Are Health at Every Size and Size Acceptance the Same?

I’ve seen a lot of talk recently on the internet about Health at Every Size, specifically as to whether HAES is a fat activist movement or a personal health practice.  My name has been mentioned in a number of these conversations (and thanks to those who cited me and said nice things!) so I thought I would clarify my position.

I believe that Health at Every Size and Size Acceptance should be two separate things with separate goals, and that’s because I do not think we should involve the concept of individual health in the fight for fat civil rights.

Let’s start with HAES.  There are lots of different ideas about what it means to practice HAES.  There are people who think there are things you have to do for your lifestyle to be considered “HAES” – some say you have to do intuitive eating, some say you have to exercise in a specific way, or that you aren’t allowed to do any kind of food measurement etc.  I think the definition of HAES should be any personal health practice that is health-centric and weight neutral.  So health is pursued through healthy habits and without an attempt to manipulate body size. People’s prioritization of their health and the path they take to get there is up to them and any health care providers they choose to consult.

I think there is activism to be done around HAES, especially as it relates to access.  Nobody is required to practice HAES or any other health practice, but if you want to practice healthy habits then there shouldn’t be barriers to that – you should have access to the foods you choose, movement options that you enjoy that are both physically and psychologically safe (so that you can, for example, go swimming at your gym’s pool without any fear of being shamed), and affordable evidence-based healthcare (so your doctor listens to you and gives you interventions proven to help your symptoms and does not bring up weight other than if there are unexplained gains or losses, or to prescribe a proper dose of medication.)  There is tons of work and activism to be done around access and it’s really important work.

I don’t think that we should use HAES as a platform to do size acceptance activism because I think that we should avoid even the intimation that some level of health or healthy habits is required for access to basic human respect and the rights to life, liberty and the pursuit of happiness.  There is absolutely NO health requirement to demand your civil rights. You don’t owe anybody “health” or “healthy habits” (especially not by their definition, and not by any definition at all.)  You do deserve, and have the right to demand, respect and the rights to life, liberty and the pursuit of happiness in the body you have right this minute – whatever your size, health and dis/ability.

I am both a SA and HAES activist, but I approach my activism very differently.   I am a Size Acceptance Advocate – everybody deserves basic human respect and civil rights and that should never be up to show of hands or vote of any kind. Fat people have a right to exist, there are no other valid opinions about that. Our rights to life, liberty and the pursuit of happiness are not someone else’s to give, they are inalienable.  SA activism is not about asking someone to confer rights upon us but rather demanding that they stop trying to keep them from us through an inappropriate use of power.

I am a Health at Every Size Practitioner.  I practice HAES and talk about it publicly because there are so many people who aren’t even aware that a weight-neutral approach to health exists. I leave room for the fact that others choose different paths to health, and I respect those decisions as I want my decisions respected. I put my fat body on display (and therefore myself up for criticism) because I am a fathlete and I deserve to exist and tell my story; and because so many fat people tell me that they wanted to be athletic but didn’t think they could until they saw someone doing it, because the message they received from society again and again is that it’s not possible.  Along with fat fitness professional Jeanette DePatie I created the Fit Fatties Forum (which now has more than 2,500 members) so that people who want to can have a place to talk about fitness from a weight-neutral perspective.  But if you read this blog regularly you know that I constantly  point out that nobody has to do what I do and that doing what I do doesn’t guarantee that another person will have the same results that I have, or that I will always be healthy and athletic.  Nor does it make me better or worse than anyone else.  Health is not a moral high ground, it is multi-dimensional, never fully within our control, and our prioritization and health path are personal.

As always, I can only speak for me and this is what I think.  There are a lot people who disagree about this, many of whom I hold in the highest esteem.  I think it’s a good conversation to be having and I think that we can continue to do the activism work even as we have an ongoing discussion to clarify our beliefs around it, that is the nature of the stage of civil rights activism that our community is in.

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14 thoughts on “Are Health at Every Size and Size Acceptance the Same?

  1. Terrific, Ragen – I would just say that I don’t consider the HAES model to be only about individual practices. The HAES model also insists that we can’t talk about health without talking about social justice, about the broad forces that threaten the health of people of all sizes, and work to change those forces. It is a model that suggests a process for one’s individual life and also a process for what we have to change collectively too. I think it all gets very confusing to people – the healthism in our culture contaminates people’s interpretation of HAES, and the resistance to healthism can make the Size Acceptance movement seem like we should not discuss health there at all, but how can we have a movement for the well-being of people and leave out how our bodies are affected? Our bodies are not required to be “healthy” – what does that even mean? but we should require our culture to not make us sick.

  2. Thank you for writing this! As a HAES business that also promotes FA, I think it can be tricky and I know I’m being “policed” by those who don’t think I’m doing it “right”. I want to cry out this; Diversity in thought and approach is a beautiful thing! If we start shaming and blaming each other for not fitting someone else’s idea of how we act, what we say, etc. then we are distancing ourselves from our intended purpose! The diet world can keep their one size fits all model! Rather than being threatened by difference, I see it as a sign that we are talking about two healthy movements. The question is; how do we grow in numbers AND NOT get hung up on creating a “method” that limits creativity and limits access.

  3. I just wanted to point out that there are many people who DO care about their health who are not necessarily in the best athletic shape. You can prioritize mental health above physical health (if it is even possible to separate the two), and that can mean less physical activity. This is still in the realm of HAES. For me, when I hear that HAES is about pursuing “healthy habits”, that triggers the conventional notion of what healthy habits are, which is unfortunate. It’s a buzz phrase that means certain very specific habits in mainstream culture, but the reality is that there are very many healthy things that people can do that don’t involve running or eating fruits and vegetables. I think that more people would declare themselves interested in their health if the notion of health were widened and not stereotyped.

    1. This is a really awesome point. Prioritizing your mental health and prioritizing your physical health can be two different things. For that matter, being “athletic” and exercising for health are two different things too. The recommended amount of exercise is 30 minutes, 5 times a day. That’s not exactly going to get you in marathon-running condition.

      Oh and as if it weren’t complex enough, the same activity that’s healthy for one person can be unhealthy for another. If running screws up your joints or sets off your asthma, then it’s not healthy.

      1. Yeah, good point about the recommended amount of exercise not necessarily making you highly athletic. One of the things I struggle with is never feeling athletic enough (nice parallel to never feeling thin enough, right?). I’ve been many different body weights and engaged in highly varying degrees of exercise of my lifetime, and there was no time when I was like “Yes, I am athletic enough to comfortably do any physical activity required of me.” I don’t know if that means that I just not a naturally athletic person, and so every physically challenging task is going to be more challenging for me than for most people no matter what, or if there is just some internalized level of perfect fitness that I have in mind and can’t reach. In my fat acceptance / giving up of dieting journey, health and exercise have been very unresolved issues for me.

  4. I’m so glad you are here. When I am feeling overwhelmed, I read your blog and it helps me feel less alone. I’ve decided to focus on my own goals in a HAES frame of mind and am working to reduce the amount of fat stigma and shaming/diet talk, etc. that I am exposed to. Today I was joining a group at a table for lunch and overhead one of my coworkers commenting on calories (or some such thing) while using her smartphone. Perhaps I jumped to conclusions, but my thought was that she was using a program for logging and tracking her eating. Don’t get me wrong, I do the same thing… but not at my meals! I’ve decided that I do not want to listen to diet talk while I am eating. I want to, guilt-free, enjoy the food I am putting into my body without having to think about the ‘value…calories…carbs…etc’. So when she said, “Susan, I have something for you…” I answered back, “if it has anything to do with tracking calories or dieting, I’d prefer not to discuss it over my lunch. My meal time is reserved for enjoying my meal”.. she was really mean. She said “fine, if that’s how you are going to be about it”. It brought the tone at the table down and she shunned me conversationally the rest of the meal. I know I did the right thing to stand up for myself, but now I’m sad that she was so snotty to me. Part of me wants to go defend myself… another part wants to go soothe my feelings in something chocolate… but a little part of me that is holding tight to the waistband of my underpants is thinking “don’t waste time explaining to her… you were not rude to her, just assertive about what you do and do not wish to discuss over mealtime… it isn’t worth the effort to convert her to your way of thinking”.

    Thank you for helping me listen to that little part of me who is being in charge of my own underpants.

    As soon as I am able, I’m subscribing!!!


    1. When I am faced with situations like that I try to ask myself ‘WWRD?’

      The answer to What Would Ragen Do? is she would decide how much effort and sanity points she was comfortable using to address the situation, figure out what boundaries she wanted to set and what consequences she was happy to impose if someone continued to make her uncomfortable. She would gently (or not – as needed) remind the person she was dealing with that she is a capable adult who is able to ask for advice when required and that she is not looking to subcontract running her underpants to anyone currently.

      What it boils down to is she would do what she was comfortable with in a given situation.

      At least that is what I believe she would do and spending a moment contemplating WWRD? is much more effective than counting to 10…

  5. Weird to think that some people think there’s one specific way to do HAES. The “no food measurement of any kind” got to me because as a type 1 diabetic, before I got my insulin pump I ate on a meal plan and had to count carbs. I still do sometimes if I’m conserving insulin for whatever reason. But I consider myself a practitioner of HAES. I’m sure that my case is not the one that those HAES people are thinking of, but if anyone has a policy like that, which they extend to others’ lives, they need to understand that there are lots of different bodies out there with lots of different needs, and what’s a healthy policy for them isn’t necessarily going to be for somone else.

    1. Yeah, not everyone has the luxury or the health to eat intuitively. In fact, not everyone can take a weight-neutral approach and achieve the best health. When my brother’s Crohn’s was at its worst and he weighed 90 lbs (he’s 5’6″ tall), he definitely could not take a weight-neutral approach to his health if he wanted to stay alive. He had to get to the hospital and get TPN (IV nutrition). There are a lot of diseases where putting on weight becomes an important goal of the patient, even if appetite is low. These include Crohn’s and other inflammatory bowel diseases, Celiac disease, cystic fibrosis, cancer (during treatment). Children with Crohn’s who are able to eat are sometimes given liquid nutrition to supplement solid food, to help them gain weight so that they can grow properly. They have to ignore their sometimes EXCRUCIATING intestinal pain and force themselves to eat (or go on TPN, if the small intestine can’t absorb anything anyhow, which my brother’s couldn’t). This involves neither weight-neutrality nor intuitive eating.

      Of course, intuitive eating and weight-neutrality probably benefit most people who are healthy or who are not insulin dependent, or afflicted with kidney, liver, or bowel disease (and probably some others that I’m forgetting). But those aren’t the best approaches to health for everyone.

  6. While basically I agree, so much of size acceptance is health based (you can’t be fat & fit or fat & healthy), it’s impossible to kill assumptions and stereotypes without including HAES in SA. I think as humans, we have internalized oppressive “rules” to such a huge extent that we carry it forward into SA & HAES even as we flee the fat oppression from others. “There is only ONE way to be healthy” type of approach is impossible in real life. And it happens in SA and it happens in HAES both, where someone is judged on behavior. If we can’t kill the judgement and assumption within ourselves, how can we ask others to do it?

  7. You know as soon as people can start putting rules around things they do… especially when it comes to “health” conversations. Kind of like religion, people think that their interpretation is the right interpretation. The way that I use both HAES and SA is to live my life… and I do agree with what someone wrote above, this is totally about my mental health. When I’m taking care of my mental health… the rest of my life including my body falls into a rythmn that works for me… only me. If you look at my FB page it’s filled with affirmations on both sides of the conversation, but the most important piece is that I be at peace, be loving and accepting of all of the decisions that I make. This is my life’s work. Thank you Ragen for this important conversation.

  8. What I love about HAES is that it’s easy to “succeed” at it in my own mind. If I follow through with the habits that I’ve established for myself, then I’ve “won” already – I don’t need to achieve a random goal of weight or looks. So _everyday_ I can congratulate myself, which I like because I don’t always enjoy the habits that I need to feel well.

  9. I totally agree with what you wrote, Ragen, about not confusing the two movements (HAES® vs. size acceptance). I am active in both, and while they have many important things in common, there are significant differences, which you mentioned. When it comes to clear thinking about these matters, you are a great role model!

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