To our valued Health at Every Size® community:
Recently, the Academy of Nutrition and Dietetics (AND) completed a review of Health at Every Size® interventions as part of their Adult Weight Management Guideline that included many fatphobic and weight biased recommendations. One of the proposed recommendations is: 4.6 For adults with overweight or obesity, it is suggested that RDNs or international equivalents not use a Health at Every Size® or Non-Diet approach to improve BMI and other cardiometabolic outcomes or quality of life. (https://www.andeal.org/public-comment-guideline-review)
We want to start by acknowledging the trauma caused by and being reactivated by AND’s actions. We see the frustration of not only the continued violence of recommendations such as these against fat people, but the violence of attempting to discredit Health at Every Size®, which to many of us represents not only a safe(r) path to health and healthcare, but a community where fat people are celebrated.
The actions of AND are not surprising. Dietetics, the concept of health, and the system of healthcare were built on and continue to thrive on fatphobic, racist, ableist, eugenicist and violent beliefs. It is doubly upsetting that their proposal comes during Black History Month. A time when the racist roots of fatphobia should be centered, rather than further promoting ideas that most harm fat Black people.
White supremacy plays a key role in the development of guidelines such as these, as well as in our response to the recommendations. We see it in the way we value the written word, especially when it includes copious citations and rubrics and people with an alphabet of credentials behind their name. None of this makes their guideline the Truth. We see it in the binary thinking, that one must be right and the other must be wrong; that for their adult weight management guidelines to remain correct, they must tear down any ideas that say otherwise. We see it in the urgency to respond immediately. We see it in the white martyr and white savior responses both at AND and in our communities. We see it in the power hoarding because fat people were not at the table. Black, Indigenous, and other People of Color were underrepresented at the table. And the ASDAH and HAES® community was not at the table.
This underscores a reality of our work. While we work to make healthcare less harmful in the now, we ultimately cannot reform a system whose core and foundation is white supremacy.
The review conducted by the AND Adult Weight Management team was limited in many ways. The first and most important of which was conducting an analysis on HAES® as an intervention for Adult Weight Management. As many of you reading this likely already know, the Health at Every Size® principles reflect the research that weight does not need to be “managed”; that pursuit of weight loss is not effective in making fat people thin; nor is the minimal amount of weight lost by most who attempt to do so, sustainable over the long term (i.e. more than 2 years); that there are ways for fat people to improve their health if they choose that do not involve weight loss.
Of the five outcomes they analyzed that make up their recommendation, three of them are antithetical to Health at Every Size® principles (lower BMI, percent weight lost, and smaller waist circumference.) For the two other outcomes (blood pressure and quality of life), only two articles each were included to draw their conclusions. Interestingly, only studies specifically using the term ‘quality of life’ were included. Other studies which included similar measures but used terms like psychological distress were not included in the team’s analysis for quality of life.
Another major limitation of their analysis was that HAES® is a singular intervention, rather than an approach to health that reflects existing research, most of which does not explicitly name Health at Every Size®. Any intervention that improves health markers regardless of weight is part of the HAES® toolkit. The search was limited to papers naming HAES® (or “non-diet”) as their intervention, along with other inclusion criteria such as only including programs overseen by dietitians and only including studies that were limited to fat people.
The result of their search choices, including the mischaracterization of Health at Every Size®, led to the identification of seven total studies included in their review. Despite lacking sufficient evidence to make claims about HAES®, they decided to write a recommendation that HAES® interventions not be used, though none of the studies showed harm, and none of the reported health outcome measures worsened during HAES® interventions.
For example, one of the papers included was designed to measure heart rate recovery time. Their results showed significant improvements in this measure in the HAES® group compared to the control group. This paper was only used in the analysis for BMI as an outcome by the team. Other studies showed improvements in dietary quality, LDL cholesterol, and binge eating. These outcomes were not evaluated and these results were not considered in making the proposed guideline statement.
Events like these remind us why the community elected to trademark Health at Every Size® and HAES®, and why the community chose to have a community-led organization hold the trademark. White supremacy and fatphobia will continue to rise up to discredit our work. HAES® was not created by any one individual and continues to evolve with our community. Likewise, we collectively protect it against efforts like this, by banding together, by remembering that their attempts cannot take away what we have built, as trauma-inducing and violent as they are.
We at ASDAH are proud that the organization has come so far to be able to respond quickly and thoughtfully to events such as these; and we’re even more proud to return to our work of building a new world with liberation for all at the center.