Why is Health at Every Size so controversial?

Dr. Wendy Oliver-Pyatt, MD, FAED, CEDS discusses the controversy surrounding the ‘Health at Every Size’ principles in relation to the treatment of Binge Eating Disorder (BED). Dr. Wendy Oliver-Pyatt will be speaking further on this topic at the upcoming ‘2015 Long Island Conference on Eating Disorders‘ on May 2, 2015 at Long Island University, CW Post Campus, Brookville, N.Y. Student Center Theater Auditorium. The conference is free of charge and open to patients, families, loved ones, and professionals. For more information and to register please visit their website.

We have known for a long time that restrictive dieting leads to temporary weight loss and more often weight cycling. We sometimes forget the weight cycling itself can be more dangerous than a stable weight, even if this weight is “overweight.” The war on obesity has not worked because it is a war on our bodies. Most people with Binge Eating Disorder (BED) don’t even know they have it. According to a national survey, just 3% of adults who met the criteria in the prior twelve months were actually diagnosed. Instead of getting serious help for the serious condition they face, individuals with BED spend their lives in battle with their body, and are condoned by a society who as a whole are advised to “eat less and exercise more;” with doctors acting as the number one culprit of weight stigmatization. In fact, a dear friend of mine who suffers from BED was once told by her psychiatrist, “You are fat every day, so exercise every day.” Does this sound like an invitation toward health?

Will someone please tell me, why is health at every size so controversial? The following was gathered from the HAES website.

Health at Every Size (HAES) is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting healthy habits for the sake of health and well-being (rather than weight control.) Health at Every Size encourages:

Accepting and respecting the natural diversity of body sizes and shapes.

Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.

Finding the joy in moving one’s body and becoming more physically vital.

What is written above seems so simple, reasonable, and validating; but, over the years, in the field of eating disorders, I have noticed adopting this stance is actually controversial.

My daughter was reading an article about prisons in Norway. What is interesting is that they actually treat the prisoners well and provide them with opportunities to have constructive lives and meaningful social interactions. What happens to these prisoners? They start to feel good about themselves and become contributing members of society.

When we treat people well, it brings out the best in them. When we treat ourselves well, it brings out the best in us. A war on ourselves is not likely to bring out the best in ourselves.

It is not always easy to convince a person suffering from BED that the focus must be on self-love, self-acceptance, and mindfulness (as opposed to weight loss) because they have been indoctrinated with a “no pain, no gain” mentality.

Eric Fromm states any art requires concentration, knowledge, respect, and discipline. In this model, we move the focus away from weight loss and toward the art of loving oneself and the art of living. Discipline is not punative, but instead emphasizes the discipline of self-care and living mindfully.

What we find is that this artistic process of mindful living begins to take hold for our clients. It seems to me the ‘Art of Loving’ by Eric Fromm and the principals contained in the Health at Every Size model have a lot in common. HAES supports adopting health habits for the sake of health and well being. What is not to love about that?

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