What Is Health at Every Size and Why Is It Important?

Many people count calories or rely on the number on a scale to try and manage their weight and health. But recent years have seen a strong push back against this diet culture approach, which often values being thin above physical or psychological health.

Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. Many studies support the idea that a non-diet approach can support health in a gentler way compared to the persistent push to achieve weight loss. As an alternative to dieting, HAES encourages body acceptance, intuitive eating, and active embodiment.

"Our current five principles of HAES are weight inclusivity, health enhancement, respectful care, life-enhancing movement, and eating for wellbeing," say Veronica Garnett, RD, Vision & Strategy Leader, and Ani Janzen, RD, Operations & Project Leader with the Association for Size Diversity and Health (ASDAH), the non-profit organization that owns the trademarks for Health at Every Size and HAES.

The HAES principles help approach health without a focus on weight or weight loss. "There are healthy and unhealthy people at all points on the size spectrum, and HAES promotes safe and equitable access to healthcare for people regardless of size, health status, and health goals," say Garnett and Janzen.

Fatphobia and weight bias are connected to all other forms of oppression, especially racism. "The focus on weight and weight loss disproportionately impacts the health of fat Black people" say Garnett and Janzen.

The HAES Movement

HAES exists because of prejudice against extra weight and fatness. Studies on starvation diets and the root causes of overeating were examined in the 1940s and 1950s in an effort to aid weight loss. The 1960s brought forth Weight Watchers, gastric bypass surgery, and thin models as a beauty standard.

Towards the end of the 1960s, a new push towards fat acceptance and body positivity began. The National Association to Aid Fat Americans (NAfinancembinc.com, now called National Association to Advance Fat Acceptance) was founded in 1969 and aimed to improve the quality of life for fat people through education, research and advocacy. It was the start of the size acceptance movement, which continues to this day.

Throughout the 1980s and 1990s, the size acceptance movement advocated that health problems among fat people were the result of stress, self-hatred, and chronic dieting, not weight. The profitable diet industry fought back with strong messages about the health perils caused by weight.

In 1998, nutrition educators Frances Berg and Joanne Ikeda, along with members of the showmethedata listserv, started using the term “health at every size." Since that time, many dietitians, psychologists, and researchers have adopted the HAES terminology in their books, seminars, and research papers.

ASDAH formed in 2003, and, concerned that weight-loss companies would attempt to co-opt HAES terminology, officially trademarked the terms Health at Every Size in 2011 and HAES in 2012.

Is HAES Becoming More Popular? 

"The underlying research that supports HAES principles and the Health at Every Size framework is reaching more and more healthcare providers and patients," say Garnett and Janzen. "It is filling a need many providers and patients can feel, but don’t always have the words or ideas to fill the gaps left by our current healthcare systems."

Garnett and Janzen say that ASDAH membership has grown every year and HAES principles are making their way into more healthcare settings, but there's still a long way to go.

"Despite our growth, we estimate that HAES providers make up less than 1% of all healthcare providers," says Garnett and Janzen. "Most healthcare providers have not heard of HAES or the underlying research, and many of those who have only know the myths." They also note problems the concept is facing: more money is invested in obesity research rather than HAES-aligned work.

Rachael Hartley, a HAES-aligned dietitian in Columbia, South Carolina, is seeing more dietitians adopt HAES principles and recognize how weight-centric approaches may cause harm. "As HAES providers share the research and science behind the movement, more healthcare providers are learning that there is a different way to help their patients and clients," says Hartley. 

Per the National Library of Medicine, there have been 48 research papers published with the "Health at Every Size" terminology in the last 10 years.

HAES vs BMI 

Body Mass Index (BMI) uses height and weight to produce a calculation that groups people into one of four weight-based categories: underweight, normal weight, overweight, or obese. The trouble is, BMI is an outdated, biased measure that doesn’t account for body composition, ethnicity, race, gender, and age. BMI is frowned upon by many health care practitioners.

"Mainstream medicine often uses weight and BMI as major indicators of health, and sometimes patients are treated as if it's the only indicator of their health," says Hartley. "Decades of research have shown that weight is only loosely associated with health."

Hartley explains that even if weight was a significant predictor of health, research has yet to reveal any ways for more than an incredibly small number of people to lose a significant amount of weight and keep it off permanently. 

Instead of relying on weight or BMI, HAES focuses on helping people engage in health-promoting behaviors. "HAES does not look at weight as an outcome of one's "success" in making behavioral changes, " says Hartley. "Under a HAES lens, providers will meet clients where they are at in providing support and exploring ways to feel better, physically and mentally."

"HAES is not about convincing all fat people to pursue health or attain a ‘healthy’ status," say Garnett and Janzen. "We are first and foremost about increasing access to quality care for fat people. We also offer a framework for care to help providers and patients think about health from a lens of fat liberation."

Simply, under the HAES lens, health status or BMI should never be used to judge, oppress, or determine the value of an individual.

HAES and Body Positivity

The term "body positive" emerged in 1996 with the founding of The Body Positive, a nonprofit organization with the goal of "ending the harmful consequences of negative body image: eating disorders, depression, anxiety, cutting, suicide, substance abuse, and relationship violence."

The body positivity movement is about developing self-care behaviors that come from a place of self-love, rather than from fear. The competencies of body positivity are to reclaim health, practice intuitive self-care, cultivate self-love, declare your own authentic beauty, and build community.

There is some overlap between HAES and body positivity, but ASDAH clarifies that HAES is not a social justice movement; it’s a framework for care.

What HAES Means For You

If you've ever felt like your health care provider dismissed your concerns or treated you disrespectfully because of your weight, shape, or size, you've experienced weight bias. A HAES-aligned practitioner will focus on your health beyond your weight, and treat you with the respect and dignity that you deserve.

"Some healthcare providers refuse to offer medications, referrals to physical therapy, and even surgery unless patients pursue and attain weight loss" say Garnett and Janzen. "This unethical approach to healthcare may account for all of the health disparities seen in fat people, and body size may not have any direct effect on health."

"Working with a health care provider who is HAES-aligned, one can expect patient-centered care, where one is treated like a person versus a number on the scale or a lab value," says Hartley. "Many people, especially those with marginalized identities, experience immense stigma in healthcare, which results in poor care and people not seeking care. HAES seeks to eliminate stigma at the doctor, therapist, and dietitian office." 

A Word From Verywell

Every body size deserves access to fair, respected medical resources. While conversations about body size and mindset shifts may continue to evolve, speaking to trusted healthcare professionals that help you feel safe and heard is crucial.