Health At Every Size: The Surprising Truth About Your Weight (51 page)

FINAL WORDS: FOR HEALTH PROFESSIONALS RESISTANT TO HEALTH AT EVERY SIZE

So you’ve been exposed to the
Health at Every Size
concept and still you don’t agree with it. Resistance is understandable. Beliefs such as “Fat poses substantial risk to health and longevity,” “Dieting is a helpful strategy for improving health,” and “Anyone can achieve permanent weight loss if only they try hard enough” are firmly embedded in our medical ideology and culture. Why should you challenge these ideas when they appear so well-established and well-supported?

Because we’re losing the war on obesity. No matter how authoritatively we repeat the “lose weight” mantra, America’s average weight is not declining. Instead of helping people get healthier, we’ve inadvertently supported rampant food and body preoccupation, damaging cycles of weight loss and regain, eating disorders, reduced self-esteem, weight discrimination, and poor health. We are violating the basic tenet of medical practice: “First, do no harm.” Rather than take responsibility for our failed paradigm, we blame our patients for failed weight loss attempts and don’t consider the well-documented biological resistance to weight loss or other challenges.

Health at Every Size (HAES) is the new paradigm, providing a compassionate alternative to the war on obesity. No harm comes from supporting people of all sizes in adopting good health behaviors.

It may be particularly difficult for educated health professionals to consider HAES seriously. Ironically, our education gets in the way of our ability to learn. The more experienced and “expert” we are in a particular field, the more likely we are to apply our “knowledge.”

Excerpt from
Health at Every Size: The Surprising Truth
About Your Weight
© 2010 by Linda Bacon.
May be freely distributed, provided that it remains in its entirety
and this copyright message appears. More info at
www.HAESbook.com
.

This can prevent us from giving serious consideration to innovative ideas.

The lens of conventional assumptions taints nearly every weight-related paper published in scientific journals. When we see the well-established association between weight and certain diseases, for example, we extrapolate that weight is the problem. It is only when we let go of conventional assumptions that other possibilities emerge. For instance, how much of the association between weight and health risk can be explained by damage caused by the weight cycling resulting from repeated diet attempts? How much is caused by the stress response resulting from weight bias? In actuality, some of the health risk may be iatrogenic, caused by the assumptions of the currently accepted weight paradigm rather than adiposity itself. Some of the risk can also be explained by lifestyle habits that are common across the weight spectrum, not physically obvious in people with a lesser biologic propensity to store fat. We ignore this at-risk “normal weight” population because of our weight focus.

It can be threatening to consider the ramifications that may come if you adopt HAES: Would it jeopardize your career if you stopped promoting weight loss? Would you lose the respect of colleagues if you adopted such a contrarian view? What would it feel like to assume a position that provokes considerable resistance? It takes a lot of courage to open your mind to a challenge when the stakes are so high.

Indeed, it may not be a conscious choice to avoid fully engaging with the HAES challenge. Many of us have strong defense mechanisms that keep us rooted to the safe and familiar. Defense mechanisms frequently operate below the level of conscious thought, allowing us to dismiss information before it threatens our worldview.

But you owe it to yourself and others to take on this challenge. Too much damage has already occurred as a result of misguided quests to support good health.

I’d like to end with some words of support for those of you who do rise to the HAES challenge. In the past, you may have recommended weight loss, thinking it was a responsible and kind thing to do. It can be very painful to reflect back on your history and consider that the advice you gave was actually quite destructive. It’s not uncommon for people to feel considerable grief when they first embrace HAES.

Don’t be too hard on yourself. You were well intentioned and did the best you could given the information you had at the time. You didn’t invent the problem. But you can seize the opportunity to undo that damage now. You will not be alone. There is a large community of health care professionals committed to HAES. Join us! Consider joining the Association for Size Diversity and Health (ASDAH) at
www.sizediversityandhealth.org
, an association for HAES professionals.

For more information, read
Health at Every Size: The Surprising Truth About Your Weight
(
www.HAESbook.com
). Visit the HAES Community Resources (
www.HAESCommunity.org
) to learn more about your colleagues and to register your voice.

FOR PEOPLE WHO CONSIDER SIZE ACCEPTANCE DANGEROUS

We’ve all heard the weight fears: obesity is said to have reached epidemic proportions, posing drastic threats to public health, increasing morbidity, mortality and health care costs, and lowering quality of life. Many well-intentioned people strongly believe that we need to fight obesity and that people who promote size acceptance are dangerous.

But here’s the rub. History shows that admonishing people to lose weight is just plain ineffective. The weight loss literature has been consistent for decades: while many weight loss methods are successful for short-term weight loss, only a tiny minority of people actually maintain that weight loss over the long term. Whether you blame willpower or accept the more scientific argument that biologic mechanisms underlie the resistance to weight loss, the simple fact remains: admonishments to lose weight don’t result in maintained weight loss for the vast majority of people. You can choose to adopt a self-righteous attitude and blame the individual, or, you can take responsibility and acknowledge that for whatever reason, your advice is not achieving the desired outcome.

Trumpeting obesity fears and hounding people to lose weight is not just ineffective, but downright damaging. They lead to repeated cycles of weight loss and regain, to food and body preoccupation, self-hatred, eating disorders, weight discrimination, and poor health. Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat. Every time you make fat the problem, these are side effects, however unintended they may be.

Those of us who advocate for size acceptance care deeply about people’s health. A large scientific literature demonstrates that improved health behaviors can improve health directly, regardless of

Excerpt from
Health at Every Size: The Surprising Truth
About Your Weight
© 2010 by Linda Bacon.
May be freely distributed, provided that it remains in its entirety
and this copyright message appears. More info at
www.HAESbook.com
.

whether weight changes. The psychological literature additionally indicates that people make better health choices when they feel better about themselves.

The argument for size acceptance doesn’t need to depend on whether you accept the considerable challenges to the current assumptions about weight and health. It’s really very simple: Your strategy has not only failed, but backfired. Shame doesn’t help people make better health choices—though it does contribute to considerable “dis-ease.” I urge you: Lay off the fat people. Science and reason do not support the value of a weight focus.

There is a compassionate alternative to the war on obesity. It’s called Health at Every Size and it involves shifting focus from weight to health.

For more information, check out
Health at Every Size: The Surprising Truth About Your Weight
(
www.HAESbook.com
).

JOIN THE HAES REVOLUTION

Interest in Health at Every Size (HAES) is growing fast. People are tired of diets, tired of feeling like failures, and tired of being scared of food. They are excited to find a paradigm that respects the diversity of human bodies and starts from the very basic premise that they can trust themselves—a paradigm that respects pleasure rather than denial.

We’re at a transition point. Many people are ready to move on from feeling shame about their bodies and being preoccupied with their weight, yet our institutions are still mired in damaging old-school thought. Large publishers hesitate to publish HAES books, worried that only books promising weight loss will sell. Many health professionals and organizations cling to the belief that fearmongering about weight and promising weight loss motivate people to improve their health practices. The mainstream media are reluctant to give Health at Every Size sufficient air time, apparently convinced that reinforcing people’s weight insecurities generates more attention.

I hope this book helps you to envision a different, more compassionate, and more respectful world, and that it gives you ideas and tools to help you make that vision reality.

I invite you to also consider some other simple, important things you can do.

The HAES Pledge: Making our Presence Known

Sign the online HAES pledge to show your commitment to HAES. As word spreads, this will show others our strength in numbers. We’ll hasten institutional change by demonstrating that there is a large audience for HAES-affirming practices.

The HAES Registry and Resource List

So many of us incorporate HAES values into our work and activities: psychotherapists, dieticians, artists, academics, bloggers. . . . The

Excerpt from
Health at Every Size: The Surprising Truth
About Your Weight
© 2010 by Linda Bacon.
May be freely distributed, provided that it remains in its entirety
and this copyright message appears. More info at
www.HAESbook.com
.

HAES Registry and Resource List have been established to foster community, educate people, and nurture the development of HAES values. Become a part of the HAES Registry. Or search the Registry to find who or what you’re looking for. Check out the Resource List to learn more about HAES-affirming books, Web sites, videos, and more—or add your resource to the list. You can even find listings for job, volunteer, research, or activism opportunities.

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