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Health at every size: A burgeoning counterculture

Photo by Gemma Chua-Tran

By now, some people have heard of and maybe even engaged with the Fat Acceptance Movement, a social movement seeking to bring attention to the inequities and biases faced by people with larger bodies in comparison to the norm of their society. These disparities permeate many aspects of life, but the movement particularly highlights issues of social attitudes and medical practice.

The Fat Acceptance Movement challenges the idea that body weight is a major health determinant, with lower weights most often considered favorable. Instead, it proposes that a higher weight may not be as much of a determining factor of health as once thought. Further, it holds that anti-fat sentiments may be, in fact, detrimental to the health of an individual. This specific focus on health became a submovement within the Fat Acceptance Movement, called Health at Every Size (HAES). HAES holds that health can be pursued by every person, regardless of size.

To understand HAES, a complex question must be posed: what is health? This answer varies greatly among medical professionals, individuals and cultures, but health is generally regarded as a state of physical, mental and social well-being. What helps people lead a life of well-being varies greatly from person-to-person. The issue is that weight has been heralded as a single determinant in defining if a person is “healthy” or “unhealthy,” when in reality, health, as a broad concept, is far more complicated and even subjective. The cultural obsession with weight in American culture permeates everything, and the medical field, while of utmost importance, is no exception.

Photo by Samuel Ramos

Currently, the scientific consensus in the medical community is that lower body weight is conducive to better physical health in that it is preventative of many diseases, though this has been subject to growing dissent in recent medical literature, with some medical professionals using the label HAES themselves to describe their philosophy and practice. The consensus is not necessarily lacking in evidence from a narrow standpoint — but its flaws rest in what it fails to consider and the perspective from which it is approached.

For example, is it possible that disease is caused by reasons independent of body weight, even if a correlation between higher body weight and a particular disease exists (there’s a reason why “correlation is not causation” is so commonly said!)? Perhaps the conversation around bodyweight and well-being in this sense is missing the point entirely by making weight simplistic hyperfocus within the complex world of health determinants and failing to address the health consequences of dieting and weight stigma. 

Are there deeper issues and greater dimensions at play in the functional health benefits of a particular weight? Weight control behaviors have been shown to be generally ineffective. Drawing from the results of 31 studies, researchers at UCLA concluded that at least one-third to two-thirds of people on diets regain more weight than they initially lost within 4-5 years. The negative physical and psychological effects of both dieting behavior and social ostracization for body size have been well documented.  For example, stress and disordered eating behaviors stemming from internalized weight bias have been linked to metabolic abnormalities and depression.

This leads proponents of HAES to conclude that health improvement and maintenance are best approached by methods unrelated to body weight. Exercise, eating nutritious food and caring for one’s mental health are all positive health behaviors that can be pursued regardless of size. What helps one person maintain their health is very personal. However, the mainstream idea that body weight itself is a major health determinant with a remedy of weight loss is misguided in that it places health purely in the hands of the individual, neglecting systemic crises such as food deserts, racism, sexism and poverty. HAES cannot be complete without accounting for these factors; the movement is fulfilled in its ideology when it facilitates conversations around public health as it relates to systemic inequality. 

HAES is intensely countercultural because diet and weight-centric ideas are so innate to American culture. Perhaps the most interesting and challenging facet of HAES and the broader Fat Acceptance Movement is that it faces great dissent from not only the general public but other social movements seemingly adjacent to it.

A quick look at the comment section on a fat-positive article reveals a myriad of comments accusing the author of “promoting obesity” and comments that are generally pejorative against self-proclaimed fat people. Though the negative reactions from other progressive movements may not be quite as strong, they exist. HAES generally regards itself as a feminist movement, though it has not been adopted by or accepted into feminism at large. Likewise, the elimination of weight-centric aspects of American culture has racial justice implications, as Eurocentric beauty standards can be seen as not only the most attractive but most healthy. Many of the leaders of the HAES movement are involved in these causes, but HAES is not yet widely seen as a necessary part of them. Fat Acceptance and HAES are gradually being adopted into other radical ideologies and American culture but remain polarizing. The future of HAES is unknown, but it is gaining visibility and traction.