What is Health at Every Size?
Written by Isabel Vasquez RD, LDN
When you think of weight what comes to mind? Health? Body image? Shame? Confidence? Workouts? Diets? In our diet culture-ridden society, you may equate weight with a lot of really deep stuff.
You may think that being thinner is better for health. You may be frustrated that people (including healthcare providers) judge you based on your weight. You may fear gaining weight. Or you may be angry that society doesn’t celebrate you and others who have larger bodies!
Whatever your thoughts and feelings around weight, a weight-inclusive approach is new to many people (weight-inclusive meaning accepting of bodies of all shapes and sizes, and not centering weight as the end-all, be-all for health or happiness).
Health At Every Size (HAES) is an approach we center in our practice here at Your Latina Nutrition. So if you’re unsure what HAES is, or simply want to learn more about it, this is the blog for you.
What is HAES?
HAES is an approach currently led by the Association for Size Diversity and Health (ASDAH), an organization whose purpose is “to create the conditions for people of all sizes, particularly those most impacted by systemic anti-fat bias, to have equitable and barrier-free access to the care and healthcare resources we need to support our wellbeing.”
HAES is rooted in dismantling anti-fat bias and ensuring that healthcare is accessible and inclusive for all people, particularly those in bigger bodies.
A big part of the HAES approach is de-centering weight as a health marker and instead, focusing on health-promoting behaviors for those who wish to make changes for their health.
More importantly, it demands respectful care for people at any body size and any level of health. It involves a commitment to combating the social injustices that those in large bodies face on a daily basis.
Body autonomy and informed consent are also at the heart of HAES.
Ultimately, people of all sizes, shapes, health statuses, abilities, races, ethnicities, ages, and genders deserve access to healthcare. Period. That is the basis of HAES.
HAES is made up of four key principles, as of ASDAH’s 2024 revision, which are as follows:
Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum.
One of the most common ways that weight bias rears its ugly head is in healthcare settings. Healthcare providers are some of the worst perpetrators of anti-fat bias, which impacts the quality of care that fat folks receive.
Fat folks’ concerns are often dismissed as weight-related, even if the concern has nothing to do with weight (e.g. a sore throat). Sometimes, healthcare (e.g. surgery) is reserved for when someone loses a certain number of pounds or reaches a certain BMI.
This HAES principle centers access to healthcare as a human right, regardless of BMI or someone’s willingness to pursue weight loss.
Wellbeing, care, and healing are resources that are both collective and deeply personal.
This principle focuses on the balance of self-care and community care when we think of health. Everyone’s feelings about health and healing are unique, and that should be accepted and encouraged.
Rather than expecting everyone to center health as their top priority for life, this principle emphasizes body autonomy. Not everyone wants to make individual changes for health, and that’s okay. That doesn’t make them less worthy.
Plus, this principle addresses how mutual aid and community care are key for wellbeing and healing. It sets the expectation that HAES providers advocate for systemic changes related to the social determinants of health like access to food and clean water.
Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind.
Anti-fat bias is extremely prevalent in healthcare settings. Healthcare providers are some of the worst perpetrators of anti-fat bias, but the bias doesn't just take place in the doctor’s office itself. Research that informs healthcare guidelines and health policy is also steeped in anti-fat bias.
Plus, many healthcare settings don't have size-inclusive equipment such as blood pressure cuffs, seating, and exam tables.
All of this anti-fat bias results in worse health and healthcare for fat folks.
So, this principle explains that in order for people of all sizes to receive adequate care, HAES providers must be committed to dismantling anti-fat bias in themselves and in society.
Health is a sociopolitical construct that reflects the values of society.
In our society, health and thinness have become almost synonymous. Yet, this isn’t an inherent truth.
The thin ideal our society upholds is rooted in anti-Black racism and white supremacy. There are also lots of ableist beliefs at the heart of our societal definition of health. And healthism—the belief that health is an individual responsibility and the end-all, be-all of wellbeing—runs rampant in cultural rhetoric.
This principle addresses the problems with this definition of health and invites us to re-evaluate what health, disease, and illness really are. Regardless, it centers access to healthcare as a human right that shouldn’t depend on one’s health status.
HAES for BIPOC Individuals
It’s important to consider how adopting this approach varies for BIPOC or those with other marginalized identities. Cultural norms vary and historical trauma and racism in the medical field impact people’s relationships with medical providers.
That being said, ASDAH’s recent changes to the HAES framework acknowledge how society’s current weight-centric approach to health is greatly informed by anti-Black racism and white supremacy.
Related: The 10 Best Anti-Diet and Wellness Books by BIPOC Authors
Particularly for BIPOC and fat folks, it may not always feel safe to confront a provider about how their weight-centric approach is harmful to you or how it doesn’t align with your health goals. In reality, it should be on the providers to ensure they’re providing inclusive care, not on you as a patient.
Medical providers’ biases against those with marginalized identities greatly impact the quality of healthcare marginalized folks receive.
Furthermore, the people included in many research studies lack diversity, which leaves room to question how truly evidence-based recommendations are for those with marginalized identities that aren’t typically reflected in these studies.
For example, while there are lots of issues with BMI, one of them is that the original population used for data-gathering was primarily white men, yet BMI is now used to evaluate our whole diverse population.
Final Thoughts
At its core, HAES is about health equity and truly weight-inclusive healthcare. We all deserve respectful care. We all deserve to work towards health if we want to in an empowering way. We all deserve to be treated with compassion and not discriminated against.
The HAES framework is one way to ground yourself in these values and work towards a more just future.
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