HAES When You’re Sick

I recently saw this question posed in an online forum.

I got the results back from my blood panel and aside from the high blood pressure, I also have high cholesterol.

I’ve sort of known this was coming for a while now. I have a family history of high cholesterol, hypertension and heart disease.

So my question is, what the hell do I do now? Is HAES irrelevant for me now? Is there a HAES approach to lowering cholesterol? It makes me wonder if HAES is best for maintaining health, rather than treating specific metabolic disorders, like high cholesterol or diabetes. Thoughts?

This is a really interesting question.  Before I get into it let me be clear that I’m not a doctor or nutritionist.  I’m just a girl with a blog and I encourage people to find practitioners they like and trust. I’m not trying to give any kind of medical advice here, but I do want to give my thoughts.

The first question I always ask when someone blames a medical issue on my weight is “Do thin people get this thing?” The answer is always “yes” so my next question is then “How do you treat it in thin people?” I want to try that before I try a risky prescription that has a 95% failure rate (which is exactly what dieting is).

Based on all the research I’ve seen the relationship between weight and health problems is correlational, not causational.  Therefore fat isn’t  proven to cause disease and weight loss isn’t shown to cure it. Health is multi-dimensional and includes behaviors, access, environment, stress and genetics. We can only control some of these and so my understanding of the Health at Every Size® (HAES) approach is that healthy behaviors, while they don’t guarantee health, are our best chance.

If you have a disease and it is to be managed, my understanding is that it’s managed through behaviors as well. And it seems to me that the recommended behaviors should be the same regardless of the size of the person with the disease. Even if weight loss weren’t statistically impossible for the vast majority of people, if thin people and fat people both get a disease, then being thin is neither a cure nor a preventative.

To me, following food recommendations to manage a health condition is at the very core of a Health at Every Size practice. You eat in ways that nurture you. Eating to manage a disease and eating to make your body smaller are two different things for me, and so eating to manage a health situation would fall well within my HAES practice, while trying to lose weight to manage a health situation would not.

I also think that we have to be careful of the information that is out there. In recent years what was considered “healthy” blood pressure has been lowered several times with the help of the pharmaceutical industry and “healthy” blood glucose levels have also been lowered.   John Hopkins-led research found that “High cholesterol levels in middle age do not appear to increase women’s risk of developing Alzheimer’s disease and other forms of dementia later in life, despite a body of scientific evidence long suggesting a link between the two.”  (See what I mean about correlation and causation…)  That article suggests that you should still worry about high cholesterol because of heart disease, but that has been questioned as well.

Also, it has been my observation that people test extreme diets to mitigate and manage disease, but do NOT test moderate ones. Recently, a study looked at reversing type 2 diabetes with a 600-calories-per-day liquid diet.  I wonder what would have happened if they had done things like eat regular small meals through the day and eat more whole grains? People seem to want to discover a “Break Through!” solution, not just “eat a little differently and move your body.”

In the end I think that we all have to decide for ourselves if, and how, we will use HAES to support us, and what health really means.


In our petition asking the National Eating Disorder Association to end is partnership with the STOP Obesity Alliance (an organization funded by pharmaceutical companies trying to get obesity declared a disease so that insurance will cover their products), we are at 567 signatures!  We’ve passed our original goal because you are awesome!!!!!  Now let’s blow the goal out of the water  –  please keep signing, passing it on and reminding people.  We cannot allow people to be declaring physically or mentally ill based on a ratio of their height and weight no matter how many pharmaceuticals it might sell or how many insurance reimbursements it might force.

23 thoughts on “HAES When You’re Sick

  1. fwiw I had high cholesterol when I was young and slender , have had it all my life and have been previously been diagnosed with diabetes some times when I was not fat. Both of my slender parents and siblings have High blood pressure but I do not. My skinny father has diabetes my mother has been diagnosed with it as well. I have successfully managed , stabilized and lowered my blood sugar to great levels through diet and supplements. My blood pressure was high only when I had untreated sleep apnea. My cholesterol is now great with a low dose of a med and diet and supplements. I am still fat. For me these things are not related.

    Today I read a study about how discrimination against various groups causes high blood pressure. They never listed fat as a type of discrimination in the article. The following article in the same journal was about how obese kids are often socially isolated because of a lack of reciprocal relationships. They did not mention that discrimination against such children may damage their blood pressure. I wanted the writers of both articles to take notes. sigh.

  2. This is something I’m really struggling with and I’m glad you wrote this entry.

    I was just diagnosed with diabetes. When I had blood work in the spring, I was told my numbers were high, but not considered diabetic and given the standard “watch your diet, start exercising” speech. Then we moved and I went to a new doctor for a problem with my shoulder and suddenly I have diabetes based on prior bloodwork. Her words? “Well, over the summer the ADA lowered the threshold for diabetic A1C numbers.” What the what now?

    Sorry, got off on a bit of a rant there, but I’ve been struggling since the diagnosis. I was doing really well with intuitive eating, but now eating freaks me out. I don’t know what’s safe, I don’t know what to stay away from completely, etc. I have to go back on Thursday and I’m going to insist on seeing a nutritionist. But I was really enjoying food again and now I’m back to feeling like I’m on a diet. So discouraging.

  3. Simply speaking as a person who has mild hypertension and for whom its hereditary, I choose to take a low dose of a mild antihypertensive medication. In my case, amlodipine besylate works very well and has virtually no side effects. It made me a bit sleepy when I first started taking it, but that passed within a couple weeks and I offset it by simply taking it before I went to bed. Everyone is different and meds are not one size fits all.
    I think I’m lucky that my hypertension causes me to have symptoms like dizziness and anxiety. My father’s was asymptomatic and he had a hemorrhagic stroke at 68. He also had atherosclerosis. His vessels were in terrible shape. Atherosclerosis causes hypertension and untreated hypertension contributes to atherosclerosis so–yikes! Yes, hypertension has to be treated.
    Do thin people get hypertension? Yes. My younger brother isn’t thin, but he isn’t fat either. He’s a noncompetitive bodybuilder who is in a high-stress profession (firefighter/paramedic) and he developed hypertension 10 years before I did. His drug of choice is Lisinopril, but that one makes some people cough like crazy. You might have to try a couple before you hit the right one.
    Hypertension has a heredity component, obviously. It is also one of those buggery little diseases of aging. I work with the elderly and have since 1988. I work with people of all sizes and the majority of them have hypertension. It is not a “disease of obesity” any more than type II diabetes is a “disease of obesity.” People of all sizes get it.
    As for hypercholesterolemia, it depends on how high your cholesterol is whether it’s worth treating it with medications, in my opinion. If it’s just slightly high, I personally would choose not to. Those are much more serious medications than the nice little advertisements would have people believe. They can cause severe muscle pain and contribute to kidney failure. If the cholesterol levels are very high, then of course that is a different story.
    My late father always said that medications didn’t have side effects, they just have effects, and you have to decide whether the benefit is worth risking the effects. I think there is wisdom in that. Of course different people react differently to different meds!
    I wish this person luck and hope she finds a solution that works for her!

  4. To Pange: I hope you get to see a smart nutritionist who will give you advice about how to eat so as to not spike your blood sugar, but who will not focus on how much you weigh or whether or not you lose weight. You might want to check out the Fat-Acceptance Diabetes Support list at http://fa-diab.com.

    It really frustrates me that so many people, even after supposedly learning about and practicing Health at Every Size like the reader above, have the impression somehow that HAES means “unhealthy eating.” Excuse me? Don’t they notice that the very first word in the name is “health”?

    As Ragen says above, and as I think should be repeated every time someone mysteriously misinterprets HAES as meaning “don’t pay attention to your health”: “…following food recommendations to manage a health condition is at the very core of a Health at Every Size practice. You eat in ways that nurture you. Eating to manage a disease and eating to make your body smaller are two different things…and so eating to manage a health situation would fall well within my HAES practice, while trying to lose weight to manage a health situation would not.”

  5. I’m a fat diabetic. I actually did have a dietician prescribe me a diet of under 1000 kcal a day, which another dietician called “malpractice.”

    I decided to try the HAES approach, and it has worked very well. To help me get started, I took my blood sugar testing kit with me everywhere at first and tested before and 2 hours after EVERY MEAL. I needed to learn for myself how my own body reacted to certain foods. Soon, I learned to know what high and low blood sugar feel like, and I could use just those feelings to help with my food choices.

    I also studied the glycemic index and read books on that, and tried to change the foods I liked for lower-glycemic versions. For example, baked potatoes are very high glycemic and raise my blood sugar fast, however, when you chill a baked potato, some of the starch gelatinizes, lowering the glycemic value of the potato. The glycemic value stays lower even when reheating. So – I have twice-baked potatoes when I’m craving a baked potato. I make my sandwiches with whole grain bread (I love whataburger because they have whole grain burger buns!). I use high-protein pasta.

    You can learn and you can still eat intuitively.

    Oh, and I found this article by Linda Bacon and Judith Matz VERY helpful: http://www.diabetesselfmanagement.com/Articles/Nutrition-And-Meal-Planning/intuitive-eating/

  6. My slim brother developed high cholesterol in his early thirties. There’s a huge genetic component. He was able to bring it down by increasing physical activity (in ways that were enjoyable for him, like rollerblading and using a Wii Fit), and switching to a diet with less fast food and more whole grains, lean proteins, and vegetables. The changes were fairly moderate – for instance, instead of going “I can never have pizza!”, he switched to making his own pizzas with whole-grain crusts, lots of vegetables for toppings, and part-skim mozzarella for the cheese. This works well for him because he enjoys cooking.

    The Fat Nutritionist has some excellent information on HAES eating for people who have to incorporate medical issues into their eating habits.

    And some people, whether fat or thin, end up needing medication because trying to change things with different eating and exercise habits doesn’t work for them. There’s a tendency in our culture to assume that fat people are always guilty of failing the diet and exercise approach, and only thin people can have the diet and exercise approach fail them, but there’s no reason to assume that the biological factors that make medication the only effective treatment only ever happen to thin people. I think trying first with the eating and exercise habits is a good thing, but if doing everything reasonable and healthy doesn’t work and medication ends up being the best option, one should not feel like a failure for not resorting to starvation or other unhealthy habits.

  7. I feel one cannot underestimate the power genetics has over us. Practically everybody in my family has hypertension, high cholesterol, and heart disease. I was diagnosed with hypertension when I was in my 40s. Shortly thereafter, my cholesterol started to creep up. I exercised and became a vegetarian, eating no flesh food and very little dairy. There was no change in either my blood pressure or cholesterol levels. I opted to start medications for both problems, since my father was originally diagnosed with arterial blockages at age 46. I am now almost 58 and have been fine since. I continue to follow a vegetarian diet and stay as active as I can. The point I am trying to make is that one out of every two people will die of some cardiovascular disease. Trust me, some of those people are gonna be thin.

  8. Greetings from Boulder! Thank you so much, Ragen, for your awareness building campaign. As a sexual healer, I’ve learned that the one thing that stops sexual pleasure more than any other is the judgment women (and some men!) have toward their own bodies.

    Keep keepin’ on, darling. Your voice is much-needed.


  9. Pre-hypertensive at a size 8 here, thanks to unhealthy habits like too much caffeine and booze… (my doctor kept trying to tell me to quit smoking, but then she’d remember I don’t do it).

    Anyway thanks for your blog as always – I love it. And I signed the petition!

    1. Aw, man! I remember Heavy D from when I was a kid watching In Living Color. Heavy D and the Boyz. The man dies and all they can talk about is his weight. So disappointing.

      1. WTF? Heavy D died? That sucks like a vacuum cleaner. 😦 I lost track of him and his work around the mid-’90s, but from what I remember, he was a fabulous and charismatic entertainer.

    2. Fat didn’t kill him, flying did (flying causing DVT causing PE causing death). But blaming fat makes money for the diet and shame industry, and blaming flying hurts the airlines so you know which way the money favors.

      If they spend even half as much time on educating people about how to avoid DVT on long trips (not just in airplanes) as they currently waste on fat shaming, most of these deaths could be avoided!

  10. I also signed the petiton. 🙂

    Trigger warning for what I’m about to write:

    I’ve just started taking insulin by injection. I’m on my second week now. I’ve been feeling like some variety of failure for having had to do so. It isn’t easy to overcome all the messages telling me that having diabetes is my fault. It makes me feel like I personally have destroyed the health care system and am costing everyone billions of dollars single handedly.

    I KNOW intellectually that none of that is true. But in my heart of hearts I still feel like it is all true.

    I don’t blame myself for feeling like that. I’ve spent years trying to deprogram all the negative messages society has given me about weight. I guess I just have a long way to go yet.

    It angers me that I have to go through all this self doubt at all. It shouldn’t be this way to begin with. Dealing with an illness is challenge enough without having to battle social stigma on top of it.

    The only good thing is that I do practice HAES and have for years. I have been eating in a manner that promotes lower blood sugar numbers for a long time now. I move in ways that make me happy without causing me pain. So at least I have this tool to help me in my latest challenge.

  11. HAES does not mean “you get to eat whatever you want as long as all your numbers are perfect, but the minute they’re not, you’d better start dieting, missy.”

    It means “you get to not be on a diet, period, ever.” Yeah, there may be certain health conditions that mean you don’t process certain foods well, and that has to be taken into consideration. But doing medical transcription, I see all these ridiculous diets people (especially old people) are given to follow at home, something like “2 grams sodium, 1800 calories a day diabetic diet, low fat, low cholesterol,” blah blah blah…really? They expect people to live on boiled celery and defatted tofu every day? I think, personally, they’re setting people up for binges by doing that. That’s the last thing you want.

  12. Thank you for sharing this honest post. HAES can work for everyone in an individual, personalized way. Health and body size are two separate things. We need to do what is necessary for our health and then whatever size we happen to be is what has come naturally. You know, in a perfect world. I know some tiny people who have high blood pressure and cholesterol. Who knows, maybe they would be healthier if they ate a little more. This is exactly why diets don’t work, because everyone needs different things.

  13. I think the thing to remember is that HAES is individual. Healthy eating and exercise looks different for everyone. Some people experience great health on a vegetarian diet, others have terrible trouble and must return to eating meat. Some people feel great on a low carb plan, others get constipated like nobody’s business. There simply is no one right way to eat. Haes is about finding the way of eating that works for YOU, that helps you feel your best, and that means taking your particular health quirks into consideration. We’ve just gotten such a healthist attitude in this country that we’ve gotten into blaming people for their health issues. But there’s no magic formula for health.

  14. Health issues in relation to HAES is a topic close to my heart. I’m chronically ill–mostly neuromusculoskeletal, autoimmune, and pulmonary issues–so the very notion of me following HAES seems contradictory. I finally settled on eating and exercising in a way that gave the most benefit with the least detriment, though it has to get tweaked every time the weather changes. Still, I have trouble calling it *Health* at Every Size. How can someone work to be healthy when they are, by outright definition, seriously ill?

    I’d say more, but I did a late half hour on the recumbent bike before the gym closed tonight–knitting while working out FTW!–and my brain has officially turned to Jello. 😉

    1. That sounds like a legitimate use of Health at Every Size. You’re doing what’s best for your health (“eating and exercising in a way that gave the most benefit with the least detriment” sounds like one of the best descriptions of healthy food and exercise habits I’ve heard). And health isn’t an on-off thing. You are healthier than you would be if you added malnutrition, exercise injuries, or other food-and-exercise issues to your current state of health. Doing the best you can for your health isn’t any less legitimate just because you can’t achieve perfect health.

  15. This struck a chord for me; I was diagnosed with high cholesterol a few months ago. At that time, I was doing yoga 4-5 times a week, not heavy (BMI argued that I was on border of Overweight, but I a) totally agree BMI is useless, & b) am almost 6′, so it’s skewed anyways), and eating better than 70% of people I know. It was a real kick in the teeth. All my hard work & I had high cholesterol anyways?!

    All of my other bloodwork was normal, just the low cholesterol score was high. To me, this says it’s not necessarily what I eat. It runs in my family, & my younger brother (on an extremely restricted diet for stomach problems) has it too.

    So no, skinny people get this too. I wasn’t impressed to be ordered to lose weight as one of the few suggestions my new doctor could offer. This doctor has potential, so I’m going to work this out myself (hopefully without drugs) and see if she’s open to learning from me! She has been so far.

    I will say that I am losing weight as a side effect of adding more healthy behaviours & being more diligent about cutting out unhealthy ones. I feel better after these changes as well, but I really believe this is because I am finally admitting that some of my favourite foods (white breads, pasta & rice) really don’t feel good in my body, and replacing them. I am learning so much.

  16. I found myself asking those very questions when I was diagnosed with Type 2 Diabetes earlier this year. After all, I might be a staunch fat activist, but I’m still hearing the same cultural messages as everyone else that “fat is bad/unhealthy” and “weight loss cures diabetes”.

    Thankfully, I had a whole host of resources to turn to, the first one was Linda Bacon’s essay “A Message for People Who Have Diseases Blamed on Their Weight” (pdf file here: http://lindabacon.org/HAESbook/pdf_files/HAES_Message%20for%20People%20with%20Disease.pdf)

    I talked to my excellent GP, and we agreed that a HaES approach coupled with medication would be the best place for me to start.

    It has been a process of trial and error, and some considerable worry on my part… but at my latest blood work this week, we got the evidence we were looking for – my blood sugar has dropped right down into normal levels. Talk about rewarding!

    HaES does work. It also costs nothing, fits in to everyone’s lives no matter their circumstances and builds you up emotionally, rather than tearing you down.

  17. As for the health care aspect – I’m mistrustful of conventional doctors. I fell that natural medicines should be explored. I have to wonder if the medications aren’t making the conditions worse. I feel that food should be treated as a medication. High fructose anything should be avoided. If it has more than 12 letters and hyphens in the name it should not be consumed by man nor beast!

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