President’s Column: Social Justice and Health at Every Size®

Lauren Muhlheim, Psy.D.

Continued...

The task of writing an article that will appear in three months and still feel current seems daunting at this point in time.

So, I’ve decided to return to my presidential theme which I introduced in the last column: All bodies, all voices. In this column, I will talk more about weight stigma in psychotherapy and introduce Health at Every Size®—an alternative health framework that respects size diversity and advances social justice.

Anti-fat bias is deeply entrenched in our society—we are all socialized to prefer thinness and fear fatness. But bodies are diverse and there have always been fat people. Body weight is primarily genetically determined, just like height (Stunkard, 1986). Evidence indicates that the vast majority of dieters do not maintain any significant weight loss beyond the short-term (Anderson et al, 2001; Mann et al. (2007); Quinn et al. (2020); and Fildes et al. (2015)). Having a conventionally thin body can be viewed as a privilege much like being born with white skin or wealth. Research shows that the second most common place to experience weight stigma is in health care settings (Puhl and Brownell, 2006).

Research and patients in larger bodies tell us that weight bias commonly shows up in the therapy room. It shows up when therapists make assumptions about a patient’s weight based on their body size, attribute higher weight to a history of trauma, and promise that resolution of trauma will result in weight loss, promote weight loss in a person in a larger body, or fail to invest in furniture and office design that can accommodate people in larger bodies (Kinavey and Cool, 2019).

Our ethics code guides us to take precautions to manage our biases and to respect differences (APA Ethics Principle D: Justice and Principle E: Respect for People’s Rights and Dignity). It is our job to be aware of our internal biases in the therapy room and this includes our own internalized weight stigma. One way to recognize and manage our weight stigma and to prevent further marginalization of people in larger bodies is to learn about Health at Every Size® (HAES®).

Health at Every Size® is an approach to health that shifts the focus from weight to health. It is a new philosophy that has emerged primarily since the late 1990s. It is promoted by the Association for Size Diversity and Health (ASDAH), which owns the phrase as a registered trademark. The primary goal of HAES® is to promote healthy behaviors for people of all sizes. HAES® is grounded in five principles:

• Weight Inclusivity: acceptance that bodies naturally come in a variety of shapes and sizes, and no size of body is inherently better than any other size of body.

• Health Enhancement: the focus on improving health more broadly and attendance to additional disparities that contribute to health including economic, social, spiritual, emotional, and physical factors.

Respectful Care: acknowledgment of weight bias and weightbased discrimination, and the commitment to work towards its end. This involves the adoption of an intersectional lens to understand different identities such as race, body size, gender, sexual identity, etc.

Eating for Well-Being: flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure—not external eating guidelines focused on weight control.

Life-Enhancing Movement: encouragement of enjoyable physical activities for people in a range of bodies with a range of abilities, to the extent that they wish to participate. No one should be shamed if they choose not to participate.

The shift to a weight neutral paradigm can be challenging when we have been taught something else our entire lives. But we all have biases and becoming aware of them is the first step. Weight stigma causes harm—including shame, eating disorders, weight cycling, and increased risk of heart disease and stroke (Tomiyama et al., Wu and Barry, 2018)—which is why this work is so important. I am so excited to share this message so we can work toward a world where people in all bodies feel safe.

I am also excited to announce that the keynote speaker at the LACPA 2022 Convention will be Thema Bryant Davis, Ph.D., the current APA president-elect. The theme will be Rebuilding Community Through Collective Healing. More details are available in a separate article in this issue.

 

 References:

Anderson, J. W., Konz, E. C., Frederich, R. C., & Wood, C. L. (2001). Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr, 74(5), 579-584.

Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015 Sep;105(9):e54-59.

Hilary Kinavey & Carmen Cool (2019) The Broken Lens: How Anti-Fat Bias in Psychotherapy is Harming Our Clients and What To Do About It, Women & Therapy, 42:1-2, 116-130, DOI: 10.1080/02703149.2018.1524070 

Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol, 62(3), 220-233.

Puhl, R.M. and Brownell, K.D. (2006), Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults. Obesity, 14: 1802-1815. https://doi.org/10.1038/oby.2006.208

Quinn, D. M., Puhl, R. M., & Reinka, M. A. (2020). Trying again (and again): weight cycling and depressive symptoms in U.S. adults. PLoS One, 15(9), e0239004. 

Stunkard AJ, Foch TT, Hrubec Z. A Twin Study of Human Obesity. JAMA. 1986;256(1):51–54. doi:10.1001/jama.1986.03380010055024

Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. A. (2018). How and why weight stigma drives the obesity 'epidemic' and harms health. BMC Medicine, 16, 123.

Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018 May;74(5):1030-1042. doi: 10.1111/jan.13511. Epub 2017 Dec 8. PMID: 29171076.