“So what’s your approach?” This is a question I get asked frequently as a nutrition therapist. I always give a brief overview – I pull from many different frameworks and modalities to provide individualized care. This blog series will serve as a much lengthier version of my answer to this question. I’ll take a look at each of the nutrition concepts and counseling modalities I subscribe to, starting with Health At Every Size (HAES). HAES is actually more of a movement, a paradigm shift, and a way of thinking about healthcare that has served as a foundation for my work, which is why I’m starting here.
My introduction to HAES (took way too long)
Like many other dietitians, when I graduated from my dietetic internship I had never heard of HAES. I was trained under traditional dietetic principles, which were grounded in a weight focused health care paradigm. The focus was on how to change people’s body size to make them healthier – a message that we are all familiar with thanks to the diet culture we live in.
Then, like many dietitians, I started seeing clients for nutrition counseling, and began to get a sense of how damaging weight loss messages can be. Many of my clients were eating very little and felt frustrated that they continued to gain weight. Some felt like they couldn’t have the foods they loved for fear they would eat too much. Many clients were switching from one diet to the next and experiencing weight cycling, usually ending up at a higher weight than when they started. The list went on. Two things most of my clients had in common were 1) they were trying to change their body size but couldn’t, and 2) they were experiencing some level of disordered eating.
No surprise that my training had done little to help me come alongside these clients. Fortunately, during this time, I came across HAES principles and immersed myself in it, eventually choosing to go back to school to study disordered eating. I wish it hadn’t taken over five years of studying nutrition for me to discover it! I know I speak for many dietitians when I say that the discovery of HAES has completely transformed my nutrition counseling practice and is the reason I am still a dietitian.
HAES Principles
HAES is a weight neutral approach that has come about due to considerable concerns and evidence that a traditional weight focused approach is not only ineffective, but harmful. If you’d like to take a look at the growing body of evidence supporting HAES, check out this paper as well this post on some of my favorite HAES studies. I can also recommend Bacon and Aphramor’s book Body Respect for a deeper look into the science behind weight and the HAES approach – including great insights on the social determinants of health.
The main thrust of HAES is to support people of all shapes and sizes in having peace with their bodies and moving toward compassionate self-care. HAES is grounded in respect – for our own selves, others, and for body diversity. HAES also has a key emphasis on bringing critical awareness to people’s own body knowledge and lived experience, while challenging scientific and cultural assumptions. (Bacon & Aphramor, 2014).
HAES In Practice
HAES shifts the focus from weight onto behavior change. In my practice, what that means is that instead of looking at weight loss as a measure of health, we focus directly on adopting positive behavior changes. Instead of diets, counting calories, or weight checks, we do the important work of body acceptance, rediscovering how to eat intuitively, and building the skills needed to move toward a healthy relationship with food and movement. As a nutrition counselor I come alongside my clients – the experts on their body – and support them in taking care of their nutrition and self-care needs in a compassionate way.
Approaching health from a HAES perspective can be a really big shift in thinking – it was for me too! I find it necessary to discuss these concepts early on and to come back to them often, as it can take time to explore questions and grapple with the information. Feelings of anger and frustration may come up when considering the reality of weight stigma and the damage of diet culture. At the same time, talking about health from a HAES perspective can feel so obvious, and like such a relief. Having these important discussions about a weight neutral approach lays the groundwork for disordered eating treatment.
