Health at Every Size: A concept to reduce weight-centric thinking and to promote body positivity

| February 20, 2023
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National Eating Disorders Awareness Week runs February 27 through March 5, and I thought it an opportune time to discuss the newly evolving concept, Health at Every Size (HAES). HAES is a methodology developed by the Association for Size Diversity and Health to promote size acceptance and body positivity, and to end weight discrimination and weight-centric thinking.

Weight-centric thinking is the conventional–and arguably outdated–approach to health that suggests weight and weight management (primarily weight loss) are the primary determinants of health.

In a weight-centric society, weight and disease are directly correlated. This correlation places increased emphasis on personal responsibility for diet-, exercise-, and other health-related choices and outcomes. Emphasizing these things can contribute to the development of disordered eating.

There are many reasons why society should reassess the weight-centric approach such as:

  • It perpetuates the weight stigma and diet culture;
  • It can lead to faddish and unhealthy dieting practices;
  • It can lead to weight cycling, which is an independent risk factor for disease;
  • It can misalign the body’s natural “set-point,” which is the body’s specific and natural weight that it wants to maintain based on genetics;
  • It poses a threat to psychological and physical health; and
  • It can increase the risk of disordered eating and eating disorders.

With an increasing cultural focus on weight loss, dieting, achieving and maintaining the ‘perfect’ figure, and the pace and ubiquity of social media trends, people tend to develop rigid rules and thinking around food. These rules foster negative connotations around food and can nudge people to identifying food as good versus bad. This rigidity, along with rules and restrictions, is linked to a high risk of disordered eating and the development of eating disorders.

Research shows that from 1999-2009, the number of men hospitalized for an eating disorder-related cause increased by 53%. 89% of teen girls have been on a diet by age 17, and 81% of 10-year-old girls are afraid of being fat. A survey from 2008 found that 65% of women aged 25-45 had some variation of disordered eating and of them, 10% met criteria for eating disorders.

This information means that 3 in 4 women eat, think, or behave abnormally around food by either skipping meals, restricting certain foods or food groups, binge eating, or feeling guilty or out of control around food. Such behaviors have become such a norm for our society; however, this state of things couldn’t be further from reality or what is truly normal. Although not all diets and dieters progress to the point of disordered eating and eating disorders, majority of persons diagnosed with an eating disorder have a history of dieting stemming from weight-centric comments and beliefs.

Focusing on weight undoubtedly detracts from the real sources of health problems and chronic disease, most of which are genetically inherited, and can promote unhealthy behaviors related to food and exercise.

One approach to shifting the focus from weight and weight-centric modalities is the HAES framework.

When we think of health risks and nutrition counseling associated with improving them, lifestyle changes are recommended. Lifestyle changes are related to behavior change, which can be done readily. It is important to remember that weight is not a behavior and cannot be spontaneously changed or modified.

It is also important to remember that health and well-being are independent of weight status. Weight and body size are primarily determined by genetics. Eating nutritious foods, engaging in physical activity, mindfulness, and meditation, all make a difference in improving the heart rate, blood pressure, and blood sugar, independent of weight loss.

The challenge is that because of the widespread emphasis on weight loss above all else, when people make progressive and beneficial behavior changes and don’t see weight loss, they become discouraged and quit what they’re doing. Some lifestyle changes may lead to weight loss, but it needn’t be the primary focus. The HAES methodology rejects the use of body mass index (BMI) and weight status as a proxy for health. Instead, this methodology works to support people of all sizes to find compassionate ways to take care of themselves, regardless of size. The focus is primarily on health and well-being opposed to weight, and promotes both physical and mental health behaviors through five principles:

  1. Weight inclusivity
  2. Health enhancement
  3. Respectful care
  4. Eating for well-being
  5. Life-enhancement movement

As far as health improvement goes, the HAES model works. It has been tried and proven to improve cholesterol, lower blood pressure, and increase physical activity, while avoiding weight cycling and improving body image. HAES emphasizes having respect for and empowering persons in bodies of all sizes. It promotes health policies that give better access to care and reduces weight stigma. It encourages people to engage in intuitive eating and enjoyable movement practices while promoting body positivity.

A person described as having a positive body image can appreciate, accept, honor, and respect their body as it is. This is not quite the same as body satisfaction, which sometimes overlaps or is mistaken for body positivity. One can be dissatisfied with aspects of their body, yet still be able to accept and honor it for its limitations, without being self-destructive and demeaning. Body positivity is important because it can be protective against the development of disordered eating and an eating disorder.

Body positivity is associated with:

  • Self-acceptance. When you are body positive, you are more likely to feel comfortable and happy with the way you look and less likely to feel impacted or pressured by the unrealistic images on social media.
  • Increased self-esteem. This is what primarily impacts how you feel about and view yourself. When you are body positive, you promote and encourage yourself in your natural form, which in turn will impact every aspect of life and contribute to overall well-being and happiness.
  • Improved and healthier outlooks on lifestyle and behavior. When you’re practicing body positivity, it is without a doubt easier to lead a well-rounded lifestyle with balanced and realistic expectations, healthier attitudes, and freedom. You are more likely to engage in healthier practices related to food and exercise when you are in sync with and respond to the all-encompassing needs of your body.

Although media and society want you to believe otherwise, there is no right or wrong when it comes to weight, shape, size, and appearance. One way to combat the pressure to fit a certain mold is by challenging beauty ideals and affirming yourself. We have the power to change the way we think, see, and feel about our bodies.

  • To help improve your body image, try the following strategies:
  • Focus on and emphasize your positive qualities, talents, skills, and attributes.
  • Say positive affirmations to yourself daily.
  • Focus on appreciating and respecting your body for what it can do.
  • Avoid comparing yourself to others.
  • Seek professional support if it is challenging for you to start these changes on your own. Professional support can help to steer you in a direction which helps you to change and challenge harmful beliefs and behaviors. (See Resources below for some places to get started.)

It is time for us to shift away from weight-centric thinking and to move forward in the HAES framework emphasizing body positivity, all-around health, and well-being.

Regardless of genetic makeup or size, everyone should be educated on the healthiest choices and recommendations for their body. After all, some people might be unaware of the ingredients in their ‘healthy’ diet that might be counterproductive to becoming the best version of themselves. This change can be achieved without placing emphasis on weight, appearance, and body size.

It is time to prioritize health in every form, respective to the person, as opposed to the standardized and outdated mold of “thin is better.” Put the social constructs to rest and begin to realize how valuable you and your body are, just as you are.


Hopkins-based Resources

Primary Care
Student Health and Wellness Center. Serves Homewood and Peabody students and trainees, as well as on-campus SOE students.

University Health Services. Serves students and trainees of BSPH, SOM, SON, and the Berman Institute of Ethics.

Students interested in working with a dietitian should reach out to their respective campus primary care clinics.

Mental Health
Behavioral Health Crisis Support Team (BHCST). Connecting behavioral health clinicians with specially trained public safety officers to respond appropriately and effectively to those in crisis, seven days a week, at 410-516-9355.

Counseling Center. Serves Homewood and Peabody students and trainees, as well as on-campus SOE students. To reach the on-call counselor, call 410-516-8278 and press “1” at any time 24/7.

Johns Hopkins Student Assistance Program (JHSAP). Serves grad students from AAP, BSPH, CBS, EP, SOM, SON, and SAIS. Getting help is free, convenient, confidential, and available 24/7 by calling 443-287-7000, option #1.

Mental Telehealth. Serves all Hopkins students.

University Mental Health Services. Serves students and trainees of BSPH, SOM, SON, and the Berman Institute of Ethics. For any urgent mental health concerns after hours or on the weekend, please call 410-955-1892 and follow the instructions to speak with a mental health professional.