identifying and political term, some academics and activists seek to use the word ‘fat’ to describe corpulent people in a positive, accepting manner.

In her foreword to The Fat Studies Reader, a ground-breaking collection of radical essays critiquing dominant cultural representations of fatness, well-known fat activist Marilynn Wann (2009: ix) defines fat studies as ‘a radical field, in the sense that it goes to the root of weight-related belief systems’. She contends that fat studies rejects the following assumptions: ‘that fat people could (and should) lose weight … that being fat is a disease and fat people cannot possibly enjoy good health or long life … that thin is inherently beautiful and fat is obviously ugly’ (2009: ix).

Interest in fat studies is such that there is now a new journal (Fat Studies: An Interdisciplinary Journal of  Body Weight and Society) and regular conferences and sections of major conferences devoted to this topic. Taking its name from other critical areas of interdisciplinary study such as gender, queer, black, Latino/a, postcolonial studies, those who designate themselves as part of this field tend to share the following ideas:

  • they prefer the terms ‘fat’ or ‘fatness’ to what they view as the medicalised terms ‘overweight’, ‘obese’ or ‘obesity’;
  • they challenge the dominant biomedical perspective on the relationship between fatness and ill health and disease (see here for my previous post on the contentions of obesity sceptics);
  • they represent fat people as members of a minority group that contends with routine discrimination and marginalisation;
  • they seek to counter and resist such discrimination and marginalisation;
  • they often adopt a feminist or queer approach in their critiques.
The sculpture Bronskvinnorna (The women of bro...

The sculpture Bronskvinnorna (The women of bronze) outside of the art museum (Konsthallen), Växjö, Sweden. The sculpture is a work by Marianne Lindberg De Geer.  (Photo credit: Wikipedia)

There is no lack of evidence to demonstrate that these writers are correct in identifying highly negative meanings and experiences around fat embodiment, many of which have been apparent in popular and medical discourses for centuries (see here for my discussion of fat phobia). A central theme for many writers in fat studies, as well as in the areas of what are variously entitled ‘fat activism’, the ‘fat acceptance movement’ or the ‘size acceptance movement’ is that they themselves identify as ‘fat’ people. Adopting the position that ‘the personal is the political’, they view their activities as part of a political project.

Other scholars prefer the terms ‘critical obesity studies’ or ‘critical weight studies’ to describe their writings on the social and cultural dimensions of obesity discourse (for example, the contributors to the collection edited by Rich, Monaghan and Aphramoor, 2011). The emphasis in these terms is on the word ‘critical’, as these scholars seek to identify and challenge the taken-for-granted assumptions circulating in mainstream lay discourses and in the biomedical and public health literature on obesity/fatness.  Here again, many of these writers actively avoid the use of the term ‘obesity’, preferring instead to use the term ‘fat’. Such writers may themselves identify as fat, but this is not the case for all or even many of them.

Some commentators in fat studies and fat activism have expressed very negative opinions about people writing on the topic who do not themselves identify as fat. When I was working on my book on fat politics and fat embodiment (Fat, published this month), this was an issue of which I was highly aware, as I have always been a thin person and have therefore never personally experienced the stigmatisation and marginalisation to which many fat people have been subjected.

However, as I point out in my book, fat people are not the only individuals who have been singled out for attention in contemporary anti-obesity discourse. Mothers of young children, regardless of their own body weight, have been positioned as key targets in anti-obesity campaigns and programs because they are viewed as responsible for monitoring and disciplining their children’s diet and weight. As one such mother, I have found myself the subject of moral discourses in relation to the ‘child obesity epidemic’ , implicated in the network of expert advice directed at mothers (see here for a previous post on the topic of maternal responsibility for children’s weight). The voices of mothers with young children have not often received attention, except when researchers want to determine how well they are conforming to advice on controlling their children’s weight. Yet there are many difficult ethical questions to negotiate as a mother in response to weight control issues. How, for example, do mothers ensure that their children are healthy without instilling a hatred and fear of fat or of their own body if they do not conform to the ideal of slim embodiment?

Another argument against the rigid categorisation of people as ‘fat’ or ‘not fat enough’ to write about the politics of fatness and obesity is that fatness is a fluid and unstable category, depending on the historical and cultural context and personal experience. People who may officially be categorised as ‘normal weight’ according to medical guidelines such as the Body Mass Index (BMI) may still feel ‘fat’, particularly if they aspire to or admire the kind of extreme thinness displayed by models and celebrities. People who were once medically categorised as ‘obese’ or ‘overweight’ but then lost a great deal of weight and reduced their weight to a  ‘normal’ BMI may still identify as  ‘fat’. Conversely, people who have always been large-bodied may resist being labelled ‘overweight’, ‘obese’ or ‘fat’ because they view their weight as normal and appropriate for them. What has been considered ‘fat’ in one historical era has fluctuated according to the prevailing norms of beauty and medical advice.

Further, it may be contended that everyone, regardless of body shape or weight, is caught up in or reacting to obesity discourse in some way or another. According to several public health campaigns and policies, we are all potentially fat people, unless we take steps to constantly monitor and discipline our bodies. Whether or not we identify as ‘fat’, it is difficult to escape the prevalence and dominance of anti-obesity discourse and fat phobia. Willingly or not, resistant or accepting, we are all implicated in the contemporary discourse that positions fat people as morally deficient, undisciplined, sick and inferior.

References

Lupton, D. (2012) Fat. London: Routledge.

Rich, E., Monaghan, L. and Aphramor, L. (2011) (eds) Debating Obesity: Critical Perspectives. Houndmills: Palgrave Macmillan.

Wann, M. (2009) Foreword: Fat Studies: An invitation to revolution. In Rothblum, E. and Solovay, S. (eds), The Fat Studies Reader. New York: New York University Press, pp ix-xxv.