I keep hearing about this concept called “Health at every Size” (HAES) and intuitive eating, and it sounds great to me! Just the sound of the words are so comforting when I feel like all that I’ve learned in nutrition is eating less or calorie counting or cutting out fat, etc. But what exactly is HAES and intuitive eating? Is it something that I could use as a future RD and is it something that I can use in my daily life? I dug into the research to find out:
The National Eating Disorders Association acknowledges that well being and healthy habits are more important than “any number on the scale.” And I agree with this. I’ve always thought that mental health is most important in life. Does it matter that you make it to the gym every day if you’re starving yourself to (literal) death? Nope. Having a healthy and happy relationship with yourself and food is paramount to anything else (especially eating). But anyway… this thought is where HAES is born. Because of the huge backlash of diet culture (eating less, looking thin, low carbs, vegan, etc) more people are skewing nutrition into a lifestyle that isn’t sustainable or healthy. Dieting can lead to food and body obsession, self hatred, disordered eating, weight cycling, and poor health. It seems that the point of dieting is more about appearance than actual health which can trigger a snowball reaction to more and more unhealthy habits to be thin. Enter HAES.
HAES is the idea that the size of your body is not a determinant for health- so just stop trying to lose the weight. It’s a frame of mind for doctors and dietitians to stop encouraging weight loss and stop further contributing to diet culture. Instead focus on the health. If someone has high blood pressure treat that- not just telling the patient to lose weight. Instead HAES uses an “anti-diet” approach called intuitive eating.
Intuitive eating is just that- listening to your own body for hunger and fullness cues. Not external cues like calorie or macro-nutrient tracking. Practitioners using intuitive eating counseling techniques will encourage their patient to accept their size, trust your own hunger and fullness cues, adopt healthy lifestyle habits (being social, finding joy in moving the body, finding nutritious food you enjoy), and to embrace size diversity. A key to this approach is the end goal is not to lose weight- it’s more to restore the patient’s relationship with food and find a balance between healthy and unhealthy foods for a sustainable lifestyle. When the patient expresses they want to lose weight, explore where that thought it coming from. Do they want more energy? Do they want to feel better? Cutting out food groups through dieting does not result in this. But does the traditional dieting approach work for any group? Should we just abandon it all together?
I read the huge literature review between body weight and health outcomes and this is the jist- Research suggests that there is a very weak link between body weight and illness. The latest NHANES study actually suggests that those in the “overweight” category lived longer than any other group. Those in the “obese” category who already have an illness live longer than those in the normal weight range who have the same illnesses. The relationship between poverty and negative health outcomes is stronger than body weight and health outcomes. BMI and hypertension are correlated but they don’t know if BMI causes hypertension (meaning that more people who are overweight have hypertension but researchers don’t know if being overweight actually causes hypertension.)
So…my thoughts. Research has not been able to directly link overweight/obesity to causing illnesses. However, research does suggest that there is some relationship between being overweight/ obese and illness. But what is that relationship? Do people who are overweight/ obese have some sort of genetic predisposition to illness? Are they eating less quality food? Are they sleeping less? Exercising less? Around people who encourage them to eat worse? Nobody knows. They do know that some relationship is there though. So what does this mean?
To me this means that there is room for HAES and intuitive eating for some patients, but maybe not all. I do think that as a culture we should stop pushing for constant messages of weight loss since the research isn’t there to prove that’s the real problem. This constant bombardment of messaging of “weight loss for health” causes people to focus on weight loss techniques instead of actually being healthy. It has caused a culture that would rather skip enjoying their gradma’s pie to be skinny than partaking in an activity that could boost their mental health. I think that intuitive eating is a much better approach for overall health and just being more in tune to when you’re full or hungry. However, I don’t think that this approach could work for everyone. I don’t think I could tell an impoverished, obese patient to just listen to their bodies about what to eat. If you have no base for what a balanced lifestyle is, then how do know how to “listen” for it? And no, the research doesn’t have any solid evidence for causation between body weight and increase illness, but there still is a relationship of some sort. And the possible outcome of worsened health isn’t worth playing around intuitive eating.
In conclusion, I think I will try to be more careful of the messages I spread about weight loss “for all.” During community education events I will make sure to focus on health not weight loss. I will talk about hunger and fullness cues and encourage people to eat what they think is best for their bodies. I will encourage people to accept different body sizes. When people ask me for individual advice I will make sure not to make it about weight loss. If they want advice for losing weight I will explore why they want to lose weight and make sure they have health goals not weight loss goals. For clinical practice I will follow the guidelines of the hospital. I trust their rules and don’t know enough about the science behind illness to make up my own guidelines.
What will you do with this info? Do you have a different opinion? Let me know!