Health at Every Size: A Reappraisal Is Deserved

In 2009 Americans spent 9.5 billion dollars on weight-loss programs, and yet we continue to gain weight, relentlessly.  And it’s been like this for the last three decades.  I wrote briefly about the movement “Health at Every Size” (HAES) in 2005, although it had begun to gain ground in the 80s and 90s.  Now two HAES practitioners have published an authoritative review of the apparent need for a shift in thinking on the approach to weight control by health practitioners; it appears in full in the Nutritional Journal.

The overwhelming advice recommended for overweight or obese individuals is to change their lifestyle; this usually involves dietary changes and an exercise regime, which produces satisfactory short-term weight loss but which can rarely be maintained over the long term.  The study provides evidence that rebuts several major myths about treating overweight and obesity. 

1.  Weight loss doesn’t necessarily prolong life – “overweight” people (i.e. BMI 25–30) have the lowest mortality, according to Centers for Disease Control (CDC) stats. 
2. Diet and exercise induced weight loss returns within 5 years, according to a National Institutes of Health expert panel.
3. Although weight loss is a sensible, positive goal, the failure rate often leads to feelings of poor self-esteem and inadequacy which, together with weight cycling, all of which have been implicated as risks for diabetes and cardiovascular disease, not to mention anxiety syndromes.
4. It's been proved that changing health behaviors, even when weight is gained, is a feasible goal and readily attained.

One unintended consequence of concentrating attention on the need for weight loss is expenditure by public bodies and private individuals amounting to billions of dollars annually. And, as previously noted, this expenditure is almost entirely ineffective.

The HAES movement challenges the accepted value of attempting weight loss by standard methods, and shifts the focus to wait-neutral health outcomes. It encourages body acceptance, and supports reliance on internal regulatory processes, such as hunger and satiety, as opposed to dietary restriction. Moreover, HAES focuses on helping people find enjoyable ways of being active, encouraging them to build activity into their day-to-day routines; this is instead of having them meet set guidelines for the frequency and intensity of exercise. Interventions focus only on modifiable behaviors where there is evidence that this will improve health. Weight is not a behavior and therefore not an appropriate target for behavior modification.

Blood pressure, lipid levels, and psychosocial assessments are the recommended foci for health improvement through HAES. There is no doubt that the number of advocates for this approach to obesity is increasing, no doubt because of the frequent failure of more standard methods such as medication, surgery, diet and exercise. Until it is shown that HAES is actually harmful, there seems no reason not to recommend it as an alternative to the numerous, expensive weight loss regimes commonly used.