Answered: Your questions about Health at Every Size

29th September 2008

Answered: Your questions about Health at Every Size

In July, I asked readers for their questions on Health at Every Size to be answered by a registered dietitian who promotes the practice. The original dietitian became unavailable, so I asked fellow ASDAH member Deb Kauffmann to step in. Deborah is a registered dietitian and a licensed dietitian/nutritionist currently in private practice in Baltimore, Maryland. She has provided HAES nutrition counseling for disordered eating to adults and teens, as well as children and their families, since 1990, and is one of the pioneers of the non-diet approach to weight management in the Baltimore area. In addition to nutrition counseling, Deborah offers Largely Positive, a free support group for adults of size promoting how to be happy and healthy at your natural weight.

Read the questions and Deborah’s answers after the jump…

How do you define Health at Every Size (HAES)?

HAES is an approach to health and healthcare that promotes acceptance of natural body weight and an understanding that people come in all shapes and sizes. The HAES approach supports pleasurable and healthful eating that is based on internal cues of hunger and fullness as well as joyful movement.

How can one practice HAES within time and budget constraints?

Practicing HAES just means taking care of ourselves without focusing on weight loss. There are many ways we can do this, such as mindful and enjoyable eating, fun movement, as well as meaningful relationships, work and hobbies. Also, I would encourage all larger folks to shop for physicians and other healthcare providers that are respectful and focus on their health concerns rather than their weight. It is perfectly appropriate to interview a healthcare provider on the phone or in person. And you might want to give your doctor one of the books listed below under Health and Weight for a Christmas present this year!

How do you define good health? And can HAES be measured in physical terms or is it more of a mindset?

It’s both. Good health takes into account such things as blood pressure and levels of blood lipids and blood glucose. Emotional and spiritual health also need to be taken into account. HAES promotes physical, emotional and spiritual health.

How does one go about practicing Health at Every Size with a chronic condition (e.g. PCOS, a thyroid problem, diabetes, fibromyalgia, etc.) or special-needs diet (gluten-free, low-sugar, etc..)?

Lifestyle changes such as diet adjustments and increased movement are often important to improve chronic conditions such as diabetes, cardiovascular conditions, PCOS and other conditions. But a focus on weight loss is not important and often damaging.

Research shows that changes in diet and physical activity result in health improvement (lower blood glucose, lower blood lipids, lower blood pressure) with no or little weight loss. Also, the NIH-AARP Diet and Health Study published in August 2006 showed that people in the overweight BMI category (BMI 25 – 29.9) had the least risk of premature death. And most epidemiological studies show that weight loss is associated with a greater risk of premature death by up to 260%. This may be due to chronic dieting and weight cycling which is associated with a much greater risk of cardiovascular disease.

Also, if diet changes are necessary for health conditions, it is important to avoid any unnecessary restriction leading to feeling deprived. For instance, instead of giving up high fat desserts, why not shop for yummy high fat desserts containing high quality fats. And contrary to common belief, high fat foods do not lead to weight gain above natural weight if eaten when hungry (and neither do high carbohydrate foods). Usually, people feel most satisfied when eating all three major nutrients (protein, fat, carbohydrate) at meals.

How does someone with binge eating disorder or compulsive overeating do HAES? (The concern here is that if they go to a nutritionist, they will be given a weight-loss diet plan).

It is extremely important for someone struggling with binge eating or compulsive eating to seek out a HAES nutritionist since dieting is one of the major causes of this type of disordered eating. Nutrition treatment for compulsive eating should involve assisting the client in eating enough total food according to internal cues of hunger and fullness, balancing the major nutrients (protein, fat, carbohydrate), including all liked foods, and eating mindfully to obtain the most pleasure from meals. It should also include HAES education regarding nutrition, the problems with dieting, principles of weight management and the relationship between weight and health.

Is the HAES approach compatible with recovery from an eating disorder such as anorexia nervosa? It seems possible that “Health at Every Size” philosophy might be misused to justify an extremely low body weight.

People struggling with Anorexia Nervosa are not able to utilize an intuitive HAES approach to eating initially because internal cues of hunger and fullness are not reliable due to physiological and psychological factors. So nutrition counseling involves much structure and setting goals to gradually increase intake and weight. Further along in recovery, when the client has achieved appropriate weight gain and is eating normally, a HAES approach to eating may be appropriate.

How can I reconcile my desire to practice HAES with my feelings that I was healthier and happier when I was thinner?

Many people put off taking care of their bodies and many other things until they lose weight resulting in feeling less healthy and happy. But in reality, we only have the present moment, so why waste it on wishing to be thinner instead of living it to the fullest right now! Some of the books listed below will give you some great ideas. Besides reading and learning about HAES, joining a support group can be very helpful. In Baltimore, I offer Largely Positive, a support group for adults of size based on Carol Johnson’s book Self-Esteem Comes in All Sizes: How to Be Happy and Healthy at Your Natural Weight. If there is no support group in your area, you can form one. To find out how, go to

We are healthiest at our natural weight, the weight our body stabilizes at when we are eating according to our internal cues. It is possible to be above natural weight due to frequent non-hunger eating and very little physical activity. If that is the case, the best way to return to natural weight is to practice HAES. A constant focus on weight loss usually causes overeating, stress and weight gain. And dieting is the best way to gain weight! 95% to 98% of people who lose weight by dieting will regain all lost weight within five years. 33% to 66% of those people will regain to higher weights. Decreased metabolic rate, increased numbers of fat cells and increased levels of a fat storing enzyme all contribute to weight gain as a result of chronic dieting.

Is it really Health at EVERY size? Can a person who is underweight or overweight or obese be healthy at these sizes?


How much research is being done on HAES? Are researchers interested in HAES able to get funding? Has the NIH supported any studies? What are the obstacles to getting funding and who (if anybody) has shown a willingness to support it?

Being a clinician versus a researcher, I am not sure I can completely answer this question. However, one important HAES study was published in the Journal of the American Dietetic Association in June 2005, “Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters” by Bacon, Stern, Van Loan, Keim. Results showed that women who recognized and followed internal cues of hunger had significant improvement in overall health, including cholesterol levels, blood pressure, physical activity and self-esteem. And there is much obesity research that supports the HAES model. A good site for more information about research is and I will list some books below.

Are there any good books or online resources for HAES?

Here are some, there are lots more!

Health and Weight
- Big Fat Lies: The Truth About Your Weight and Your Health by Glenn Gaesser
- Health At EVERY Size: The Surprising Truth About Your Weight by Linda Bacon (hot off the press!)
- The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health by Paul Campos
- Rethinking Obesity: An Alternative View of its Health Implications by Paul Ernsberger and Paul Haskew (published in the Journal of Obesity and Weight Regulation Summer 1987)
Compulsive Eating
- Overcoming Overeating by Jane Hirschmann and Carol Munter
- When Women Stop Hating Their Bodies by Jane Hirschmann and Carol Munter
- The Diet Survivor’s Handbook by Judith Matz and Ellen Frankel
- Intuitive Eating: A Recovery Book for the Chronic Dieter by Evelyn Tribole and Elyse Resch
- Breaking Free from Emotional Eating by Geneen Roth
- Losing It: False Hope and Fat Profits in the Diet Industry by Laura Fraser
- Great Shape: The First Fitness Guide For Large Women by Pat Lyons and Debby Burgard
- Don’t Weight, Eat Healthy and Get Moving NOW! by Kelly Bliss

Size Acceptance
- Self Esteem Comes in All Sizes: How to Be Happy and Healthy at Your Natural Weight by Carol Johnson
- Live Large: Affirmations For Living The Life You Want In The Body You Already Have by Cheri Erdman
- 10 Steps to Loving Your Body (No Matter What Size You Are) by Pat Ballard
For Parents
- Preventing Childhood Eating Problems: A Practical, Positive Approach to Raising Children Free of Food and Weight Conflicts by Jane Hirschmann and Lela Zaphiropoulos
- Your Child’s Weight: Helping Without Harming by Ellyn Satter


For more information, contact Deborah at 410-982-9667 or; or visit

Click to Bookmark
This entry was posted on Monday, September 29th, 2008 at 11:35 am and is filed under Body Image, Eating Disorders, Fitness/Exercise, Health, Nutrition & Fitness, Interviews. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There are currently 6 responses to “Answered: Your questions about Health at Every Size”

Join the conversation! Post your comment below.

  1. 1 On September 29th, 2008, Health at every size info! « Sparkle Pants said:

    [...] A great post on Health At Every Size! [...]

  2. 2 On September 30th, 2008, Christi said:

    Thank you so much. I really needed to read this right now.

  3. 3 On September 30th, 2008, Some Answers about HAES « Strenua - Strength and Vigor said:

    [...] out this great post over at The F-Word, a registered dietician answers some of the many basic questions people have about Health at Every [...]

  4. 4 On October 1st, 2008, What is Health At Every Size (HAES)? « Fat Acceptance 101 said:

    [...] Every Size (HAES)? Posted on October 1, 2008 by the Lindsay of Babble-on This article was originally posted by Rachel at It has been reposted here with permission from both Rachel and Deb [...]

  5. 5 On October 1st, 2008, femmina said:

    My question is, if one is going to find a nutritionist…how do you go about finding a HAES Nutritionist?

  6. 6 On October 1st, 2008, Rachel said:

    I’ll find out for you, Femmina.

  • The-F-Word on Twitter

  • Categories

Socialized through Gregarious 42