Health at Every Size: a Weight-neutral Approach for Empowerment, Resilience and Peace

Abstract

Obesity is high on the agenda of governments and health and welfare agencies worldwide. The placement of body weight at the centre of discourse about health is referred to as the weight-centred health paradigm (WCHP). Critical analysis of the WCHP has increased in recent years, resulting in arguments for a paradigm shift. Critique of the WCHP encompasses ideological, empirical and technical issues. The consequences of the WCHP have been identified as an adipophobicogenic environment (an environment that creates fat hatred and weight stigma), and diminished health, wellbeing and quality of life for people with weight concerns. Many critics argue that it is time for a change of paradigm. The Health at Every Size® (HAES)® 1 approach offers a more salutogenic, compassionate, humane and evidence-based approach to weight concerns. HAES is a strengths-based, ethical approach to enhancing the holistic health and wellbeing of all people. It does not advocate that people are automatically healthy at every size, but that people at every size can be supported to adopt practices that will enhance their health and wellbeing, irrespective of whether these practices result in changes in body weight. The HAES approach aims to empower people to do what they can to improve their health, including developing their resilience and capacity to cope with the trauma of living in a weight centred and adipophobic society. Ultimately, the HAES approach aims to create hope for people to make peace with their bodies.

Ethical considerations for clinical work with fat clients: Psychologists’ roles.

“…Researchers and practitioners often fail to accurately present the difference between correlation and causation in these interrelations, account for the role of confounding variables, or correct unsupported beliefs regarding the relationships among BMI, health, and mortality among their colleagues, clients, and the public, however (Bacon, 2010; Bacon & Aphramor, 2011; Calogero et al, 2016; O’Hara & Taylor, 2014). Misrepresentation of this nature can result in members of the public, including current and prospective clients, being subjected to inaccurate and potentially harmful contentions that an “obesity epidemic” is saturating our nation with disease and death, and that “waging war” on “obesity” via weight loss is needed to rectify this so-called dire problem (Calogero et al, 2016; Campos et al, 2006; O’Hara & Taylor, 2014). Yet, the veracity of these claims is not supported by current research and disconcertingly stimulates weight-based fearmongering, stigma, and fear of fatness within society (Bacon, 2010; Calogero et al, 2016; Campos et al, 2006; Tylka et al, 2014).…”

“…Although the vast majority of psychologists undoubtedly strive to meet the ethical principles described, these data collectively suggest that clients may face unintentional harm when they undergo psychological treatment that focuses on weight loss as a primary goal. The aforementioned ethical concerns have elicited calls for a paradigm shift away from the weight loss-focused “obesity” treatment perspective (Bacon, 2010; Bacon & Aphramor, 2011; Calogero et al, 2016; O’Hara & Taylor, 2014; Tylka et al, 2014). In meeting this aim, a nondieting, weight-neutral paradigm has emerged that promotes the health and well-being of people across the weight spectrum, and advocates for body size acceptance (Tylka et al, 2014).…”

“…The weight-neutral paradigm conversely seeks to improve individuals’ health and well-being as foremost goals, and accomplishes these aims by increasing clients’ abilities to eat based on their physiological hunger and satiety cues and engage in pleasure-based movement for the purpose of enhancing quality of life (Bacon, 2010; O’Hara & Taylor, 2014; Tylka et al, 2014). Of note, the weight-neutral paradigm is not against weight loss, per se, but rather the pursuit of weight loss, in light of the aforementioned evidence that such endeavors have not proven effective or safe for most clients in the long-term (Calogero et al, 2016; Dombrowski et al, 2014; Mann et al, 2007; Tylka et al, 2014), and recognizes that health is best defined as a holistic, multidimensional construct that does not center on weight as a primary marker of health and well-being.…”

“…Focus of this nature has led to widespread development of treatment initiatives that center on weight loss as a primary goal. Weight loss-focused treatment efforts demonstrate limited efficacy, however (Bacon & Aphramor, 2011; Bombak, 2014; Tylka et al, 2014), and have been associated with weight-based stigma, adverse physical and mental health outcomes, and the proliferation of adipophobicogenic environments (milieus that propagate weight stigma and hatred of fat bodies; Bacon & Aphramor, 2011; O’Hara & Taylor, 2014; Papadopoulos & Brennan, 2015; Tylka et al, 2014).…”

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“…The values of beneficence and non-maleficence require effective treatment benefit and an active awareness of avoiding harm, both of which are violated by promotion of weight loss (Bacon & Aphramor, 2011). A weight-centered paradigm is ineffective, harmful, and unethical (O'Hara & Taylor, 2014). There are no legitimate reasons to promote an intervention that has a history of poor outcomes and failure along with a high likelihood of iatrogenic results (Bacon & Aphramor, 2011;Bangalore et.…”