What is Health at Every Size?
HEALTH AT EVERY SIZE (also known as HEALTH AT ANY SIZE) is a health-centered paradigm that focuses on total health and well-being, not weight. It promotes active living, eating well without dieting, and a nurturing environment that includes respect and acceptance for people of all sizes.
Healthy Living at Your Size
It’s time to take a new approach to wellness and wholeness. Time to focus on promoting healthy, happy living for both children and adults. This is an urgent challenge for countries around the world. The cult of thinness that permeates our lives has taken its toll. Viewing health through a weight-centered perspective has not helped families become healthier. Instead, research shows it is causing harm.
The healthy living approach that embraces self-acceptance, respect and diet-free eating comes as a refreshing change. With roots in Health Canada’s Vitality program of the early 1990s, this approach offers the simplicity of stress-free living. Vitality sums it up this way, “Live actively, eat well and feel good about yourself and others.”
Preventive of both weight and eating problems, it’s a health-centered, compassionate approach that leaves restrictive thinking behind and promotes health in body, mind and spirit for people of every size. Everyone qualifies. Right now, just as we are.
A paradigm shift
This paradigm shift is being called health at any size, or health at every size, or simply healthy living.
With this approach the health care provider asks: How can I help this individual be healthier at the size she is now? How can we promote health without fostering new problems related to disordered eating or weight loss attempts? How can we reduce stress and help this patient enjoy a normal lifestyle that embraces living actively and eating well?
This philosophy honors diversity as a positive characteristic of the human race, and reassures parents that, of course, children can be healthy at their natural sizes. The notion that thin people are healthy and large people unhealthy is false.
The response is everywhere positive to this approach. People recognize that the body cannot be shaped at will. They are weary of our long history of diets that don’t work and sometimes kill, the widespread nutrition deficiencies and arrested development of teen girls, the deadly increase in eating disorders, and the unconscionable harassment of large children and adults.
Do no harm
The health at any size approach recognizes that problems of overweight, eating disorders, malnutrition, size bullying and dangerous weight loss attempts are not separate issues. All are interrelated. All are intensified by the diet industry’s current “war on obesity” being fought on newspaper front pages and in medical clinics. They need to be addressed together in a comprehensive way to avoid doing harm. The war can end peaceably.
This health at any size approach helps to prevent problems and heal the damage done. It embraces these concepts:
- Accept and respect your own and others’ unique traits and talents; celebrate diversity.
- A healthy lifestyle is achievable by everyone, unlike so-called “ideal weight.”
- Enjoy physical activity every day, your own way, as natural and beneficial.
- Enjoy eating well without dieting; rediscover normal eating — tune in to hunger, appetite and fullness.
- Enjoy full nutrition; honor balance and variety; all foods can fit.
- Focus on wellness in body, mind and spirit; focus on overall health and well-being.
- Enhance supportive relationships and good communication with family, friends and within communities.
Research confirms the wisdom of the health at any size approach. A recent two-year study at the University of California tested 78 obese women, defined as chronic dieters. Half comprised the health at any size group; the other half began a well-respected behavioral dieting program (Bacon L. JAmDietAs. 2005;105:929-936).
Women in the first group learned to recognize and follow internal hunger cues, and feel positive about their size and shape. Over the two years they improved in metabolic fitness measures (blood pressure, blood lipids), in energy expenditure (more active), eating behavior (less restraint, eating disorder pathology), and psychology (self-esteem, depression, body image), and maintained a stable weight. They sustained all benefits for two years, and 92 percent stayed in the program until the end. A highly successful effort.
As we might expect, women in the dieting group lost weight the first year and temporarily improved in many health measures. But in typical yo-yo fashion, they regained the lost weight in the second year, lost all their hard-won health benefits, and nearly half dropped out within the two years. Nothing new here, unfortunately.
The health at any size movement also takes on the misinformation being spread by the industry in their “war on obesity,” such as the exaggeration of health risks.
Katherine M. Flegal, PhD, Senior Research Scientist at the National Center for Health Statistics, CDC, explains, “Although people think there’s all this evidence out there showing a high mortality risk associated with overweight, in fact the literature doesn’t show it.” Far from it. Flegal’s research, analyzing 30 years of actual deaths in the US, corrected an earlier CDC report that indicated severe risks related to overweight. She showed instead that being clinically ‘overweight’ is associated with a lower death rate than so-called ‘normal’ or ‘healthy’ weight. (JAMA 2005;293:1861-1867). It confirmed much earlier research that had been studiously ignored.
Further, despite nearly three decades of intensive research, obesity specialists have failed to show success for any of the current weight loss methods, whether diet, drugs or surgery. All are considered experimental. None are proven safe and effective.
- Dieting causes short-term weight loss lasting no longer than six months, followed by regain, known as weight cycling, which carries its own risks, and can lead to food preoccupation, bingeing, dysfunctional eating and sometimes eating disorders.
- Drugs offer only minimal weight loss of about 5-11 pounds, regained when the drug is stopped; it must be taken long term with increased risk. Of 6 million U.S. adults treated with fen-phen/Redux, the FDA reports that one-third developed leaky heart valves, fatal to some, and others died of primary pulmonary disease.
- Gastric surgery for weight loss carries risk of nearly 5 percent death rate (nearly 50 percent for patients age 75 and over) according to Medicare studies, (JAMA. 2005;294:1903-1908), and more than 60 complications.
The 1990 Congressional hearings exposed much deception and fraud in the weight loss industry. In 1992 the National Institutes of Health reported not one diet company could produce research showing safety and success for any program.
In their 1998 New Year’s Day editorial, Marcia Angell, MD, and Jerome P. Kassirer, MD, editors of the New England Journal of Medicine, warned, “Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition.”
Freedom to get on with life
Today there is overwhelming agreement among health professionals and the public about the failure of weight loss programs to bring about lasting change. And there is widespread concern for the harm they cause.
“Healthy bodies come in all shapes,” says Steven Blair, PhD, Senior Scientific Editor of the Surgeon General’s Report on Physical Activity and Health. “We need to stop hounding people about their weight and encourage them to eat a healthful diet and exercise.”
Sally Smith, Director of the National Association to Advance Fat Acceptance agrees. She tells health care professionals, “Provide quality health care, not weight cycling.”
The health at any size approach frees people to take pleasure in food again, to enjoy activity without the goal of calorie burn. It frees children from struggling to fit unrealistic size expectations, and parents from the confusion of conflicting advice. It frees girls and women who have kept themselves thin but limited by restricting food, so they can live in fulfilling ways and get on with what is important in their lives. Through this approach, people of all sizes are moving on to a more enriching life of wellness and wholeness.
— Francie M. Berg, M.S.
(Adapted from the book Underage and Overweight: Our Childhood Obesity Crisis – What Every Family Needs to Know, 2005. Copyright 2008, 2004, by Francie M. Berg)
Advocates of Health at Any Size combat the misinformation being spread in the 'war on obesity' with credible science and common sense.
“Healthy bodies come in all shapes. We need to stop hounding people
about their weight and encourage them to eat
a healthful diet and exercise.”
–Steven Blair. PhD
Senior Scientific Editor,
on Physical Activity and Health
"Although people think there's all this evidence out there
a high mortality risk associated with overweight,
in fact the literature doesn't show it."
–Katherine Flegal, PhD
Senior Research Scientist, National Center
for Health Statistics, Centers for Disease Control and Prevention
“The data linking overweight and death, as well as the data
showing the beneficial effects of weight loss,
limited, fragmentary, and
–J. Kassierer and M. Angell,
New England J Medicine, NEJM, Jan 1, 1998
And to quote an astute observer of our culture who might
chuckle at our current obsession with thinness:
"It ain't what you don't know that gets you into trouble.
It's what you know for sure that just ain't so."