Revisiting the Health at Every Size Framework

In early 2023, new American Academy of Pediatrics guidelines for managing children's weight were released. I was shocked and disheartened by this news because, as a parent myself, I know that health is not dependent upon any size.

I will not get into the new guidelines here, as they do not directly relate to the diabetes community. But I do want to revisit the movement of Health at Every Size (HAES) and how it can be beneficial, regardless of age or body weight.

What is Health at Every Size?

Health at Every Size (HAES) is a framework designed to allow weight-neutral care and to help end size-based stigma. There are 5 principles guiding this framework. They are:¹

• Weight inclusivity: respecting the diversity of body sizes.
• Health enhancement: supporting policies that make health information and care equally available to all.
• Eating for well-being: people can check in with their own natural satiety and likes and dislikes, rather than eating for weight control.
• Respectful care: healthcare practitioners reflect on their inherent biases and work to end weight stigma.
• Life-enhancing movement: encouraging people to engage in physical activities they choose and enjoy.

The beginnings of this framework started in the 1960s, gathering steam in the 90s. Intuitive eating is a related movement focusing on listening to the body and letting go of rigid dieting rules.

But isn't weight loss necessary for health?

Growing evidence shows that focusing on health behaviors rather than body weight is more important for overall well-being and diabetes care. In fact, a recent study found that participants in a HAES program had health marker improvements regardless of whether they lost weight or not.¹

HAES is about overall health and well-being rather than focusing on numbers or rigid rules. In my opinion, it is a kinder, gentler way of providing healthcare and assistance.

What are the benefits of a Health at Every Size provider?

If your body size is outside the limits of a "normal" body mass index (BMI), you may have felt apprehension, shame, or guilt when heading to the doctor. You may have even experienced direct bias in the form of being told to lose weight rather than having your symptoms addressed and diagnosed. Unfortunately, weight bias is quite common among healthcare providers.²

However, if you can find a doctor or healthcare provider who abides by HAES principles, you will be treated with the respect you deserve. With a HAES provider, you can ask not to be weighed. You will be asked questions about your diabetes-related symptoms without being told you need to lose weight. And, perhaps most importantly, you will be treated with respect.

Doesn't that sound nice? It sure sounds good to me!

How to find a Health at Every Size provider

Although there appears to be a growing number of doctors, physician assistants, and registered dietitians who support the HAES framework, you will need to do some work to find them. Currently, a complete list of HAES providers is unavailable online. However, with some searching, these providers can be located.

Intuitive Eating counselor directory

If you are looking for a dietitian, visit the counselor directory on IntuitiveEating.org. The directory shows a list of intuitive eating counselors that you can find by location.

As mentioned, intuitive eating is a slightly different framework than HAES, but it is closely aligned with HAES and its practitioners have similar values. If you find an intuitive eating dietitian or mental health professional, you can ask them for doctor recommendations.

Online search

You can also search online for "HAES providers" and the name of your town or closest city.

These providers are not in every single city, but they do exist. And they can provide the supportive, respectful care everyone deserves, regardless of race, disability, or body size.