Too often, overweight and obesity is ascribed by a broad spectrum of healthcare practitioners as due to the wilfulness or the failings of their larger patients. This is a view that has been entrenched in the training of medical professionals for many decades. While there is increasing awareness in the medical profession that the causes of obesity are multiple and much more complex than simply over-eating, there’s still a long way to go to weight acceptance. As Mat alludes, it remains a common experience for larger people to be refused medications, physical therapies and even surgeries until they diet and lose weight, depriving them of the same quality of healthcare afforded to slimmer people on the spot. In addition, numerous studies have now shown that this doctor-driven demand for dieting is often ineffective because, while larger people following restrictive diets may well lose weight initially, the longer-term outcomes of the strategy tend to be poor, and they frequently regain the weight. This stressful yo-yo experience has negative impacts on both their mental and physical health with the result that, in time, their experience with the medical fraternity has left them worse off, all-round.
“I believe that the HAES® approach will in time influence public policy due to several factors that have arisen recently. There is a critical mass of research highlighting the ineffectiveness of dietary restriction in the long-term. There is also increasing evidence that weight alone is not the most important determinant of health. As a population, South Africans are talking about inclusion and tolerance more than ever before. I feel that it is the public that will call out health professionals and demand more inclusive treatment, including public healthcare policies.” says Mat.
It's for this reason that some dietitians have become ‘HAES®-informed’. In 2021, a group of South African Dietitians created Non-Diet South Africa. Gayle Landau, also a registered dietitian and certified intuitive eating counsellor says: “The World Health Organisation defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. I think that the five HAES® principles embrace this definition and provide a holistic framework which can be used to guide practice."
This approach offers patient care that does not centre weight as the main health outcome but rather focusses on behaviours that support mental and physical wellbeing as outcomes. Health at every size provides an alternative narrative to the weight-centric diet approach, and if implemented would hopefully protect those in larger bodies from any weight stigmatisation in the healthcare system.
The HAES® Approach is based on five core principles for healthcare professions:
The HAES®, or Health at Every Size, approach is advocated by the Association for Size Diversity and Health (ASDAH), a non-profit organisation with an international membership.