Health at Every Size: Further Thoughts and Clarification of My Viewpoint

The response to my last post from Screaming Fat Girl (as well as comments from RDhiker that arrived a few days later) really got me thinking.

SFG writes:

I don't think health is possible at literally every size. At some point, the stress on the body from being very overweight will have an effect on the heart, circulatory system, etc. People who have never lived life over 300 lbs. for any long period of time can't possibly understand the stress it places on the body [...] Most of the FA who are talking about being healthy at large sizes aren't yet 40. Trust me, as someone who has lived most of her adult life over 300 lbs. and topped out near 400, your body will tolerate it a lot better when you're young. You start to develop problems as the years go by. For quality of life, most people could use some help in dealing with their relationship with food (which often results in weight loss). Denying this does nothing for the bodily acceptance movement except make it look willfully ignorant and therefore disingenuous [...]

However, I think we need to stop even addressing health as if it were equally possible at every size. It is not. Sure, you can be fat and healthy, but you can't be healthy at every weight (that includes extreme thinness as well as extreme fatness)[...]

Let me start by saying that I have enormous respect for SFG. She is someone who really thinks about things and certainly takes nothing at face value. She is a courageous person who has made great strides forward in forging a healthier life for herself.

So, to SFG and my readers in general, consider the following thoughts the continuation of a fruitful and respectful dialogue.

First, I'd like to set some parameters:

First parameter: Some of us choose to make "healthy" choices while others don't. I know that SFG and I agree on this point: your quest for health (or lack thereof) is your decision. I'm not here to tell anyone that they must try to be healthier. That attempt is a choice.

Second parameter: I insist on using the words quest, try and attempt because I know that life isn't fair. Our healthy choices are tempered by heredity, the hand we were dealt at birth (or, quite often, in the womb) and the traumas and experiences we have had throughout our lives. My late MIL lived a happy, active life until she dropped dead of a heart attack at 82. She ate lots of junk food, drank copious amounts of coffee and smoked like a chimney. Yes, she may have lived longer had she not smoked, but she far exceeded the average life expectancy of a woman born in 1927 in Canada (61, according to Statistics Canada). My mother, on the other hand, was a model of healthy eating. She spent much of her adult life housebound--severely crippled by arthritis. So yeah, life isn't fair.

Third parameter: My healthy choices are not yours. You may be a vegetarian, or eat a diet heavy in meat and shun most carbs including fresh fruits and some vegetables. You may be a runner who runs without any problems far into old age or you may be a person who is prone to shin splints and should avoid running at all costs. The healthy practices of A might fast-track B into illness.

Now, let's get down to brass tacks:

In my mind, there is a difference between fat acceptance (FA) and Health at Every Size (HAES). I certainly believe in FA in the sense that behaviours such as fat shaming and blaming, prejudice and bias against fat people, the assumption that a fat person is slothful, lacks self-control (in terms of eating and often other areas--witness the often interesting association between fatness and sexual voraciousness) or is less worthy of respect have no place in a civilized world. FA is an attitude, a belief that fat people are...people, neither better nor worse than anyone else. However, FA is not specifically linked to health, be it good or bad.

HAES, on the other hand is a dynamic, on-going process; it results from the choices we make every day, tempered of course by heredity and pure old luck. HAES, to me, means considering oneself at the place (weight) one is today, and saying "what can I do to be healthy or healthier?" Considering that 95% of people CANNOT maintain a significantly lower weight after dieting, I question the worthiness of responding, "just diet".

HAES does not mean ceasing to strive for health. It means that while you are probably never going to be a size 0 you can commit to engaging in a host of practices that CAN help you to be healthier, though not necessarily any or much svelter.

I'm going to go out on a limb and say that I suspect many of the morbidly obese we so worry about got there by dieting. If they have health concerns, why aren't we working with them to improve their health through gentle movement (acquafit, if your joints are suffering; or starting with just a few minutes of walking and building up to longer periods; or stationary biking--as long as you don't have a knee like mine, lol), or through nutritional counselling? Rather than putting the overweight back in the dieting straight jacket that got them into this fine mess, why aren't they directed towards resources to teach them the fundamentals of mindful eating (if that is helpful--and it certainly is neither helpful nor needed in many cases)?

And while I'm on the topic of mindful eating, allow me a short rant: People are unconvinced of its merits because dieting has ROBBED them of their ability to read their own signals of hunger and satiety. This is the true tragedy of the diet culture: the people who need it most have lost their their ability to read their body's own signals--the signals that enable all living beings to continue to stay alive and healthy.

I also suspect that many morbidly obese people may have reached a physical state of disequilibrium due to years of mental and sometimes physical abuse. They have felt it necessary to develop a protective layer of fat around themselves. Again, dieting is not the solution. In such cases, improving one's physical health and rebuilding a healthy relationship with food require psychological intervention or simply helping the person to physically escape the abusive relationship. The disordered relationship with food is actually a symptom rather than a cause. How can a woman stop gorging herself when gorging is a defence mechanism to prevent abuse and attack or simply a way of forgetting what makes her so unhappy in life?

Those of us who seek to improve our health need to approach this goal by using a variety of approaches rather than resorting to dieting--which has proven itself to be not only usually ineffective (perhaps not in the short term but certainly in the long term) and downright counter-productive in perhaps the majority of cases.

Some people may lose weight through implementing techniques that first and foremost improve their health such as movement, mindful eating, and psychotherapy to get to the root of their disordered eating. And that's fine. However, we know that for the vast majority of people, it is practically impossible to lose weight and in particular maintain a weight loss.

Moreover, though there may indeed be certain correlations between a higher weight and certain health problems, weight loss is not a magic potion that will solve all our health woes. If that were the case, there would be no slim diabetics and my particular knee problem would not be common amongst ballerinas--not the fattest group in the general population (this, according to my surgeon, who has made knees like mine his life's work).

My bottom line is that--if you so desire--you should do your best to achieve the best health possible for you, no matter what weight you are at today.

There is ample proof that weight loss at any cost can be deleterious to both one's mental and one's physical health. There is ample proof that maintaining significant weight loss is impossible for 95% of the population. Furthermore, there is ample proof that taking truly positive steps to improve one's health do lead to better health outcomes, even if they do not always lead to a significant weight loss. We need to move, to learn to eat relatively normally rather than adopt a binge/restrict pattern and some of us also need to work towards overcoming the psychological reasons for obesity, though this last point certainly does not apply to everyone.

Health at Every Size really is all about health.

Of course, I am far from exhausting the topic of HAES, but I've kept you reading long enough. To be continued...

Addendum: I just read a blog post by a medical doctor whose extremely strict approach to eating leaves no room for compromise. I must admit I continue to be perplexed. Since so few studies have been done on how mindful eating can be used to help binge eaters, we still don't know what can actually be done. I certainly feel unqualified to talk about binge eating since I have never been a binger myself. However, I find it hard to accept that binge eating can only be treated by severely circumscribing one's eating and adhering to what essentially amounts to a straight jacket approach to food. I don't think human beings are made to live in a state of constant restriction. The opposite of severe restriction is severe bingeing. Someone who is in a constant state of severe restriction cannot learn moderation, which I believe is the key to self-regulation, and the restrict/binge cycle cannot be broken. To what extent is binge eating physiological and to what extent is it a learned behaviour? And do the two cross-pollinate each other?