Health At Every Size: Promoting Obesity?

We have all probably seen some form of debate around the issue of “fat acceptance”, usually with those of a certain size espousing its merits and their detractors. As a paper written by Jon Robinson points out, the momentum behind the concept of Health At Every Size (HAES) – which is in many ways has parallels to “fat acceptance” though they are by no means the same – stems from the fact that sustained weight-loss is very difficult to achieve in the long-term for overweight and obese individuals. As Robinson writes:

“Although research and experience have clearly demonstrated that focusing on weight loss as a primary goal is most likely to produce weight cycling and, over time, increased weight,[4–9] the HAES approach certainly does not suggest that all people are currently at a weight that is the most healthy for their circumstances. What it strongly purports, however, is that movement toward a healthier lifestyle over time will produce a healthy weight for that person.”

Even with the caveat of promoting a healthy lifestyle, the name of the movement is somewhat of a misnomer; most people would recognise that the extremes of the weight distribution – the anorexics and super obese – is unhealthy and potentially fatal, yet it fails to address exactly what is healthy for an individual, apart from appeals to the absence of disease symptoms. An excellent review by Penny & Kirk (2015) points out that:

“…the HAES approach does have some important limitations as a public health approach to obesity. These relate to intervention study size and design, generalizability to other populations (e.g., gender, individuals with higher BMI, and those without disordered eating) and its applicability to certain proximal personal and social influences. Existing studies tend to comprise small sample sizes, limited evaluation of physiological outcomes, inclusion of individuals with BMI within the overweight and class I obesity range rather than class II or III (the fastest growing BMI ranges across the globe34), a tendency to treat obesity behaviourally by focusing on individual characteristics to the exclusion of environmental influences, and a focus on female White participants with a history of binge eating or chronic dieting in Western cultures.”

While I think that it is an important distinction to make between a healthy lifestyle and weight, we have to admit that we don’t know that much about how weight influences health and longevity. For example, if we consider weight as a consequence of the calories in-calories out model – although there are caveats – we can conceivably see that someone who gets an excess of calories from consuming a plant-based diet will be overweight but not necessarily have the same risk factors as someone who gets an excess of calories from consuming mostly junk food. However, I don’t think the majority of overweight and obese individuals are consuming too many calories from fruit and vegetables. The junk foods available are laden with saturated fat, salt, and sugar which makes them highly palatable to the point of addiction. Hence, overweight and obese individuals usually consume a high quantity of saturated fat, cholesterol, and added sugar which makes it difficult to tease part the effect of excess adipose tissue on health to that of these substances. It could be that saturated fat and cholesterol are the drivers of cardiovascular disease rather than weight per se – we simply don’t know.

I think it is too simplistic to believe that HAES is promoting obesity. Health is a tricky concept, but others have been right to criticise health-interventions which focus purely on a number on a scale. It can be psychologically difficult to change your lifestyle, particularly if you have been eating badly and not exercising for many years, even decades. On top of that, overweight and obese individuals have to contend with a society which promotes both calorie-laden, nutrient poor food-stuffs and the concept of thinness equals health. We clearly cannot have both and expect to see a healthy society. We could make it easier for individuals to buy healthy foods, such as by not having tempting junk food around every aisle in a supermarket. We could have a large fresh produce section and replace unhealthy, sugar laden snacks at the checkout with healthier alternatives. Obesity is a public-health issue and we should be treating it that way rather than claiming it is only individual responsibility.

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