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Dietitian Dish: Health at Every Size (August 2021)

Hey Mountaineers!

I can’t believe we are back in session! I have really enjoyed seeing more familiar (and new) faces around campus this past week. The buzz of moving into a new space, starting a new job or getting back into a learning environment fills me with anticipation for a great semester to come. In case you are new (or someone that just needs a refresher), I wanted to give a quick shoutout to some wonderful resources we offer on campus.

  • If you are interested in receiving nutrition-related counseling, complete the contact form and I’ll reach out to you.

  • If you or someone you know needs psychological and counseling services, contact the Carruth Center.

  • If you are interested in meeting new people, trying a new activity or participating in health activities, check out our Refresh program and other student activities.

Now, without further ado, I’d like to introduce our topic for this month! I’d like to discuss the concept of HAES. This acronym stands for Health at Every Size. Maybe you’ve heard of it, or maybe this is your first time, but if you Google 2021 health trends, HAES will be somewhere in the conversation.

Health at Every Size (HAES) is a health-centric and social justice approach to improving size acceptance and multidimensional health through eating and movement related to well-being (Association of Size Diversity and Health, 2021). One goal related to HAES is to untangle weight from health. The big question is, can someone pursue health without pursuing weight loss? And the answer to this (within the HAES approach) is an unequivocal yes! To explain why, let’s look at the five basic principles of HAES.

Principle 1: Weight Inclusivity

This principle separates weight from health by rejecting the “idealizing and pathologizing of specific weights” (Association of Size Diversity and Health, 2021). Put simply, weight does not equal health. Currently, most healthcare practices use a weight-normative approach, meaning that there is an assumption that weight is directly correlated with disease or poor health. However, countless publications do not support this approach, because the highest risk for mortality is connected to individuals with a BMI of less than 18.5 which would be considered underweight. Isn’t that ironic, considering “being thin” is coveted in today’s society? (Tylka, et al, 2014).

So, is there an alternative to this weight normative approach? You bet! We call it the weight-inclusive approach. This approach supports the evidenced-based assumption that every person (with access to sufficient safe and nutritious food) can receive unbiased healthcare and attain mental, physical and emotional well-being, independent of weight (Tylka, et al, 2014). Basically, this approach is challenging the idea that body mass index (BMI) is a good indicator of health. Fun fact: BMI was created in the 1800’s by an astronomer and was never intended to be an individual assessment of health.

A 2021 study done by Matheson, King and Everett found that healthy lifestyle habits were “associated with a significant decrease in mortality regardless of baseline BMI” (Matheson, King & Everett, 2012). These researchers wanted to define healthy lifestyle habits and morbidity risk in a large population base. The definition of healthy habits within this study was: five or more fruits and vegetables consumed daily, exercising regularly, consuming alcohol in moderation and not smoking. What was the conclusion? When you implement health behaviors, your health improves (regardless of BMI)!

Principe 2: Health Enhancement

This principle includes strategies for all individuals, including those who are marginalized due to gender, race, class, ability, body size, etc. to practice self-compassion and self-care through information and services that improve well-being (Tylka, Piran, LaMarre, & Daníelsdóttir, 2019-03). Access to services and care that promote all individuals’ physical, emotional, mental, economic, social and spiritual health though equalizing access is key (Association of Size Diversity and Health, 2021).

Unfortunately, not everyone has access to grocery stores that offer healthful foods, or are close to home, nor do they have the time or financial resources to purchase and prepare these items, as well as access to affordable healthcare. When we consider health enhancement for all within the HAES framework, supporting health policies that “improve and equalize access to information and services” is an essential consideration (Association of Size Diversity and Health, 2021).

Principle 3: Respectful Care

The HAES principle of respectful care focuses on ending weight discrimination, stigma and bias. Weight stigmatization is both a social injustice and public health issue that negatively impacts disproportionately, individuals in larger bodies. The negative impact of weight stigmatization includes increased cortisol levels (increases heart rate and blood pressure), oxidative stress levels (inflammation), eating disturbances, depression and anxiety, C- reactive protein levels (inflammation), diabetes risk, body image dissatisfaction and lower self-esteem (Wu & Berry, 2017; Tomiyama et al, 2018).

Drake and Ogletree added to this list of negative consequences related to weight bias which include increased risk for disordered eating, body dissatisfaction, fewer education or employment opportunities, lower pay, lower quality of healthcare, increased stress, and decreased quality of life (Drake, & Ogletree, 2018). Wow, right!? Because of this, acknowledging our biases, as well as ending weight discrimination, can increase the respectful care people receive, especially for those that are impacted by weight stigma (Association of Size Diversity and Health, 2021).

Principle 4: Eating for Wellbeing

Since we’ve covered the principle of eating for wellbeing in the June issue, we won’t go into too many particulars. But essentially, by eating intuitively and “promoting flexible, individualized eating based on hunger, satiety, nutritional needs and pleasure, rather than any externally regulated eating plan,” individuals can focus on wellbeing and health, rather than weight control (Association of Size Diversity and Health, 2021). Following the intuitive eating principles can promote eating for one’s wellbeing versus using food to manipulate body size and weight.

Principle 5: Life Enhancing Movement

Did you know that the phrase physical activity has a different meaning compared to exercise? Physical activity is any movement of skeletal muscles that requires energy. Another word for this is “movement”. Exercise, on the other hand, is considered planned, repetitive and intended to improve physical fitness with the typical inference of manipulating body weight. So, what’s the bottom line? Joyful movement encourages us to partake in pleasurable activities which ultimately leads to sustainable health outcomes. What joyful movements do you like to partake in? Dance parties in the kitchen? Taking a walk in nature or playing soccer with friends? No matter what you enjoy, joyful movement is just that…something you enjoy doing!

Well, there you have it folks! Our first week of school is underway, and while I am sure it is filled with getting used to new classes, catching up with friends and so much more, I hope you find some yummy foods and joyful movement in your day. Until next time!


  1. Association of Size Diversity and Health. (2021). HAES principles.
  2. Drake, T., & Ogletree, R. J. (2018). Development of the health and weight attitudes scale. Journal of Nutrition Education and Behavior, 50(5), 506–510.
  3. Matheson, E.M., King, D.E., & Everett, C.J. (2012). Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med, 25(1):9-15.
  4. Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity, 983495.
  5. Tomiyama et al. (2018). How & why weight stigma… harms health. BMC Medicine, 16:123.
  6. Tylka, T., Piran, N., LaMarre, A., & Daníelsdóttir, S. (2019-03). Health at Every Size: A Social Justice–Informed Approach to Positive Embodiment. In Handbook of Positive Body Image and Embodiment: Constructs, Protective Factors, and Interventions. New York, NY: Oxford University Press.
  7. Wu & Berry (2017). Impact of weight stigma on physiological & psychological health outcomes… A systematic review. J Adv Nurs. 1-13.