The Health At Every Size® Approach

The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual. 

The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.

The Health At Every Size® Principles are:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
   
   
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
   
   
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
   
   
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
   
   
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

 Download a copy of ASDAH's HAES Principles here.

Q: Where did the ASDAH HAES® Principles originate?

When ASDAH first formed in 2003, the original steering committee (Claudia Clark, Miriam Berg, Roki Abakoui, Donna Pitman, Paul Ernsberger, Catherine Shufelt, Veronica Cook-Euell, Judy Miller, Lisa Breisch, Francie Astrom, Renee Schultz, Darshana Pandya, Judy Borcherdt, Joanne Ikeda, Ellen Shuman, Dana Schuster) agreed that the work of the organization would be based on a set of Health At Every Size® Principles. Most of the versions of the HAES Principles in use at the time incorporated aspects of tenets previously put forth by Joanne Ikeda, Karen Kratina, Francie Berg, and/or Deb Burgard. Some listed both the basic beliefs that were consistent with a HAES model and those that were not acceptable under a HAES model, while all included reference to: acknowledging size acceptance and diversity; pursuing an aware/intuitive approach to eating; engaging in individualized and enjoyable physical activity; and recognizing/appreciating health as being multi-faceted. Based on these shared understandings, the steering committee crafted and adopted the five original Health At Every Size Principles that have appeared on ASDAH materials and the website from 2003 through 2013.

Q: Why did ASDAH determine it was a good time to revise and update its HAES Principles?

Over the years since the principles were adopted in 2003, ASDAH has received a great deal of thoughtful input from members and other groups regarding such issues as healthism, ableism, cultural imperialism, and the health implications of socioeconomic status and weight stigma. It gradually became clear that ASDAH's original HAES principles, while sound in and of themselves, did not fully reflect the evolving political and sociocultural milieu or the growing consensus regarding the social determinants of health.

ASDAH's ten-year anniversary has been a natural time for reflection, strategic planning and contemplation about our role as a leading voice in the international HAES community. The HAES approach has gained traction and developed roots in the public discourse about weight, size, and health. In this revised set of principles, we seek to acknowledge social justice and access concerns while remaining true to the underlying lived wisdom of the HAES approach as it has been practiced for many years.

Q: What was the process used to arrive at the current HAES Principles?

When the ASDAH Leadership Team decided in early 2013 to move forward with a review and possible revision of the principles, the decision was made to create a HAES Principles Task Force that would meet at our educational conference in June 2013. This intention was announced to the membership, and, since only a sub-set of ASDAH members would be able to attend this event, an invitation was sent to all members after conference, encouraging them to consider joining the project teams that began their work at the conference. Dana Schuster, in her role as ASDAH's Internal Policy Committee (IPC) chair, facilitated the initial discussion held at conference, in which Shelley Bond, Kathy Kater, Judith Matz, Christine Ohlinger, and Amy Herskowitz participated. Kathy agreed to head up the project team after conference, and Judith, Chris and Amy continued to work with her to draft an initial proposal. The Weight Stigma and Intersectionality task force teams formed at the conference also provided language they felt would be important to incorporate in updated principles.

Once the input of these project teams was gathered, the IPC attempted to coherently "merge" the critical components into one document. This proposal was then reviewed and approved by the ASDAH Leadership Team, which is comprised of the 2013-14 elected Board of Directors as well as the current committee chairs. The newly updated Health At Every Size Principles, now available on the ASDAH website, are the final result of this process.

Q: Principle #1 states that "no weight should be pathologized," but aren't there pathological weights, such as an adult at 68 lbs with an eating disorder or a 600-lb bedridden individual?

When a weight-specific lens is applied to health, the myriad contributing factors affecting an individual's well-being are usually lost. The Health At Every Size® approach shifts the focus to acknowledging and respecting an individual's circumstances, and works to investigate and support options that are available to him or her to help make choices that benefit his/her health and well-being. For either the 68-lb. or 600-lb. person, using a HAES approach puts the focus on his/her behaviors, unique set of abilities, and available resources, and places them in the context of their life as the primary areas of concern and consideration. Each individual will have his/her own strengths and vulnerabilities, and will likely respond to stimuli in their unique way. Improving a person's health is a process that begins by contemplating what it would take to make certain determinants of health available and accessible to different individuals, and not by pathologizing any specific weight.

Q: Doesn't supporting "personal health practices that improve well-being" suggest a healthist agenda?

Healthism is the idea that following a particular set of health behaviors is "good" and not doing so is "bad." Unfortunately, "health" is one of a long list of categories that our culture tends to use to value an individual's worth, along with appearance, size, weight, age, ability, gender, race, and others. Healthist judgments have also crept into our discourse around public health, with spiraling health care costs being implicitly or explicitly blamed on the so-called "choices" of various groups, including fat people.

ASDAH's HAES Principles reject judgments about health and any discourse of individual responsibility around health, in favor of a discourse of individualized health needs. None of us are alike, and each of us is entitled to make up our own minds about what "health" means. The preamble to the HAES Principles defines health as a resource or a capacity, rather than as a "state" that can be good or bad, in order to refocus health professionals and policy makers on what can be done to empower individuals and communities toward wellbeing.

ASDAH also recognizes that many of the factors that determine our health are not individual in nature. Social, political, and cultural factors - including but not limited to poverty, access, and all forms of stigma - may have an even greater impact on health outcomes than individual choices. On a collective level, we support creating health-promoting environments and removing barriers to access. On an individual level, we seek to empower people to engage in those personal practices that best support health and wellbeing for the individual. There should be no judgment about what people choose to do (or not do) to enhance their well-being.

Q: What does it mean when Principle #3 mentions that individuals' differing identities may affect how they experience weight stigma and should be addressed when providing HAES information/services?

Our social and cultural identities are multi-dimensional and complex. No one is "only" an ethnicity or a gender or a religion or a size. We are all these things, and more. This is sometimes referred to as the concept of intersectionality, which recognizes that various social and cultural categories are not independent, but rather intersecting. These multi-dimensional, intersecting identities mean that we may also be subject to intersecting systems of privilege and oppression. Likewise, an individual may be subject to multiple, intersecting forms of stigma, including weight stigma.

The public health community has long recognized the importance of social determinants of health in contributing to health status. Stigma, including weight stigma, is an important determinant of health and contributes to the health inequities that pose one of our most intractable health problems worldwide. Intersectionality needs to inform how we think about the complex problem of health inequities. This informed perspective will lead to a better understanding of how the social determinants of health affect health status and to more effective solutions.

Q: Economic access and environmental safety directly impact an individual's ability to be "eating for wellbeing" and engaging in "life-enhancing movement." Did ASDAH consider these issues in revising Principles 4 and 5?

Yes, ASDAH views the issues of access, economics, and safety as critical components of wellness, not only as they pertain to food and physical activity, but also as they impact all of healthcare. Hence, these concerns are referenced in the framing paragraphs so they apply to all of the principles. This can be seen in the statement that the HAES model "is an approach to both policy and individual decision-making, addressing broad forces, such as safe and affordable access, that affect health" and with the assertion that it is an approach that "grounds itself in a social justice framework."