What is Health at Every Size and Intuitive Eating?

Written by Illa Garcia, MS, RD, CEO December 2018

Edited by Vanessa Carriillo March 2023

I keep hearing about the concept of "Health at Every Size" (HAES) and intuitive eating, and it sounds great to me! The words themselves are comforting when I consider that all I’ve learned about nutrition is eating less, counting calories, and cutting out fat. But what exactly is HAES and intuitive eating? Can I use them as a future Registered Dietitian (RD) and in my daily life? I did some research to find out.

The National Eating Disorders Association acknowledges that well-being and healthy habits are more important than "any number on the scale." I agree that mental health is crucial in life. Does it matter if you make it to the gym every day if you're starving yourself to death? No. Having a healthy and happy relationship with yourself and food is paramount to anything else (especially eating). This thought is where HAES is born. Due to the enormous backlash of diet culture (eating less, looking thin, low carbs, vegan, etc.), more people are adopting nutrition habits that are unsustainable and unhealthy. Dieting can lead to food and body obsession, self-hatred, disordered eating, weight cycling, and poor health. The point of dieting seems to be more about appearance than actual health, which can trigger a snowball reaction to more and more unhealthy habits to be thin. This is where HAES comes in.

HAES is the idea that the size of your body is not a determinant for health, so just stop trying to lose weight. It’s a frame of mind for doctors and dietitians to stop encouraging weight loss and contributing to diet culture. Instead, focus on health. If someone has high blood pressure, treat that – don't just tell the patient to lose weight. HAES uses an "anti-diet" approach called intuitive eating.

Intuitive eating is listening to your body for hunger and fullness cues, not external cues like calorie or macronutrient tracking. Practitioners using intuitive eating counseling techniques will encourage their patient to accept their size, trust their own hunger and fullness cues, adopt healthy lifestyle habits (being social, finding joy in movement, finding nutritious food you enjoy), and embrace size diversity. A key to this approach is that the end goal is not to lose weight – it’s to restore the patient’s relationship with food and find a balance between healthy and unhealthy foods for a sustainable lifestyle. When the patient expresses they want to lose weight, explore where that thought is coming from. Do they want more energy? Do they want to feel better? Cutting out food groups through dieting does not result in this. But does the traditional dieting approach work for any group? Should we abandon it altogether?

I read a comprehensive literature review between body weight and health outcomes, and this is the gist: research suggests that there is a weak link between body weight and illness. The latest NHANES study suggests that those in the "overweight" category lived longer than any other group. Those in the "obese" category who already have an illness live longer than those in the normal weight range who have the same illnesses. The relationship between poverty and negative health outcomes is stronger than body weight and health outcomes. BMI and hypertension are correlated, but it's unclear if BMI causes hypertension (meaning that more people who are overweight have hypertension, but researchers don't know if being overweight actually causes hypertension).

So, here are my thoughts: Research has not been able to directly link overweight/obesity to causing illnesses. However, research does suggest that there is some relationship between being overweight/obese and illness. But what is that relationship? Do people who are overweight/obese have some sort of genetic predisposition to illness? Are they eating lower-quality food, sleeping less, exercising less, or surrounded by people who encourage unhealthy eating habits? Nobody knows for sure, but there is some relationship between being overweight/obese and illness.

To me, this means that there is room for Health at Every Size (HAES) and intuitive eating for some patients, but maybe not all. I do think that as a culture, we should stop pushing constant messages of weight loss since the research isn’t there to prove that weight loss is the real problem. This constant bombardment of messaging about “weight loss for health” causes people to focus on weight loss techniques instead of actually being healthy. It has created a culture where people would rather skip enjoying their grandma’s pie to be skinny than partake in an activity that could boost their mental health.

I believe that intuitive eating is a much better approach to overall health and being in tune with your body's hunger and fullness cues. However, I don’t think that this approach could work for everyone. For example, telling an impoverished, obese patient to just listen to their bodies about what to eat may not be effective. If they have no base for what a balanced lifestyle is, how will they know how to “listen” for it? Although research does not have any solid evidence for causation between body weight and increased illness, there is still some relationship of some sort. The possible outcome of worsened health isn’t worth playing around with intuitive eating.

In conclusion, I will try to be more careful about the messages I spread about weight loss “for all.” During community education events, I will make sure to focus on health, not weight loss. I will talk about hunger and fullness cues and encourage people to eat what they think is best for their bodies. I will encourage people to accept different body sizes. When people ask me for individual advice, I will make sure not to make it about weight loss. If they want advice for losing weight, I will explore why they want to lose weight and make sure they have health goals, not weight loss goals. For clinical practice, I will follow the guidelines of the hospital. I trust their rules and don’t know enough about the science behind illness to make up my own guidelines.

What will you do with this information? Do you have a different opinion? Let me know!