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.

Loving yourself in a fat-phobic society

The 2012 season of the Australian The Biggest Loser focused on the loneliness and despair endured by the contestants.  Not only were the contestants forced to expose their semi-naked bodies to the viewing audience as part of the ritual weighing-in process, they were also encouraged to bare their souls. Thus, for example, a promo for the series showed one of the male contestants sitting on a stool gesturing to his fat body and saying “Look at me – no-one loves this!” Another male contestant said, “I’m ready for love” and the words ‘Love yourself’ scrolled across the screen.

The episodes featured the now-familiar visuals of the contestants pushed to exercise hard, shown sweating, red-faced and out-of-breath, grimacing in pain, crying and losing their temper as the hard-bodied and hard-faced instructors shout at them to force them to persist. Scenes involving the temptation of the fat people were also part of this series. The contestants in one episode were faced with a room full of junk food and sweet treats – chocolates, cakes and the like — as a means of testing their self-control and ability to resist temptation.

The underlying meanings of this program are all too clear. Fat people are lonely, unloved, emotionally volatile and sad; they deserve punishing exercise routines and stringent diets as part of their weight-loss efforts; they are childish and need a stern authority figure to force them into proper weight-loss habits; they find their gluttonous desire for treats difficult to resist. The focus on love in this season combines two ideas: that fat people do not love themselves, or else they would not have allowed themselves to become fat, and that no-one else is sexually attracted to them because of their fat bodies. Such people are represented as objects both of pity and contempt.

Recent critiques in the social sciences and humanities have drawn attention to the ways in which obesity is represented in medical and popular culture. In response to massive publicity given to obesity in western countries, including Australia, new areas of study focused specifically on the social and cultural aspects of obesity have emerged, entitled variously ‘critical obesity studies’, ‘critical weight studies’ or ‘fat studies’. They refer to a ‘fat-phobic’ society, in which fat people are excoriated and humiliated for their size, where it is assumed that fatness is the direct result of greed and lack of self-control and that fat people are inevitably unattractive to others.

Members of the fat acceptance movement have engaged in political activism in the attempt to overcome this discrimination and to reclaim the term ‘fat’, which they prefer to the ‘o’ words – overweight and obese.

Some social scientists and nutritionists have examined the obesity science literature and argued that much of it is characterised by generalisations and speculations, and that the contention that overweight (as distinct from morbid obesity) automatically poses health risks has not been scientifically proven. It is further argued by these critics that continual attempts by fat people to lose weight can actually be negative to their health status if it involves extreme diets, being caught in a cycle of losing and gaining weight or poor dietary habits.

Partly as a response to this critical position, a movement called Health at Every Size has emerged which champions the idea that good health may be experienced at a range of body weights if attention is paid to regular exercise and eating healthy foods. From this perspective ‘loving yourself’ may well involve relinquishing the desire to lose a lot of weight and instead acknowledging that a healthy lifestyle may be achieved even if one does not conform to the cultural ideal of slenderness.

The critical position and the Health at Every Size movement raise important questions for how the public is educated about the health effects of overweight and obesity. In the meantime, programs such as The Biggest Loser continue to profit from perpetuating negative representations of fat people in a fat-phobic society and humiliating and punishing their contestants for their sin of being fat.

Further reading:

Fat Studies journal (http://www.tanf.co.uk/journals/UFTS)

Michael Gard and Jan Wright (2005) The Obesity Epidemic: Science, Morality and Ideology. London: Routledge.

Michael Gard (2011) The End of the Obesity Epidemic. London: Routledge.

Deborah Lupton (2012) Fat. London: Routledge (due for publication in September)