by Dana Schuster, MS
In my role as a HAES advocate in the Health and Fitness realm and as an active volunteer with ASDAH, I often find myself trying to “bridge” with professionals and advocates from related disciplines. As I attempt to look for both common ground and be cognizant of points of divergence, I have become aware of an all too common, and seemingly “blind” entrenchment in weight-based thinking on the part of health colleagues. The way in which many health professionals talk about their work leads me to believe that they give no more thought to questioning the wisdom or efficacy of using body size, weight, or BMI as a baseline determinant for health, than they give to questioning the importance of breathing.
This realization again came to me in a powerful way recently, when I attended portions of the Association of Professionals Treating Eating Disorders (APTED) conference (I was there to staff the ASDAH exhibit booth). I became acutely aware of the degree to which weight seems to be embedded as a primary goal of many “successful” interventions for eating disorder (ED) professionals and treatment facilities. In reflection, I realized that up to that point in time all of my contacts with experts in the ED world had been with those who were already members of HAES communities.
Yes, my HAES comrades from the ED realm had talked about their own frustrations with the “disconnect” they saw in their colleagues’ views of ED clients relative to their expressed views of “fat” people. But until I sat in these ED workshops and listened to the conversation among these mostly non-HAES professionals, the degree to which weight-based outcomes seem to govern both ED thinking and practice had not quite hit home.
Some of the people I listened to and met probably do not even have an inkling that there might be an alternative approach to consider, let alone know the specifics of how they could actually work from a weight-neutral perspective. The idea that their weight-based thinking might be harmful in a broader context has probably never entered their minds. And, since they work in a field that apparently sets criteria for illness and recovery largely based on the “percentage of ideal body weight” that a client achieves (a reference I heard repeatedly), I found myself working hard to discover a point of reference where one might “connect” to talk about HAES principles.
I sincerely hope that readers who do work in the ED world from a HAES perspective will speak up with your comments and ideas about walking this tightrope. From my lay perspective, I tried to jot down some possible connection points I heard from the conference presenters that just might be worth exploring further in pursuing the compatibility of a HAES approach. I fully acknowledge that my ideas may arise from a place of ignorance and lack of experience, or may have already been attempted by others. Of course, my eagerness to find potential bridges might also simply arise from my general tendency to look for the positive in everything.
That said, here are the ED strategies I heard presented that might provide common ground for HAES proponents to build on:
- “Strengthening the healthy self”
- Encouraging individuals to “feel your feelings but challenge your thoughts”
- Focusing on the “toxic environment vs. changing the canary”
- Facilitating an individual to “reach out to people, not to his/her eating disorder”
- Maintaining an “agnostic view of cause” (no blame)
- Supporting the goal of putting “adolescent development back on track”
While I am not the person to bring expertise to exploring these points in significant detail, I will take the liberty of sharing a few of my additional thoughts on a couple of the aforementioned points.
It is clear that our culture generally asserts that a “healthy” state of being is inherently tied to a specific weight range, but I heard something a little different in this statement as presented in the ED workshops. It seemed that their concept of a “healthy self” was a broader and wiser notion – one that was about the positive and nurturing part of every person that knows s/he is a worthwhile individual who deserves to be taken care of. Is this not exactly the same concept that allows us to adopt HAES practices in our weight-obsessed world?
There is no doubt that the HAES model also encourages people to “challenge their thoughts” in much the same categories that the ED world seems to: food, restriction and dieting; body image and the glorification of thinness; perfectionism; self-esteem and nurturing. While the nuances and boundaries that each perspective presents may be different and need explorative discussion, it seems that the basic categories of concern do provide common ground that we share, and hence create a platform on which we might build together.
Lastly, I imagine most would agree that the toxicity of our environment around food, eating, and body image is likely to be a major point of commonality. Again, the specifics may well be somewhat divergent, but if the HAES and ED communities made a concerted effort to come together to brainstorm how we can together challenge our current poisonous culture, both groups could end up moving forward in a way that supported our mutual goals.
I look forward to an ongoing exploration of this topic with all of you who are willing to share your insights, ideas, and concerns. Perhaps we will find this discussion will lead us closer to a way of building bridges so that we might maximize our ability to successfully and broadly infuse HAES thinking into a wide range of health disciplines.
(1) Dr, Deb Burgard, The War on Obesity: The Eating Disorders Community at a Crossroads (Presentation at Eating Disorder Recovery Support, Inc. Conference 2012).
(2) Dr. Deah Schwartz, Some thoughts about Health At Every Size (HAES) (blog post)
(3) Dianne Neumark-Sztainer et al., Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents (American Journal of Preventative Medicine article)