As a psychotherapist, I specialize in treating adolescents, survivors of trauma, and individuals with eating disorders, body image issues, anxiety and depression. A few years ago, I stumbled upon a paradigm shift known as “health at every size” (HAES), which now greatly informs my life and my practice as a therapist.
I believe that adopting a HAES framework is critical for helping our patients to achieve both their physical and mental health goals. It is especially crucial for those who are treating individuals with eating disorders and body image issues to practice within a HAES informed approach.
What is Health at Every Size?
Health at every size does not suggest that all individuals are healthy at their current weight.[i] Rather, it is a weight-neutral approach that puts emphasis on health behaviors, as opposed to a number on the scale. Put simply, health at every size “supports people of all sizes in finding compassionate ways to take care of themselves.”[ii]
Health at every size is a social justice movement that aims to challenge scientific and cultural assumptions. HAES also honors differences in regards to race, gender, ethnicity, disability, class, religion, sexual orientation, size, and other attributes.[iii]
The three key components to health at every size are respect, critical awareness, and compassionate self-care. HAES honors and respects body diversity, as well as people’s lived experiences.[iv]
HAES helps people to find joy in movement, as well as to eat in an attuned and flexible measure that values pleasure and honors one’s bodily cues of hunger and fullness.[v]
Shaming individuals for their weight and size is not helpful and has been shown to have a myriad of detrimental effects on physical and mental health.[vi] For instance, those who experience weight-bias have been shown to be at higher risk for depression, body dissatisfaction and poorer health outcomes.[vii]
Health at Every Size and Eating Disorder Treatment
Even among eating disorder clinicians and treatment centers, fat-phobia and weight-stigma exists. For instance, much of the more traditional approach to treating patients with anorexia involved convincing them that they were “not fat.”
For example, I remember hearing about treatment centers that utilized an activity of tracing the patient’s bodies to indicate that they are smaller than their mind is telling them.
On the surface level, this kind of approach seems helpful. However, it only serves to reinforce the false belief that “thin” is good and “fat” is bad.
Weight-stigma and fat-phobia within the eating disorder treatment community is harmful to everyone who is trying to recover. Some individuals who are struggling with eating disorders may feel that they are “not thin enough” to merit treatment.
Additionally, body-diversity exists and some people’s natural body size will be larger than the thin-ideal standard. When clinicians directly or inadvertently reinforce fat-phobia and weight-bias, it can be harmful in regards to their client’s ability to fully recover.
If you have been practicing within a weight-biased approach, it’s important to be compassionate with yourself. We are all inundated with diet-culture on a daily basis and it makes sense that you might have picked up some of these stigmatizing viewpoints.
However, you can work to educate yourself on the principles of health at every size and to incorporate it into your therapy practice.
I’d highly recommend checking out the books “Health at Every Size” and “Body Respect” by Dr. Linda Bacon to learn more about this powerful movement.
Together, we can support our clients of all sizes in finding compassionate ways to take care of themselves.
[vi] Chalker, A. (2014). Weight-Bias and Anti Fat Attitudes. Retrieved from http://www.inquiriesjournal.com/articles/931/3/weight-bias-and-anti-fat-attitudes-sources-impacts-and-prevention-methods
[vii] Chalker, A. (2014). Weight-Bias and Anti Fat Attitudes. Retrieved from