I got a question from a reader who is a personal trainer. She is absolutely into working with her clients from a Health at Every Size, but she very respectfully asked the following question:

If we encouraged people before they were fat to practice intuitive and mindful eating, and healthy joyful movement habits, would people get fat? (Of course barring instances where weight gain is due to medication or other unintended cause). *This insinuates that preventing fatness would be desirable for that person- of course, not everyone’s goal/choice* How does a non-fat child, for example, become a fat teen or adult, without taking in more calories than their body needs and not moving enough to counteract the extra food, barring a unintended cause like medication side effects? Where does HAES stand on this in terms of preventing weight gain through mindful eating and movement? Would preventing fatness be anti-HAES?

Thanks for asking! First, to be very clear I can only speak for my own understanding of HAES, I am not speaking for the whole movement or for anyone else.

I believe that bodies, like everything in nature, come in many shapes and sizes. When you consider that adult shoes come in 200 different size/width combinations just to try to suit the wide variety of human foot lengths and widths, it’s silly to think that human bodies only naturally come in one narrow ratio of height and width. So I think that if everyone followed HAES practices we would see body diversity. I think the thing that is getting in the way of the expression of the natural diversity of body sizes is dieting – which, for the vast majority of people, artificially lowers body weight in the short term, but is the most statistically reliable way to cause weight gain in the long term.

The idea that people don’t gain weight unless they take in more calories than their bodies need is also more tricky than it sounds. The amount of calories that a body burns can change in both the short and long term and is affected by a number of things including body composition (amount of muscle, fat, bone, amount of type 1 vs type 2 muscle etc.), stress, sleep, hormonal cycle, movement, age and more. Also, though very efficient bodies may not “need” as many calories to function, the person’s hunger may exceed that number of calories and constant hunger has not been shown to lead to positive mental or physical health. HAES suggests taking satiety and food enjoyment into account, rather than attempting to treat the body like a machine.

I think the problem that we are having is that we are stuck believing that body size determines health and so we suggest that people focus all of their eating and exercise on achieving that particular body size. The problem isn’t that we haven’t found the right way to manipulate body size through eating and exercising to create health- the problem is that’s the wrong goal. We don’t need to use body size as a proxy for health – we can inexpensively measure health in terms of metabolic health, strength, stamina and flexibility. Then we can focus on health and healthcare practitioners can prescribe health based solutions for health issues, rather than body size solutions for health issues.

A mountain of evidence shows that habits are a better predictor of health than size, and even though we know that there are healthy fat people and unhealthy thin people, and there are no diseases that fat people get that thin people don’t also get, so body size is certainly not a guarantee of health.

My understanding of Health at Every Size is that it’s a health practice where one focuses on healthy habits and allows their body to settle at whatever weight it settles and so I think that any attempt to manipulate/prevent a body size through food and exercise does not fall under the HAES umbrella.

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