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History of the Health At Every Size® Movement—The Early 1990s (Part 3)

by Barbara Altman Bruno, Ph.D., LCSW

In response to requests from our readers, the Health At Every Size Blog is honored to reprint Barbara Altman Bruno’s history of the HAES movement. Most of the installments of this history have been previously published in ASDAH member newsletters. This post is Part Three in a series.

The early 1990s looked bad for diet programs and products, and good for the developing anti-diet movement–a term possibly coined by Overcoming Overeating’s Carol Munter in response to a press query.

Canadian Donna Ciliska, responding to the recommendations by Susan and Wayne Wooley in “Should Obesity Be Treated at All?”1, created a psycho-educational, non-dieting program to heal weight-loss obsession in fat women. Her book, Beyond Dieting (New York: Brunner-Mazel) was published in 1990.

Jaclyn Packer’s dissertation, Barriers to Health Care Utilization: The Effect of the Medical Stigma of “Obesity” on Women, was accepted by the City University of New York Graduate Center in 1990.

Also in 1990, a small group including members of the Fat Underground, the Fat Feminist Caucus, and NAAFA, formed the Council on Size & Weight Discrimination (CSWD). Incorporated as a not-for-profit advocacy group in 1991, CSWD works with governmental and regulatory agencies, educates the public, and provides consumer advocacy for larger people, especially in the areas of medical treatment, job discrimination, and media images. Lynn McAfee, Director of Medical Advocacy for the Council, testified at the National Institutes of Health Consensus panel on Weight Loss Technology in 1992, resulting in recognition of the effects of weight discrimination in the USA.

Oprah Winfrey’s rapid 1988 weight loss on Optifast had soon been followed by her rapid, public regain. Representative Ron Wyden held hearings in Congress in 1990 about the diet industry, followed in 1993 by hearings of the Federal Trade Commission. Many of the largest diet companies were in trouble. Weight Watchers, Jenny Craig, Medifast, Optifast, and Ultrafast were charged by the Federal Trade Commission with deceptive advertising. Psychologist and eating disorders expert David Garner–whose experience with weight-loss experts led him to coin the term, “data-resistant researchers”–testified against the diet industry in Congress. He and Susan Wooley published “Confronting the failure of behavioral and dietary treatments for obesity” in Clinical Psychology Review in 1991.

Hundreds of people sued NutriSystem in 1991 for precipitating gall bladder damage through medically unsupervised, rapid weight loss. The New England Journal of Medicine published a major study of weight fluctuations in the Framingham Heart Study, which indicated that those who underwent high weight variability were 25 to 100 percent more likely to be victims of heart disease and premature death than people whose weight remained stable.

Health Canada sponsored the Vitality/Vitalité program from 1991 to 1995. The program was intended to convey to the public healthy lifestyle messages: eat well, be physically active, and feel good about yourself.

In 1991, Mary Evans Young, a consultant from the UK, decided to do something about the perils and futility of dieting after she read about a teenager who hanged herself, thinking she was too fat (at an American size 12) and saw a television program about three women who underwent stomach stapling. She declared the first International No Diet Day (INDD) in 1992 with a picnic with about a dozen women, plus media. By 1994, INDD “was observed in most major cities of the USA, all the Canadian provinces, New Zealand, Australia, Moscow, Ireland, and Europe, as well as in dozens of places throughout Britain2. It continues to be observed each year on May 6.

Psychologist and eating disorders specialist Joe McVoy organized a 1991 conference in Virginia called “Treating Obesity in the 90s: Realities and New Directions,” to seek a consensus about future treatment for obesity. Speakers included Susan Wooley, Janet Polivy, Joel Gurin, Ellyn Satter, Nancy Barron, Pauline Powers, and Walter Vandereycken. The consensus that developed was to replace dieting with healthy living. Members of this first gathering of practitioners named their organization AHELP (the Association for the Health Enrichment of Large People) and met through 1996.

NAAFA published the NAAFA Workbook and Study Guide (n.d.). Edited by Carrie Hemenway, who asserted that one could be both fat and healthy, it included (among others) chapters on health, fitness, self-esteem, employment, and activism. The second edition, Size Acceptance & Self-Acceptance (1995), edited by Executive Director Sally Smith, added to those topics chapters including self-acceptance, image, family relations, discrimination, diversity, and the size acceptance movement. NAAFA published educational brochures for fat people about eating disorders, for therapists and healthcare providers, for fat children, and about topics such as diets and airline travel.

In 1992, the National Institutes of Health (NIH) Technology Assessment Conference on Methods for Voluntary Weight Loss and Control declared that permanent weight loss is elusive for most dieters, and that weight loss may increase death rates. Researcher Jules Hirsch stated, “No statistically sound evidence was presented at the conference to indicate that commercial, nonmedical programs have any enduring efficacy…by two years and surely by five years, the majority of subjects beginning any weight loss program will have returned to their starting weight. Probably fewer than 5% of those beginning the program will lose the weight and maintain it for as long as five years.”[f1]

Canadian dietician Linda Omichinski created the non-diet HUGS program after listening to her dieting clients. Like her 1993 book, You Count, Calories Don’t (Winnipeg, Manitoba: TAMOS Books), her philosophy was based on a positive attitude and self-esteem, and led people away from dieting. Also in 1993, Terry Nicholetti Garrison published Fed Up! A Women’s Guide to Freedom from the Diet/Weight Prison.

The diet industry, having lost both credibility and business earlier in the decade, sought to recoup its losses by fighting back. In 1994, Shape Up America! (SUA) debuted at the White House, with former US Surgeon General C. Everett Koop as front man. SUA’s sponsors behind the scenes included Heinz/Weight Watchers, Jenny Craig, Ultra Slimfast, and NutriSystem, and diet drug maker Wyeth-Ayerst, and its staff were all associated with Heinz/Weight Watchers. Koop repeatedly used the highly inflammatory and inaccurate statement that 300,000 Americans died every year due to obesity, despite being warned that he was misrepresenting the JAMA study on which he based his claim3.

Published to the HAES Blog with permission from Barbara Altman Bruno. Copyright © 2017 Barbara Bruno. All rights reserved.

Readers can access previous and subsequent installments of this history here:
Part 1   Part 2  Part 4   Part 5   Part 6   Part 7


(1) In Eating and Its Disorders (1984), New York: Raven Press.
(2) Young, Mary Evans, Diet Breaking (1995). London: Hodder & Stoughton, p. 210.
(3) Bennett, J.T. & DiLorenzo, T.J. (2001). Public Health Profiteering. New Brunswick, NJ: Transaction Publishers, p. 67.


Barbara Altman Bruno, Ph.D., LCSW, is a clinical social worker,  size acceptance activist, and HAES pioneer.  She has presented at clinical conferences, appeared in television, radio, magazines, newspapers, and demonstrations, and has written many articles, including well-being columns for larger people, guidelines for therapists who treat fat clients, a brief history of HAES, and a book, Worth Your Weight (what you CAN do about a weight problem).  She is former co-chair of education for ASDAH and is on NAAFA’s Advisory Board.

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