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HAES vs. Weight Management

An interesting thing has been happening lately. Some prominent doctors have started (at least occasionally) sounding like...


I go back and forth on my opinion of this. Is our message being co-opted and twisted by the medical establishment, or are attitudes changing for the better? Is the weight centered paradigm finally shifting?

Here's something very HAES-like from Dr. Rick Kausman.

Dr Rick Kausman is a medical doctor who is recognised as the Australian
pioneer of the person-centred approach to healthy weight management. Rick
has written two books including the award-winning 'If Not Dieting, Then
What?', he is the creator of a number of other resources, and has had
several articles on healthy weight management published in peer-reviewed
journals. Dr Rick is a Director of the Butterfly Foundation and a Fellow of
the Australian College of Psychological Medicine.

He talks about "everyday foods" and "sometimes foods." He talks about "weight management" rather than "weight loss" (or HAES, for that matter). Part of me is really suspicious of that terminology, but I have to admit that it would be easy to frame the same behaviors I would call HAES as weight management, since for me, a fairly stable weight - over decades - has been a side effect of HAES. And to be completely honest, yeah. There are foods that I enjoy but don't eat very often or only eat in small quantites because my body doesn't feel good when I eat them or because they're very heavy. I guess those could be framed as 'sometimes foods.'

Anyway, this HAES/weight management thing seems like it might be worth discussing. The relationship between fat acceptance and weight management is complicated. I'm pretty sure that a significant number of people in the fat acceptance movement have been below their maximum weights for quite a while, but are still fat. There are many of us that sorta kinda manage our weight the way we'd be expected to if we were thin - just listening to our bodies and striking a balance. I call it HAES and I try not focus on weight or size, but I have to admit that it's convenient to have a stable weight and I'm glad it's a side effect of HAES for me.

In the end, the difference between HAES and "weight management" can be in the intent and the focus. The two can look very similar from outside. HAES is meant to be 100% weight-neutral, but in this society, 100% weight-neutrality is difficult. Is HAES-like behavior that's conceptualized as weight management really so different? Maybe it's not complete weight neutrality that's the most important; maybe it's simply the removal of weight or BMI-based goals. If mental health, energy levels, and medical numbers other than BMI are priortized and if the goal is not to reach a certain prescribed weight, then damn. It is indeed very close to HAES, and it might help a lot of people make peace with their bodies and find ways to feel better, both physically and mentally.

Then I remind myself that "health" is a social construct that's being used as a bludgeon in our society, and that maybe the people on the fat acceptance side who have an ideological problem with HAES ("Health At Every Size") have it for exactly this reason - that it can intersect with the softer side of the medicalization of fat bodies.

What do you think?

Feeding tubes? Really? | Stories I've seen lately in my MedPage Today

vesta44's picture
April 30th, 2012 | Link | One thing I think could help

One thing I think could help people a lot when it comes to food and how doctors talk about eating and managing weight is that instead of saying there are 'everyday foods' and 'sometimes foods', they should be telling people to pay attention to how their bodies feel after eating - do you feel energized, lethargic, bloated, just so-so, comfortable, stuffed, pleasantly full, still hungry, etc. If more people could learn to pay attention to how food affected them, what foods made them feel energized, full, comfortable, ready to take on the world, etc, maybe there wouldn't be so many problems with food being demonized and people thinking that they have to restrict themselves from certain foods altogether (and then end up binge-ing on them).
But none of that is going to happen as long as society is fixated on an "ideal" body type that everyone is supposed to have. Until society realizes that bodies are diverse and there is nothing wrong with that, we will always have those who discriminate against those who don't meet the "norm" and revile anyone who is "different". And I'm not sure if having the medical community endorsing HAES is going to change things all that much for fat people. There are just too many who will remain convinced that HAES is just another fad that doctors will eventually drop - after all, the medical community can't make up its mind about what is healthy for us as far what we should eat, that changes from month to month, year to year, depending on who is doing the research and who is paying for that research.

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

loniemc April 30th, 2012 | Link | I think about my own FA

I think about my own FA journey, and I do think we are making progress. I first embraced size acceptance because I had heard some people lose weight that way. Then, I made the "good fatty" argument. Now, I think everyone deserves respect, no matter their habits.

I'm not surprised that we are seeing this same process crop up with health professionals. I am trying to find a happy balance between patting people on the back for even kind of getting it and encouraging them to go farther.

NoSurgery May 8th, 2012 | Link | HAES vs. Weight Management

My kid's pediatrician talks to her about exercise and eating healthy, not about weight loss or diets. This is a huge change from when I was a kid and my doctor talked to me as young as 10 years old about dieting. When I asked her to recommend a doctor for me, she gave me a name and said "He likes chocolate like I do." I thought this was kind of funny. Kind of like whispering when you tell you someone you're Jewish. It's a mixed bag at this point. Far to go, but I do think things are starting to shift a bit.

moxie3's picture
May 8th, 2012 | Link | I have a daughter who is

I have a daughter who is 6'1" and when she was just about 5/6 years old was told by her pediatrician to see a weight management specialist. When we saw this doctor she told us stories about Native Americans who had some change in their hunting/gathering methods. Anyway it was not every fruitful and at the time and feeling like I was in the wrong followed every direction they gave me.

Anyway at this point in my life things have changed. I think I have learned more about genetics and and about fat in general and know that everyone is different. Including myself who I tend to blame for all the fat issues of the world! Just because I was the only fat person in my family doesn't mean I was bad or that I was to blame for all the fat people in the world or myself. We tend to luck out with certain doctors and not so much with others. We just have to be aware of this issue so not to blame ourselves constantly or our children.

NoSurgery May 9th, 2012 | Link | Couldn't agree more. There

Couldn't agree more. There is a whole world of blame for parents who "let" their kids be fat. It amazes me all the time. People stop me and give me advice on how to handle my "problem". I do think we've lucked out on the doctor front, because I have a friend whose kid has been placed on every "medical diet" possible and she's only 14. The best thing we can do as parents is go in and demand that the doctor follow certain HAES principals or threaten to choose another provider. It takes balls, but it's ana amazing lesson for fat kids to see their parents take control.

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