“Is Health At Every Size ® really possible?”
“Are you telling me fat people can be healthy?!”
You’re in the right spot if you’re asking these questions. This article is an honest overview of Health At Every Size.
This article features expert Kori Kostka, a mindful-at-heart, Registered Dietitian for over 10 years.
Kori is going to help us answer some common questions about Health At Every Size.
- What Is Health At Every Size?
- What is Weight Inclusive?
- Is Health At Every Size True?
- What Does The Health at Every Size Program Emphasize?
- What Benefits Could Our Society Gain By Adopting A Health At Every Size Approach?
- Can You Be Healthy Fat?
- What Do You Say When Your Client Says, “But I Need To Lose Weight”?
Please note: for question topics 3-6 I’m including these questions because they are frequently asked online, although not directly asked or answered during the interview. I’ll be writing my own brief thoughts for question topics 3-6.
Here is the full video
Here’s a little tidbit about Kori!
Kori started off as your typical meal planning RD, working on an acute medical floor in a hospital, but quickly realized her clients needed more. The shift into primary care nourished her love of counselling.
Kori made the move to start up an online mindful eating business during her first maternity leave, where she coaches clients and clinicians mindful eating.
Kori has some excellent resources on her website (like truly excellent resources including presentations with relevant information) if you’d like to learn more.
For more information about Kori Kostka and her presentations, you can visit Kori’s website at https://www.mindfuleatingwithkori.com/
You can also follow Kori on Instagram at @mindfuleatingwithKori (https://www.instagram.com/mindfuleatingwithkorik/)
What Is Health At Every Size? Section 1/7
So the Association for Size Diversity and Health, is a nonprofit association that people from all over the world are members of and it’s an association that just houses a registered trademark on Health At every Size, only as an active protection from the diet industry co-opting it.
Basically the Health At Every Size principles are not against weight loss, it’s against that pursuit of weight loss.
Another key aspect of Health At Every Size is trying to come from a weight inclusive perspective in terms of health, and also a social justice lens.
In Health At Every Size, we talk about marginalized and oppressed voices and how to ensure our messages, our words that we use with our clients, the words we have on our website, on our Instagram, that these words don’t have unintended consequences or harms.
How can we just come at our messages from a place that really supports a holistic well-being and let that be something individually designed, individually guided?
What is Weight Inclusive? (23:25)
There’s a lot of misconceptions about that the word ‘inclusive’.
To clarify inclusive really just means that instead of approaching health based on body mass index where the BMI of these categories are “healthy” or “unhealthy”.
We know there’s a lot of misconceptions around BMI in terms of from the fitness industry. Body Mass Index only looks at mass. BMI doesn’t look at what that mass is.
It doesn’t look at the fact that the BMI was developed by a white male population. Yes, there has been some changes around the body mass index to diversify it, but it was actually designed as a population tool.
From a research perspective, BMI helps us to stratify population – but this shouldn’t inform individuals.
But what’s happening in places like in wellness, fitness, and nutrition is it’s being used as a goal weight.
Let me give you an example of how BMI shows up in our everyday lives. This is not a weight inclusive approach.
Example – If you have someone who’s of higher weight going in to see a doctor for a flu shot and the doctor says “Hey, your BMI is 35, you should see our dietitian and lose weight” when it has nothing to do with the fact that the patient came in for a flu shot.
We could call that weight stigma and weight discrimination. This is not a weight inclusive approach!
So inclusive care is a patient being able to go into the office and just being treated for whatever’s going on, putting weight aside and saying, “Okay, if I need knee surgery, what can I do in the meantime to strengthen the muscles around my knee” instead of a doctor saying you need to lose X amount of pounds.
Same is true for someone who’s in a smaller body going into the doctor and not getting the same sort of tests that someone of a larger body might get.
So our current system is classifying health based on someone’s appearance and size whereas weight inclusive care is putting that weight aside and just treating the well-being of the client or patient that they’re dealing with.
Is Health At Every Size True? Section 2/7
People are asking “Is Health At Every size True?”
I do want to be clear – there is debate in a cultural sense around the meaning of Health At Every Size, and even other holistic health movements like intuitive eating.
Here’s a great exerpt from Medical Daily which I feel perfectly encapsulates this discussion.
“The HAES movement is, at its origins, about fairness and equity, and about not judging books by their covers, or people by their weight. I support all of that; scales do not measure human worth. I fully endorse the push back against obesity bias in our society,” Katz said. “But the simple fact is that excess body fat is a risk factor for most major chronic diseases — it just is. So if weight is an indicator of health risk, it must be treated as such.
Those like Katz worry that HAES proponents sometimes smudge the distinction between weight not being the most important measure of health and weight not being relevant at all to health.“
Basically HAES is great – but people are concerned that HAES practitioners are saying that health and weight are not correlated.
Now here’s my person opinion about whether Health At Every Size Is True Or Not
There’s a famous Zen quote … “Kill The Buddha!”
The Zen quote refers to the buddha image in your mind …
The idea of the Buddha. Meaning don’t get fixed on an idea or position.
Keep your perspective open. If somebody is presenting an absolute opinion on something – this is bound to false …
Reality is in the gray around, not black and white.
So how does emptiness relate to Health At Every Size?
If you say fat people are unhealthy – that’s an absolute position. It’s wrong.
There are plenty of fat people who are healthy (not worrying about political correctness here).
But … to say that health and weight are not correlated either is also an absolute position.
And here’s where I LOVE Kori’s answer:
The Health At Every Size principles are not against weight loss, it’s against that pursuit of weight loss.
To me, that’s what Health At Every Size is most about. It’s about your intentions.
So in this sense of the phrase Health At Every Size – yes, Health At Every Size Is True.
Here’s another post where I talk about these issues of size acceptance, weight bias, body shapes and body acceptance:
What Does The Health at Every Size Program Emphasize? Section 3/7
To answer this question full you may want to check out this Fact Sheet by Size Diversity and Health.
Here are a few of the major points that the Health At Every Size Program emphasizes:
- The HAES approach is an antidote to the model centered on weight / size on which much of the existing public health policy is focused.
- Significant scientific evidence supports the HAES method and demonstrates that “obesity” is not the health risk claimed to be.
- The HAES approach is focused on empirical evidence showing that interventions for weight loss are not successful in improving health and often cause harm.
- To individuals across the weight continuum, the HAES method relies on the empirically validated factors associated with health and longevity.
Perhaps most importantly …
The HAES movement emphasizes the problems with our current system.
- Insurers deny health care coverage simply because of high BMI, independent of overall health, despite research showing that weight cannot be directly correlated to health status. This is weight stigma.
- Restrictive dieting and weight cycling can lead to physical complications including slowed metabolism, reduced muscle tissue and body temperature, and eating disorders. (Eating disorders are in some circles seen as the direct result of dieting. I believe this to be true as well … dieting is the gateway for many eating disorders.)
What Benefits Could Our Society Gain By Adopting A Health At Every Size Approach?
In a nutshell … shame is a big problem.
People avoid seeking out doctors, programs, advice, etc …
Because when they go into the doctors office, bigger people are shamed.
It’s embarrassing when someone tells you to lose weight when you just wanted some cough drops!
So people avoid trying to improve their health because of shame.
Health At Every Size is about countering this societal shame – and that’s why I love this movement.
Here are some ways our society could benefit by incorporating more HAES.
- While only dieters lost weight in a study comparing the HAES paradigm to a diet method, both participants originally showed comparable changes in physical health, rates of exercise, therapeutic steps, and eating habits. Dieters had recovered their weight after two years and lost the health improvements, while the HAES community retained their change in safety.
- The HAES model practices help with healthcare coverage and reliable accessible preventive prevention and treatment programs were made available to people of all sizes.
- In education and employment, the HAES program will provide resources for all young people and adults to benefit from a weight-neutral perspective about the value of consuming nutrient-rich foods and participating in fun physical activity.
- The HAES concept guarantees that size-diversity is included in the human diversity to be celebrated and supported in the diversity training initiatives of education, government and school environments. (Human bodies come in all sorts of sizes even when healthy! We need to honor different bodies’ sizes.)
- Weight control does not support health outcomes or success.
Now in this next section we’ll be addressing about how to implement the Health At Every Size principles in conversation with clients.
What Do You Say When Your Client Says, “But I Need To Lose Weight”?
Please note – this section is written for a health professional answering a client’s question.
If you are a health profession who embraces the Health At Every Size paradigm, then how do you respond when you get asked about weight loss?
This section of the interview deals with a situation where your client wants to lose weight.
The quick answer is that you meet the client where the client is at in a patient centered way.
Not sure what this ‘patient centered’ way means? Continue reading the dialogue or listen at 34:46…
After we talk about …
- what is patient centered?
- how do apply patient centered?
Then we’ll cover how to answer a client’s question about weight loss from a patient centered perspective.
For now, let’s first explore the meaning of the Patient Centered paradigm.
What Is The Patient Centered Paradigm?
This is such an important conversation. I get asked this all the time. I just got asked this a couple of days ago.
To really answer this question you have to understand that patient centered care is being highlighted in our medical world.
(Previously when you went to the doctor’s office, the doctor would simply tell you what to do. You obeyed the doctor’s orders. No questions asked. This is known as a top-down approach. Patient Centered Care is essentially the opposite. It’s a bottom up approach. Continue reading for more details …)
So when I first graduated, I would classify myself as a weight centric dietitian. I was very weight focused.
And I don’t mean that in a negative way, that’s just kind of how I operated. The old food guide in Canada was very numbers focused on portion sizes and portion control. So that’s just kind of how I operated.
And then I shifted over time into the Health At Every Size paradigm where I was doing more mindful eating and intuitive eating.
(Here’s where things get even more interesting…)
But I was projecting that Health At Every Size paradigm onto people. So when people would come into my office and they’d say, “I want to lose this amount of weight” or “Can I weigh myself on your scale?”
At first I was like, “No. Sorry you can’t do that.”
So even though I was embracing the Health At Every Size paradigm, I hadn’t learned how to translate that message from a patient centered care way of doing that.
(Kori, at this point in time, was still using a top-down approach like most doctors. She hadn’t fully embraced the patient centered way of doing health care.)
How Do Practice Patient Centered Care? (36:47)
To practice Patient Centered care I think motivational interviewing training is super helpful.
Basically Patient Centered Care is meeting the patient where they’re at.
So when a client asks me about weight loss, I try to ask open ended questions and be curious about the client.
I’ll ask the client to tell me about:
- past attempts at losing weight
- what’s worked
- what’s not worked.
- what would be ideal for client
- what is client missing.
To get the client to open up about their experience, you ask open-ended questions. You use reflective listening and lots of empathy.
And then you mix in action planning.
So eventually the client will give a clue about what they’d like to change. This is known as change talk.
An example of change talk is when clients say, “I want to…” or “I’m thinking about …”
And the client could want to do anything. They could want to learn more about hunger or fullness, or maybe they are interested in learning more about regular meals. Maybe it’s about fitness.
From there, I’ll use the client’s own motivation to ask “What are some ways you can do that?”
(This is patient centered care. You discover the motivations of the client. You ask questions instead of issuing commands.)
What Do I Say To My Client When They Ask About Weight Loss? (39:52)
So now you have learned that:
- patient centered care is discovering the clients motivation by asking questions and using empathy to build a connection with the client
- you practice patient centered care by helping the client realize what they want and then letting the client decide how they’d like to take care of themselves
We know that dieting is bad.
We know that the pursuit of weight loss is bad.
(Remember, Health At Every Size is not against weight loss. It’s against the pursuit of weight loss.)
What if a client wants to lose weight?
What if a client wants to do something that’s unhealthy for them?
How do you respond? You can continue reading or listen at 39:52)
So if a client wants to weigh themselves we have a conversation about it.
(Again, remember patient centered care. We, as health care providers, ask questions. We drop our biases and we empathize with the client.)
Here are some things you might ask your client:
- What does the number on the scale mean to you?
- What’s gonna happen if you lose weight?
- What’s gonna happen if you gain weight
- If you step on the scale and the number goes up, stays the same, goes down. Can you tell me about that?
- Would you be willing to do that at the end of our session instead of the beginning of the session?
So if you can see like the way I’m saying these questions, there’s no judgment.
When you ask questions without judgment and with genuine curiosity, it will help you to have a conversation with a client, and meet them where they’re at.
And then each time as you build rapport, they’re more likely to come back.
You’ll have a chance to, to help them embody more of Health At Every Size practice that will be better for their long-term health.
What If Client Wants To Try The “New Fad” Even After Being Asked Open-ended Questions? (51:38)
Now sometimes as a health care provider, you simply need to be able to state the facts in a calm way.
But it helps to ask permission to state the facts first!
Here’s where this part of the interview takes off …
Imagine you’re helping a client and you’ve gotten their story. You’ve built a connection with them.
Now imagine you are at a point where the client has realized that their past attempts at dieting have backfired.
They know that dieting doesn’t work …
But then the client wants to diet, or try different diet programs in the name of weight management!
(Client don’t know getting an eating disorder is related to dieting. Somehow weight companies never mention eating disorder research … wonder why …)
This happens a lot because the Diet framework is so deeply ingrained in people.
Plus, the Diet Mentality can be sneaky …
Ever notice how Weight Watchers and Oprah they are saying their programs are about “Lifestyle”.
Well, this is Diet Mentality that’s being hidden.
So patients can get confused.
If a client wants to diet in these circumstances, what do you say?
So this happened to me last week. Someone was talking to me about fasting and I could just feel myself wanting to revert back to the top-down approach where I just tell the person what to do.
But this isn’t the patient centered way.
So I told myself, “Okay, breathe, stay with awareness, right? Mindfulness. Just stay where you are, stay with the client, stay with the conversation. Don’t go into like research mode.”
So I take a deep breath and I get myself grounded.
What I’ve learned from yoga is I literally dig my toes under the ground and just center myself off. If I can do mountain pose, I’ll do mountain pose.
So I get grounded and then I just do what I do every time I ask questions.
- Can you tell me what you know about Keto?
- Can you tell me what you know about intermittent fasting.
At some point I’ll say, “Would it be okay if I share some things about it?”
And what I do is simply present the facts like a calm lawyer.
- Dieting doesn’t work
- Purposeful attempts at weight loss do not work