Before moving to Woodmere from Queens in 1965, Deah Schwartz hadn’t paid attention to the extra dimples and folds on her budding 9-year-old body. She had no clue that she was chubby and, as a young athlete, never thought her body was “wrong.” But after the move in third grade, the pressure to be thin engulfed her without warning.
Schwartz, now a recreational therapist based in California, said the culture shock left her reeling and, as a result, she battled with her weight for decades. It’s also what eventually led to her embracing Health At Every Size (HAES), a movement supporting healthy habits for health’s sake, rather than for weight control and aesthetics.
“Weight may be a part of how we look at the balance of health, but it can’t lead the way,” said Randi Zimmerman, the director of psychotherapy for the Facilitated Eating Events and Direction (FEED) program at the Eating Disorder Treatment Collaborative in Jericho. She agreed that focusing on health only as it relates to body size and shape is counterproductive and espoused HAES’s aspiration to change attitudes toward obesity.
“This preoccupation with thinness has not made us healthier,” Zimmerman said. “What it does is stigmatize the overweight and obese, which impedes self-betterment.” To combat the stigma, HAES aims to spread acceptance of size diversity and intuitive eating—reading the body’s natural hunger signals instead of tracking calories or restricting food intake.
The concept is not new. In 1967, The Saturday Evening Post published “More People Should Be Fat!” a story in which author Lew Louderback claimed dieting is emotionally destructive, temporary and therefore less likely to lead to better health. Later, in the 1980s, disparaging diets was almost as fashionable as the fitness craze, and bookshelves around the country filled with titles like Diets Don’t Work, The Dieter’s Dilemma and Breaking the Diet Habit.
Still, the thin-is-in outlook persisted without incident until 2010 when nutritionist Linda Bacon’s book Health At Every Size: The Surprising Truth About Your Weight made a splash. “I wanted to support people in improving quality of life and feeling better about themselves,” said Bacon, a health professor at City College of San Francisco and a researcher at the University of California. She labeled HAES a peace movement and, in her book, listed its four tenets: accept and appreciate your size, trust your body’s internal systems, embrace size diversity, adopt healthy lifestyles and find the joy in moving.
HAES gained momentum and reached a new high in 2014, taking pop culture by storm with songs touting heft (Meghan Trainor’s “All About That Bass”), fashion houses and magazines utilizing plus-size models (Calvin Klein and Vogue), and lingerie ad campaigns swapping slogans (Victoria’s Secret “Perfect Body”). It was the year actress Melissa McCarthy’s plump, dimpled face graced the covers of more than a half dozen magazines and Lammily made her debut. The first “normal sized Barbie” was made using the measurements of a typical 19-year-old woman’s body, replete with a sticker package of acne, cellulite, scars and stretch marks.
In an ideal world, this would all be a non-issue, according to Schwartz. “It would be nice if [overweight actresses’] size was not part of the story,” she said, adding that there would be no need to counter the emphasis on thinness as the standard of beauty because “people would appreciate other people on a continuum.”
Even if pop culture and the public begin to embrace size diversity, the medical establishment is “locked into the ‘fat-is-bad’ mentality,” Bacon said. “It’s so ingrained in medical culture to blame everything on weight that it’s just way too hard sometimes for physicians and other medical practitioners to be critical thinkers,” she said. Bacon would like doctors to recognize that placing emphasis on weight loss doesn’t work and wants them to keep an open mind to HAES. “There’s no harm in that,” she said.
At Rockville Centre’s Mercy Medical Center, director of physical medicine and rehabilitation Perry Stein believes there might be. “If this movement is encouraging people to be healthy at any size—making healthy choices such as avoiding processed foods, increasing physical activity, limiting refined sugars—then that’s ok. They’re doing us a service,” he said. “If, on the other hand, it’s saying that everybody is entitled to be whatever weight they want and they shouldn’t pay attention to anyone trying to educate them as to what healthy choices might look like for them, then I don’t think that’s a good thing.”
Although HAES does not advocate obesity, it encourages people to ask physicians for diagnoses and treatments unrelated to weight loss. “The first thing most medical professionals will see is the fat, the weight, the BMI,” Schwartz said, “and they should be treating people more equally.” But this approach could have adverse effects, according to Stein, who said it leaves him “working with one hand tied behind my back.”
It would be foolhardy to ignore the myriad data linking some chronic diseases to obesity, Stein added. North Shore-LIJ’s Nancy Copperman, director of Public Health Initiatives, echoed Stein’s sentiments, noting that in the last few decades the rate of obesity and related chronic illness has doubled and, in some cases, tripled.
Copperman supports HAES’s health-centric message and judgment-free approach, particularly because she believes that obesity is relative and there’s no perfect weight or body size. But she warned: “Our body is not made to carry that much weight; once you get into very high weights, you’re going to have more [health] problems.”
Bacon and Schwartz insisted that ongoing longitudinal studies will provide new data showing that HAES boosts self-esteem and health, and dismissing some of the links between fat and illness. “The HAES research people are really trying to do rigorous studies and those take longer than a year or two,” Schwartz said.
But for Stein, time is of the essence. “I don’t think we can afford to wait so long for studies that [HAES] believes will dispel the notion that there’s a correlation between obesity and chronic disease,” he said. “I wouldn’t hold my breath waiting for that study to come out.”
Studies or not, HAES has changed Schwartz’s life. “I’ve come to a place where I no longer obsess about my body constantly,” she said. “I know that my yo-yo dieting days are over. I don’t like to measure my self-worth based on my clothing size or weight. I am a perfect size me and it is a daily practice not to care about other people’s opinions.”