HAES® is a Cornerstone for Recovery

HAES® is a Cornerstone for Recovery 

By Lisa Pearl, MS, RD, LDN, CEDRD-S, CEDS 

I have been a career-long Health At Every Size (HAES®), intuitive eating, and mindfulness practitioner. Sheer good fortune allowed me to meet and work with mentors who offered me these perspectives back in the early 80’s. At the time, the HAES® paradigm was somewhat alternative, but it just made good clinical sense as a philosophical base from which to launch recovery from dieting disorders and poor self-concept. In my estimation, the HAES® paradigm has stood the test of time.

The fundamental core principles of HAES® (see chart) provide a framework to also address the social justice issues that perpetuate eating and body image disorders as well as the profound consequences of a Weight Centered Health Paradigm (WCHP). Thanks to many phenomenal clinicians and advocacy groups, there are tremendous resources for education, prevention and clinical application of the HAES® principles. (See reference list) If you are new to the field or to HAES®, I strongly encourage you to dig in to these incredible resources. There is something for everyone.

The HAES® approach fortifies the concept of self-acceptance whilst our clients develop a more resilient, restorative and compassionate relationship to body and food.  Despite the ever -shifting tides of nutrition science, I have maintained the belief that the relationship one has to self-care and body image is a reflection of your deepest sense of self.  Attempts to diet away dissatisfaction with the body is a missed opportunity to deepen the understanding and potential healing of the whole self.

Using a HAES® approach also fits in nicely with the concept of the Hippocratic Oath to do no harm. Despite billions of dollars in research money, I have still not seen any research that compels me to believe a focus on weight loss is EVER helpful. There is a staggering degree of unintended harm done by uninformed clinicians who recommend weight loss as a medical intervention without any clinical relevance. Lilly O’Hara and Jane Taylor have done an excellent critique of the Weight Centered Health Paradigm (WCHP) that should be required reading in the training of all health care professions (1). The work of Vadiveloo, Mattei, Tylka, Bacon and Aphramor further substantiate the importance of a health care paradigm shift to HAES (2, 3, 4).

Based upon my experience as a pediatric specialist, I want to emphasize the life-time of damage that can occur when children are told that their bodies are inadequate/unacceptable/unhealthy because of their size. The incidence of eating disordered behaviors following participation in a pediatric weight loss program is alarming. My practice is full of clients whose debilitating body image and eating disorder began on the heels of being advised to stop gaining weight as a child. Critical stages of development are influenced and damaged by the delivery of weight-focused messages which can cause children to doubt their value, their social confidence, their sense of trust in the world and within themselves. Imagine the impact and resulting difficulties in reworking one’s self-concept if being unacceptable/unattractive/too big for the world was an integral part of your development.

Recently, I consulted on an all too familiar situation of a 16-year-old girl with anorexia nervosa. She had been in outpatient treatment for approximately 6 months and was making progress with her nutritional rehabilitation, emotional stability, and body image. However, she was still struggling with eating disordered thinking and behaviors including a preoccupation with food, appetite disconnection with episodes of restriction and bingeing, blood glucose abnormalities and continued fear of weight gain. Prior to her acute weight loss, this client had been completely healthy, active, and following her growth curve at the 75th percentile. At her last medical appointment, her weight had reached the 50th percentile and despite her continued eating disordered behaviors, she was told that she was now at the perfect weight for her height with a BMI in the 50th percentile and that she “could stop gaining weight now”.
Here are some thoughts from the consult:
From a nutrition perspective: the girl’s pre-morbid weight, which was a reflection of completely normal eating and movement behaviors, suggests that her body was meant to grow at HER percentile.  For a medical practitioner to suggest that she should be less than her biologically appropriate weight, will reinforce the eating disordered thinking that drives her restriction and bingeing and will interrupt any further normalization of her relationship with food. It dismisses the natural diversity of physiology and further endorses cultural misconceptions and disordered eating.

From a psychological perspective: The same threatening message that created this girl’s pursuit of weight loss and ended in treatment for anorexia nervosa was again reiterated as soon as her body began to normalize The emotional and psychological development of this child was at imminent risk when she began to absorb the message that she cannot trust her body, that her body in its’ natural state is unacceptable, and that she must be responsible for and control her own physical development in order to be “OK”.

From a treatment team perspective: the lack of consensus on treatment goals and approach could undermine this client’s trust in her team and her recovery.

Here is the really good news: in an attempt to prevent this client from taking a nosedive back into her eating disorder, her outpatient dietitian encouraged her therapist and psychiatrist to address this issue immediately with the client, and as a team they wrote to the medical practice expressing the need and rationale for a weight-inclusive HAES approach especially during eating disorder treatment.

Two of the biggest reasons to encourage a HAES® approach is for the prevention of eating disorders and the elimination of weight stigma and its devastating effects on psychological, behavioral and physical health! However, I can honestly look back at my career and feel tremendous joy for the vast majority of clients who have found recovery through the integration of HAES®, intuitive eating and mindfulness. Healing this integral and connected relationship to one’s self offers a path to authenticity and a release from the mindset that causes harm, disconnection, and dis-ease.  And yes, all kinds of health parameters improve regardless of weight.

Foremost HAES® author, Linda Bacon, writes, “Health at Every Size principles help us advance social justice, create an inclusive and respectful community, and support people of all sizes in finding compassionate ways to take care of themselves.”

It is impossible to un-see the negative impact of a weight centric approach to health. This may be why I have had the great privilege of watching many recovered individuals go on to work in the field. I have witnessed how their lived experience has deeply informed their passion for the work, both in clinical and social justice settings.  We are all negatively affected by a weight-centric culture. So, if you are one of the many who have taken to heart all of the threatening messages about weight and health, reading and researching HAES® might turn your perspective upside down. I hope you too will find the curiosity and self-compassion with which to navigate the integration of HAES® into your practice. I believe it is the clinical and cultural cornerstone that supports both the prevention of and the recovery from eating disorders.

 

The Health At Every Size® principles are:•   Accepting and respecting the diversity of body shapes and sizes

•   Recognizing that health and well-being are multi-dimensional and that they 
 include physical, social, spiritual, occupational, emotional, and intellectual aspects

•   Promoting all aspects of health and well-being for people of all sizes

•   Promoting eating in a manner which balances individual nutritional needs, hunger,
 satiety, appetite, and pleasure

•   Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather 
  than exercise that is focused on a goal of weight loss

www.sizediversityandhealth.org.

 

About the author:

Lisa Pearl, MS, RD, LDN, CEDRD-S, CEDSis a licensed dietitian and eating disorder specialist. She is the founder of CNC360 as well as a clinician with over 35 years of experience in providing treatment, education, training and mentoring in the field. Lisa’s services include nutrition therapy, case consultations, and professional supervision. She is also the co-creator and co-director of a new graduate internship program at Simmons University in Boston for certification in the Treatment of Eating Disorders. More of her bio at www.cnc360.com.

 

References:

  1. Lily O’Hara and Jane Taylor (2018): “What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift” Sage Pub., Vol. 8, Issue 2 https://journals.sagepub.com/doi/full/10.1177/2158244018772888#abstract
  1. Maya Vadiveloo & Josiemer Mattei (2017): “Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults.” Annals of Behavioral Medicine, 51:1.
  2.  Tracy Tylka et al. (2014): “The Weight-Inclusive versus Weight-Normative Approach to   Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss.” Journal of Obesity, volume 2014.
  3.   Linda Bacon & Lucy Aphramor (2011): “Weight Science: Evaluating the Evidence for a Paradigm Shift.” Nutrition Journal, 10:9. 

Other Resources:

Body Respect by Linda Bacon and Lucy Aphramor and Health At Every Size by Linda Bacon are two powerful books that examine our misguided focus on weight as a determinant of health. Dr. Bacon’s website is full of additional information: https://lindabacon.org/_resources/.

Body of Truth  by Harriet Brown examines the connection between science, history and culture and how it effects our weight-centric preoccupation and health care system.

Our Services: We offer individual support (supervision) for dietitians and psychotherapists looking for a weight inclusive, HAES® perspective at  cnc360supervision and check out our blog by Heather Bell on how science continues to misinterpret and misrepresent statistics on weight and health at www.cnc360.com or When Objective Clinical Research Is Anything But Objective

If you are a dietitian hoping to work in the eating disorder field with a HAES® informed approach, check out the new Treatment of Eating Disorder concentration in the Department of Nutrition and Dietetics at Simmons University in Boston.

http://www.simmons.edu/academics/graduate-programs/dietetic-internship-program

Christy Harrison offers many HAES® informed resources, podcasts and on-line trainings.

You can find her at: https://christyharrison.com/

And lastly, a word from the brilliant, Ragan Chastain, “The most effective public health message discourages body stigma, encourages people to see their bodies as worthy of care, and offers additive solutions. The best kind of health care is blame free, shame free, future oriented, and evidence-based. The focus should be on health, not body size.” 

 

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