Valentine’s Day has just passed us by and February is American Heart Month.  So it should come as no surprise that this blog post is going to talk about the Health at Every Size® approach to a healthy and happy heart. 

Many of us have had our poor hearts broken by medical professionals who have railed on us to lose weight for the sake of our cardiac health.  Fat and heart disease are associated–meaning that people who are fat may be somewhat more likely to experience heart disease.  But does this mean being fat causes heart disease?  Can you effectively prevent heart disease and maintain a healthy ticker using a Health At Every Size Approach?

There is a lot of new evidence indicating that healthy behaviors have a far greater impact on heart health than weight.  In fact a significant study recently published in Circulation magazine (The Journal of the American Heart Association) indicated that healthy behavior—specifically exercise had a far greater impact on heart health and mortality from heart disease than body size.  This was not a small or isolated study.  It followed over 14,000 subjects for over 11 years.  But the outcome was clear—fitness trumps fatness in terms of longevity and heart health.

So, there are a variety of Health At Every Size® behaviors that we can adopt to keep our tickers in tip top shape.  Here are five good ones to get you started: 

1. Exercise Joyfully: As indicated by the study referenced above, fitness is one of the most important factors in maintaining heart health.  You don’t need to be a marathoner or a professional athlete.  We’re looking for a total of 150 minutes per week or 30 minutes on most days of the week.  Even as little as 75 minutes per week can have a positive impact on heart health.  It doesn’t need to happen all at once, it doesn’t need to be hard core and it doesn’t need to happen at a gym.  Work in the garden.  Walk the dog.  Park a little further away from your favorite outlet mall.  Find pleasurable and manageable ways to work fitness into your life.
2. Manage your Mood: Some studies indicate that your emotional outlook on life can significantly impact your cardiac health.  People with Type-A personalities, depression and unexpressed anger seem to be more prone to heart problems than those with a happy-go-lucky approach.  Luckily there are positive steps you can take to cope with that stress.  One step is mentioned above.  Exercise enhances mood and helps cope with both depression and anger.  Other techniques include relaxation techniques like breathing exercises and meditation.   And if you’re having difficulty managing stress, anger or depression your own, seek the services of a qualified mental health professional.
3. Care for your Teeth:  There is a lot of recent evidence linking dental health with heart health.  Gum disease can lead directly to heart disease, infecting the inner lining of the heart (endocarditis).  Some research also suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation.  So do like your mom told you—brush, floss and see your dentist regularly.
4. Know your Numbers:  It’s important to be aware of your key cardiac indicators including your cholesterol and blood pressure levels.  That means seeing your doctor regularly.  And since you’re seeing that doctor regularly, it’s smart to pick one that doesn’t raise your blood pressure through the roof.  White coat hypertension is a well documented phenomenon which causes some people to exhibit significantly elevated blood pressure in their doctor’s office.  So try to pick a doctor you can respect, who respects you and with whom you can communicate effectively.
5. Eat Colorfully Close to Nature:  I’m not suggesting the dreaded “D-word” here, (You know, the one that starts with “die” and ends in agony and frustration.)  But there is a lot to be said for eating a variety of delicious foods, from both land and sea, that are close to a natural state.  Heavily processed foods tend to be very high in sodium and other chemicals.  For some (but not all) people, high sodium levels lead to higher blood pressure.  Fruits, vegetables, whole grains and seafood can help maintain a healthy heart and can also be quite delicious.  So make your heart happy while you pump up the variety in your diet with a colorful plate of fabulous foods.

 A downloadable version of this Health At Every Size Tips for a Healthy Heart is available here.

Remember me?” Beth asked following my presentation at a community-based hospital.  “Of course I do!” I responded.  Beth had been in my Diet Survivors group about 7 years ago, and had come a long way in breaking the diet mentality and developing a healthy relationship with food.  In fact, I was surprised to see her at this event, since the purpose was to introduce participants to a non-diet, Health At Every Size® approach, with the option to pursue an eight-week program.

 Beth explained that she had loved my group, and had felt much calmer in her relationship with food at the time that she left. But, she told me, she “just couldn’t handle” the acceptance part of the HAES^SM approach.  In the years that had intervened, she went back to Weight Watchers, losing lots of weight, and then, inevitably, gaining it back.

It made me sad to hear Beth’s story.  I don’t have illusions that I can help move everyone from the culturally induced body hatred to a feeling of being at home in their body, but I couldn’t stop thinking about the amount of energy wasted by this talented, smart and kind woman as she continued the yo-yo diet cycle. 

There’s a term in the field of psychology called disavowal, which means that you know something – but at the same time, you don’t let yourself know that you know it!  In other words, you disavow the thing that’s too hard to consciously acknowledge. When it comes to the failure of diets, disavowal occurs not only for individuals, but at the cultural level as well.  Think about how many times we hear a report that diets don’t work, “but it’s still good to keep trying,” or a finding that people can be healthy in higher BMI ranges, “but it’s still probably a good idea to lose some weight.”  These cultural messages to lose weight despite the lack of evidence for efficacy seep into the individual’s psyche, making it all the more difficult for people like Beth to move toward acceptance.

In coining the phrase diet survivor, my co-author (and sister!) Ellen Frankel and I hoped to encourage people to come out and openly declare that they’re done with dieting.  But, we also recognize that people go through a process of loss and grief as they let go of all of the fantasies associated with dieting and weight loss.  Here is a summary of how we describe that journey in The Diet Survivor’s Handbook:

Denial

You may find yourself questioning whether you must truly give up on the idea that diets can make you permanently thinner.  After all, research shows that diets fail in the long term about 95 – 98% of the time.  That still leaves a tiny percentage of people who have lost weight without regaining it back.  You might imagine that you can become one of those people, even though experience says otherwise.  Dieting is seductive, and you may be in denial about the inherent failure of diets.  You may need to engage in another cycle of dieting before being convinced that this is true for you.

 Anger

You may lament, “Why me?”  You may turn your anger against yourself by berating your body, or you may direct your anger at others.  It may seem unfair that some people are naturally thin no matter what they do, while you’ve tried so hard to achieve that body size.  As you come to understand the physiology of dieting and body size, you may also become angry when others continue to judge you based on size.

 Bargaining

Even though the concepts related to diet failure make sense, you have a wish to diet one more time to lose weight before incorporating principles of attuned eating and acceptance.  Your attitude is, “Let me just lose weight first, and then I’ll quit dieting.”

 Depression

You’re being asked to live your life without the goal of weight loss when, up until now, your life was focused and organized around this premise.  The sadness of shifting beliefs about the merits of dieting and the requisite of thinness is a difficult challenge.  You may feel that you’re being asked to give up on yourself when, in fact, the opposite is true.  You have the opportunity to live an authentic life based on principles that contribute to physiological, psychological and spiritual well-being.

 Acceptance

This is the point where you accept the inherent failure of diets and no longer choose to diet in an effort to become thinner.  At this stage, you understand that dieting wreaks havoc on your ability to find your natural weight.  You see the cost of dieting in both physical and emotional terms, and you’re no longer willing to pay the price.  You’re committed to taking care of yourself the best way you can and allowing your weight to settle in its natural range as a function of attuned eating and engaging in physical activity that suits both your body and your lifestyle.

Last night I met with Karyn, a client that I’ve been working with for about six months.  Even as she’s come a long way in breaking the diet mentality and becoming an attuned eater, she’s been struggling with her body image.  “Something came to me this week,” Karyn announced with a smile.  “I’ve been reading more books and googling for Health At Every Size information.  I really get that I need to just accept my body as it is and stop focusing on trying to change my weight.  When I can do that first, my eating will really fall into place.” 

I still get tingles when my clients have their “aha” moments, and I hope that Karyn will be able to sustain the feeling she had in my office.  It’s clear to me that the HAES culture makes a transformational difference in people’s lives as it permeates the larger culture. I don’t know whose website she went to, or which blog she read, but I do know that our collective voices and activism, whether it’s in public forums or private conversations, is significantly breaking through the cultural disavowal of diet failure.  Perhaps if Beth were in my group now, she would find that burgeoning support for the Health At Every Size approach in the greater culture would help her to finally feel comfortable in her own skin.  I like to think so.

Lately the Strong4Life campaign in Georgia has received a lot of publicity and a LOT of pushback.  For those of you who aren’t familiar, this is a group of ads that depict fat children in black and white photography and seeks to convey how miserable it is to be a fat child.  They claim that this is a “wake up call” for parents who apparently don’t know that their kids are fat and have somehow missed the message in our culture that being fat is a “bad” thing.  They insist their goal is not to make kids feel bad (even though the images look like shots of hardened criminals).  But it’s hard to imagine that chubby children encounter these ads via magazines, the web, television and even giant billboards and feel GOOD about themselves.

 But ASDAHonians should take heart.  This week I’ve interviewed two amazing women who are involved in specific pieces of activism aimed at counteracting the negative effects of this ad campaign.  Both of these activities are extremely easy to join and both have used new technology and social media to create a groundswell of publicity around and support for the Health At Every Size® approach to health.

 ASDAH Member Marilyn Wann has initiated an amazing campaign called “I STAND against weight bullying.”  In this campaign, Marilyn has created a design template that imitates the Strong4Life ads and invites people to submit pictures of themselves and positive statements to represent themselves.  Marilyn’s amazing design team takes the photos, cuts out the images of the people and puts them as well as the positive statements into the I STAND design template.  These photos are then shared via facebook, twitter, tumblr, flickr, and other social networking tools. You can see some of the images submitted by your very own ASDAH leadership team here in this blog post.  So far well over 200 images have been created.  I caught up with Marilyn in the midst of this extremely popular project and she agreed to an interview:

What gave you the idea for this project?

I’ve been aware of these awful billboards since they went up last year.  I always thought they were a hateful blight on the Georgia landscape very much like the 1-800-GET-THIN billboards are a blight on the California landscape.  I tend to think visually and so I was aware of how much damage these negative images can do.  But I started to wonder about how I could take the negative charge of their images and turn it into a positive charge for people of all sizes.  What if we could create and share positive images of people of all sizes who are comfortable and happy in their bodies?  How powerful would that be?

 How did the project start?

The project started with a single STANDard.  (I call these images STANDards.)  I just wanted to create one of me with a powerful image and statement.  I had a friend snap a few quick cell phone pictures of myself, and then Nicole Peirce helped me create an image that looked very similar to the Strong4Life versions.  But the image had large red letters on it.  Those letters made me feel tense.  I realized that the color red usually implies warning or danger or fear.  This is the opposite of the feelings I was hoping to convey.  So we changed the red to hot pink, which to me symbolize health and happiness and joy.  Once we did that, we realized that we had a very powerful image and we posted it.

 So then you invited others to join you?

Yes!  The moment I posted the picture, I realized it was something other people could do too!  Almost immediately people started asking if they could submit images too.  So we just developed it as a “meme dream” and put out invitations.  And I want to say something about those invitations.  They are open to EVERYBODY.  I have had people email or call and say they want to do an image, but they have a health issue or they are in a wheel chair or they have some other reservation.  This is an open invitation.  If you have a picture and something positive to say, you’re welcome.  And the images have just been pouring in!

 Why do you think this has been so popular?

There are plenty of us that are good and angry.  But we want to express our anger while doing something good.  This effort unites people in our movement.  It’s hard to feel powerful when you feel like you are completely alone.  But when you see hundreds of images of people of all sizes standing up and saying, “hey I love myself and I love my body and my life rocks!” well, how powerful is that?  We take the finger pointing and finger wagging and blaming of Strong4Life and turn it on its head. Instead of spreading fear and prejudice, we stand AGAINST bullying and FOR joy and life and health.

 How do you think the “I STAND against weight bullying campaign” represents the Health At Every Size® approach to wellness?

I think this represents the HAES^SM model mostly in terms of its positive approach.  It takes the approach of the pleasure principle as opposed to the punishment principle.  It’s the difference between motivation and eagerness.  When we are asked to do something we may not really like (which for me might be to go to the gym and get on an exercise bike) then we have to be continually motivated.  But when we do something healthful we like (which for me is going for a fabulous bike ride outside) we feel a sense of eagerness.  When it comes down to it, people are eager to like their own bodies.  They are eager to engage in pleasurable activities.  They are eager to eat delicious and sustaining foods.  A HAES approach is about connecting with this eagerness.  These images from dozens and hundreds of people are coming from their own hearts and express the eagerness experienced in a Health At Every Size life. People end up avoiding exercise or nutrition when those goals are motivated by shame. Enjoying eating well and exercising can come from loving one’s body and not hoping to change one’s body–core values, I imagine, of these photos and of the HAES principles.

 ASDAH Member, Blogger and Fat Activist Ragen Chastain has worked with several other members of the size acceptance community to create a campaign to raise money for billboards that feature a size-positive response to the Strong4Life ads.  She spearheaded the Support All Kids Billboard Project and kicked off the fund raising last week.  Since last week’s launch, she has raised over $12,000 for size-positive billboards in Georgia.  She only needs about 250 more donors to make a contribution (at any size) to unlock a $5,000 matching grant from More of Me to Love.  You can help by making a donation.  I caught up with Ragen this past weekend and she graciously agreed to an interview.

How did you come up with the idea for the billboard campaign?

I had been thinking for a while about how powerful it would be to have positive images of fat people on billboards as a way to give people of size a chance to see ourselves positively represented in the media.  I talked about my frustration about Strong4Life on my blog and someone from wellroundedmama.blogspot.com left a comment saying that she wished we had enough money for our own billboards.  I felt that this would be an amazing response to the Strong4Life campaign.  The next day did a poll of my blog readers and people were excited about it.  The only negative comment I got was that I shouldn’t bother because there was no way we could raise the money (which the commenter estimated to be $3,000).  I felt like our community was ready to do something big, and I didn’t want to be held back by the notion that we shouldn’t try something big because it’s difficult or because we might fail.

Who else is working on it with you?

This has been a massive team effort.  Marilyn Wann  from Fat!So?, Shannon Russell  of Fierce Freethinking Fatties, and Rachel Adams who did our web design were absolutely instrumental in this effort.  Jay Solomon  (ASDAH member) and the folks from More of Me to Love  also extremely generous in offering a $5,000 matching donation that was half of what we needed to raise to put our billboard up, as well as getting the word out.

Why is this important to you?

They are kids.  They are kids and they are being shamed and stigmatized by an organization that purports to care about their health.  All the while that organization is taking hundreds of thousands of dollars in donations from corporations of which they claim to be critical (Pepsi, Coke, Golden Corral etc.).  They are kids standing on the front lines while adults humiliate them and call it healthcare, and we need to get their backs.

What has surprised you the most about the campaign so far?

I was most surprised at the speed of the response.  I believed we would hit our goal of raising $5,000 in the first day but I thought that it might be a mad dash at the end of the 24 hour Big Fat Money Bomb.  Then, as I prepared to get everything posted at midnight people were e-mailing me asking for the link so that they could donate. Once we launched it the support literally poured in – we raised $1565 in the first hour, when I went to bed (at 4am!) we were at $3,290.  By the end of the 24 hours we were just over $12,000.

 If you had your dream come true, what would the outcome of this campaign be?

If my dream came true every kid who has ever been bullied or made to feel less than because of their weight would find this campaign and realize that they are worthy and valued and deserving of respect in the body they have now.  Their new understanding would be supported when First Lady Michelle Obama stood at a microphone and said “I had the best of intentions when I focused on the weight of kids as a way to improve their health, but I now know that was a mistake, I was wrong and I’m sorry to all of the kids who were hurt when I confused their weight with their health.  We are going to support developing healthy habits and high self-esteem in kids of all sizes using a Health At Every Size® approach. This is Dr. Linda Bacon, she’ll explain the research and talk about our new campaign…”

 What one thing do you most want people to know about this campaign?

Right now I want people to know that we have raised enough money to put up our billboard and we are now raising what we need for other media including bus shelter signs, smaller billboard in downtown Atlanta etc. following the model created by Strong4Life to make sure that we get this message out.  The More of Me to Love Matching grant is a challenge grant and to unlock it we need to get 1,000 individual donors.  We are currently running a Solidarity Dollar campaign and if people want to support what we are doing.   No donation is too small!

Do you think this is a good way to spread a Health At  Every Size message?

I think that this is a great way to spread the message.  Since CHOA’s controversial billboards have made it into National Media, our response is has the opportunity to earn National Media as well.  In fact we’ve already been contacted by a major network news program, BBC News, and we’ve had an article in SF Weekly.  We are getting the message out that shaming is bad for children’s health, and that we can be for developing healthy habits in kids of all sizes without stigmatizing any kids at all. The Health At Every Size paradigm is an evidence-based way to do just that.

Is there anything else you’d like to share?

Thank you. I’m reticent to start listing people lest I miss someone but thank you to Marilyn, Shannon, Jay, Rachel, everyone at More of Me to Love, NAAFA, ASDAH and everyone who is involved in this campaign.  I’m so excited about what we can do for kids in Georgia and the reverberation it could have. We have accomplished something huge and we should be incredibly proud of ourselves.

This is a remarkable time in the Health At Every Size movement.  Ragen, Marilyn and their amazing partners (and that includes many of you!) have created unique opportunities to create positive, HAES messages for kids, parents and other people of all shapes and sizes.  I encourage you to take a moment to contribute just a little of your time, money, energy, voice, creativity, publicity or other resources to these amazing efforts! 

ASDAH President Deb Lemire blogged about the Strong4Life website video campaign that accompanied the billboards.

ASDAH’s Leadership Team Supports the I STAND project!

Not pictured:   Jennifer Copeland, Education Co-Chair; Paul Ernsberger, Research

Decades of research on the placebo effect support that people’s perceptions and expectations about their health can positively influence physiological parameters as well as the course and outcome of treatment. But, is the opposite also true? Can negative expectations adversely affect our biology? The answer to this question is yes and the phenomenon is called the nocebo effect.

The word nocebo comes from the Latin nocere (to do harm) and is defined as “the causation of sickness or death by expectations of sickness and death and by associated emotional states.” People most commonly equate the nocebo effect with Voodoo, a concept well-documented in so-called “Traditional Societies” throughout the world. There is, however, substantial scientific evidence that the nocebo effect is alive and well in contemporary Western Cultures.  Here are a few examples from the research over the last 4 decades:

When individuals with asthma were told they were taking a drug that would make their breathing more difficult, airway resistance increased even though the drug was composed simply of saline solution.

People who were susceptible to poison ivy developed rashes when given a harmless look-alike plant and told it was the real thing

25% of people with food allergies developed symptoms when injected with a benign substance and told that it contained the foods to which they were allergic.

The suggestion that a mild electric current was being passed through the head of healthy volunteers caused headaches in about 2/3 of the people in spite of the fact that there was actually no electric current.

 A recent study in the journal Pain clearly demonstrates the power that people’s perceptions can have on their physiology. The authors reviewed 73 clinical trials from 1988 through 2007 involving comparison of the efficacy of 2 different anti-migraine medications (non-steroidal anti-inflammatories, and anticonvulsants) vs. sugar pills (placebos).  Non-steroidal anti-inflammatory drugs are known to cause stomach problems. Side effects from anticonvulsants include paresthesia (burning, itching, and numbness) and memory loss. In each study, participants were told they were going to be taking either one of the two drugs or a placebo. In all cases, people who were taking the placebo had side effects that were related to the drugs they thought they might be taking. No one who thought they might be taking an NSAID reported tingling or memory problems, and only people who thought they might be taking NSAIDS reported experiencing stomach problems.

Negative thoughts, feelings and expectations on the part of health care professionals can translate into potentially dangerous and even life threatening consequences for the people they are trying to help. In his excellent book, The Placebo Response, Dr. Howard Brody says that anytime a patient “feels less listened to, without a good explanation, uncared for, and less in control, then we’d predict that a nocebo effect is possible.” He goes on to say: “in our complex and often too impersonal health care system, nocebo effects must be rather common.”

In fact, the literature is replete with stories of individuals who appear to have suffered serious untoward consequences as a result of nocebo effects or what Dr. Andrew Weil refers to as medical “hexing.”  In Spontaneous Healing, Dr Weil relates the story of a woman in her early 40’s who came to see him from Finland after being diagnosed with multiple sclerosis. Although the symptoms to that point had been limited to muscle weakness in one leg, she was depressed and related her story almost without emotion, as if it was all happening to someone else. It turns out that, as can be the case with this type of disease, the initial diagnosis had taken a long time to make and involved many tests. After finally sitting her down in his office and delivering the bad news, her neurologist excused himself and left the room only to return a moment later with a wheelchair that he invited her to sit in to “practice” for when she was totally disabled.

In a study at Massachusetts General Hospital, patients about to undergo surgery were randomly assigned to control and experimental groups that were matched for age, gender, underlying disease, severity of disease and type of operation. Those in the control group were addressed by anesthesiologists in a cursory manner. The anesthesiologist gave them his name and told them that he would be giving them the anesthesia the next day and that everything would be fine. The same anesthesiologists spoke warmly and sympathetically to those in the experimental group, sitting on the bed, holding the patients hand and discussing exactly what they should expect in the way of pain and suffering. The operations were performed the next day by surgeons and nurses who were not aware of which patient belonged to which group. The patients who experienced that simple 5-minute act of compassion needed only half the pain killing medication and were released from the hospital 2.6 days sooner than those in the other group!

Contrary to the traditional dogma of the separation of the mind from the body and of psychology from physiology, the literature on placebo and nocebo clearly demonstrates that thoughts, beliefs and emotions can powerfully affect our physical health. In all therapeutic encounters, treatment is delivered within a psychosocial context based on the expectations of the patient which is strongly influenced by her/his relationship with the involved provider. Every interaction has the potential to detract from or promote the healing process. Furthermore, the beliefs that people hold prior to entering into the therapeutic process can influence the outcome in either direction.

For the work that we do around size acceptance and weight and health, this information has particular significance. It helps us to begin to understand the devastating damage that can result from oppression, weight stigma, discrimination, marginalization, labeling, bullying, etc. even when they are done in the name of health. With the accumulated knowledge of the powerful effects that perceptions and expectations can have on our physiology it is time to realize that it is not only sticks and stones that can hurt us.

My new year nearly began on a depressing note, because of the way I ended the old one. Right around December 31, I read an article in the Environmental Nutrition newsletter, The Fit vs Fat Debate, written by the dietitian who moderated my September debate with John Foreyt before members of the Academy of Nutrition and Dietetics (formerly American Dietetic Association, or ADA).

This article was hardly the first to bring me down with mindless assertions of conventional thinking on fat, disease and dieting. But as a total misrepresentation of my long-sought ADA platform, it cut particularly deep. It also seemed to undermine my confidence and sense of progress after a year that included many Health at Every Size®(HAESsm) highs, like favorable press, a spirited, community-building ASDAH conference, a successful summer workshop, and the emergence of this blog. If this one article could bring me down, I wondered, how could I find the courage to go forward into 2012 and the years beyond, still pushing against all the odds for a paradigm shift on weight and health?

I know I’m not alone in sometimes wondering how to go on advocating fat-acceptance in a fat-phobic world, so I’m using this first blogpost of the year to share with my HAES homies the resources that pulled me out of the rut. Hopefully, they can help all of us reinforce ourselves and one another when we need to. First, though, some background on the article. 

She Just Didn’t Get It 

The ADA, as you may recall, insisted that HAES belonged on the conference dais only in a debate format, faced by a counter-argument. It was the job of this article’s author, Christine Palumbo, to moderate, and she informed me beforehand that she would be writing a journal article based on the panel. At her request, I suggested numerous HAES resources to support her learning, including my book and the article I co-authored in Nutrition Journal (Weight Science: Evaluating the Evidence for a Paradigm Shift), as well as a partial transcript of the debate.

So why was none of this information in the article that emerged? How could she have heard so little of the HAES case – missed, in fact, the entire debate aspect of the debate? Her article merely recapitulated conventional thought and either ignored or misinterpreted the HAES perspective. “If you’re overweight or obese,” she wrote, ”There’s no argument that your goal should be to get fit through diet, exercise, and slow, steady weight loss,” Really, Christine? What were you moderating, if not an “argument” about that very point?

 Ms. Palumbo takes as gospel the standard statistical fear-mongering that “two-thirds of Americans are overweight or obese.” (That we even take those numbers seriously astonishes me. Set arbitrary definitions and you can create any fraction you want.) She ignored substantial evidence I presented on the influence of commercial interests that played a role in creating and then benefit from BMI-based definitions. She then parroted unquestioningly the notion that fat leads to death and disease. I mean, even Dr. Foreyt conceded that mortality data show fatter people living at least as long as those in the “normal weight” category. And even he conceded that confounders muddle epidemiologic associations.

 I was even more disturbed– stunned actually – by Ms. Palumbo’s sidebar on HAES, which she labeled an “alternative weight loss approach.” Was she even there at the September debate? How could she have missed the central thesis of every piece of writing I supplied her with? HAES is decidedly not about the pursuit of weight loss. To the contrary, HAES shifts the focus from weight to health. Reducing it to a movement for overweight people was yet another rather egregious missing of the mark.

 To too many in the dietetics community, HAES qua HAES is just too threatening. They want to co-opt it into just another weapon in the anti-obesity arsenal when in reality, HAES exists to disarm their war against obesity.

What We’re Up Against

On reading the article, though, I felt more than ever like a victim of that war. I found myself in a dark place, where I felt disillusioned and hopeless, and my life work suddenly felt meaningless. I had presented Ms. Palumbo with my best stuff. She was, she assured me in an e-mail, “trying her best to capture both points of view.” She seemed, in fact, to be a kind person who wants to do the right thing. Yet, despite all this, all my efforts at education failed even to dent her armor.

For anyone with a HAES perspective and committed to social justice, it’s easy to get discouraged this way because the truth is, this a HAES-hostile world. Our greatest efforts can seem like droplets in an ocean of conventionally accepted thought; especially when our opponents find so much buoyancy in that sea of ideas.

What happened that rendered Ms. Palumbo so unable to consider a new perspective? I don’t know. But I would like to take advantage of this platform to contemplate the challenge we’re up against. Consider a generic woman with her traits: a white, middle-class dietitian in North America, whose BMI places her in the “normal” range.

She lives in a world where her thinness is currency, conferring attention, respect, jobs, and quality health care, among other advantages. She avoids the daily humiliations heaped on fatter people, the looks of disgust, the blame, and the news reports that her shape constitutes a public health crisis. Everything in her training reinforces this posture. It is likely that she was even drawn to her profession because she has absorbed these cultural values more deeply than others and fears becoming fat, herself, and subject to the stigmatization she perpetuates.

She stands to lose a lot by challenging the mainstream paradigm: the self-righteousness and sense of entitlement that many “normal weight” people feel for having “achieved” their weight; the female bonding around food and weight anxieties, the support and respect of the professional community she is invested in, social approval, even her career. Moreover, she would have to reflect on her history and come to terms with the fact that her beliefs and actions, however well-intended, were actually quite hurtful to others.

In light of the tremendous penalty that could come from engaging with the HAES challenge, I expect it isn’t always conscious choice to avoid it. Many of us have strong defense mechanisms that keep us rooted to the safe and familiar and protect us from hearing information that might threaten our identity and worldview.

Letting Go as a Way to Hang On

Putting all this in context made it easier for me to understand why change is coming so slowly despite all my efforts. My next step was to reach out for support from other HAES advocates who I respect tremendously. That they experience similar resistance reminded me that the outcome may have little to do with me and also lifted some of the pressure I was feeling to break through. Given what we’re up against, I need to just do the best I can, I realized, learn from it, and then let go.

My best defense, I remind myself, is to take good care of myself and stay happy, despite the pain and injustice that surround me, and to maintain my strength to carry on. Only by cutting myself a little slack on the results, can I keep up the strength to keep trying. And I have to try because it is only if I stop trying that I give up any chance of winning.

I have never forgotten a conversation with my father in the last months of his life. He reflected on how he had done everything right, obeyed the rules, gone from “rags to riches” and created a lucrative business, created a good marriage, and fathered children who made him proud. His life was “a success” by any conventional measure. Yet why, he wondered, did he feel like a failure?  

It’s a shame that he waited until so late in life to recognize that what matters is feeling pride in who we are, as opposed to placing value solely on our accomplishments. I inherited this to some extent – the constant drive for achievement, never feeling like what I do achieve is enough. (Did I really need three graduate degrees!?!) But that late in life conversation reminded me to think hard about what I need to achieve success. I have achieved the conventional kind of success, involving wealth and standing and prestige (and thinness). But by itself, it leaves me feeling the same emptiness my dad did. 

No. My efforts to make a good life for myself heed my father’s lesson rather than his example. I do what I do – making the case for HAES in the face of almost overwhelming opposition – because it’s the right thing to do, regardless of outcome.

And, finally, I can console myself with the hope that change does happen. Many dietitians are already championing a HAES perspective. HAES did make it to the agenda of the ADA conference. Some dietitians were able to hear the message and are converts or at least opening to a HAES perspective. Mainstream news outlets have been asking if all anti-obesity efforts are such a good thing.

It helps to remember how often we have been astonished by the sudden crumbling of institutions and extraordinary paradigm changes: the American Revolution, the March on Birmingham, the Stonewall riots, Tahrir Square…  And let’s not forget that it is now scientific consensus that the earth is round.

Change happens because ordinary people organize, insist on challenging the system and speaking their truths, and do not give up. So, as hard as it can be to feel I’ve tried and failed, I take comfort knowing at least I’m still trying.

Ahh January.  After the champagne flutes and the ball drop and the confetti, it’s time for the annual Big Shift.   What is the big shift you ask?  Well the Big Shift (or the B.S.) is when the entire country moves from thoughts of spending time with family and spending money and eating big wonderful meals and fabulous homemade treats to thoughts of shame and guilt. Every ad on television features a guy holding out pants that are 10 sizes too big for him or babes in bikinis and high heels glibly promising to create a whole new you.  It’s enough to fuel a full-on fat panic.  And that fat panic can lead to injury.

Fueled by fat panic, many people try to do too much too quickly after the holidays.  They jump right into an exercise program and end up limping right back out with a sports-related injury.  According to the British Osteopathic Association, panic over holiday weight leads to a 20 per cent increase in the number of people visiting their osteopaths for treatment in January. 

But it doesn’t have to be that way.   You can significantly increase your fitness level and still stay safe.  You just have to apply a modicum of common sense and a few simple rules:

1.  Assess your current fitness level.  Ah, the life of the weekend warrior.  You haven’t played softball since you were 10, but how hard can it be, right?  You got a new bike for Christmas and want to take that baby out for a 15-mile ride, except you haven’t done that before, EVER.  Your personal trainer wants you to produce great “results” for his before/after bulletin board so he trains you so hard you can’t get out of bed the next day.  And it’s a surprise that the sports medicine doctor is completely booked at the end of January?   The answer here is just two words: start small.  Think back to the last time you did any sort of exercise.  Was it recent (less than a month ago?)  Did you feel okay afterwards?  If you recently exercised and felt okay afterwards, whatever you did that day was a reasonable starting place for that particular form of exercise.  If you’re trying a new form of exercise, you need to back off even further.  Just because you can walk for 20 minutes, doesn’t mean you can play 20 minutes of squash without getting hurt.

If  you haven’t worked out in a long time (or ever) you need to start very small in a safe place and check in regularly with your body to determine your starting point.  You can get some help from a personal trainer.  Or you can check out my “Rock the Block” exercise as a great way to determine your starting level.

2.  Ramp up Slowly.  If you’re walking 3 miles per week this week, it doesn’t mean that next week you should do 6. According to the American Academy of Orthopaedic Surgeons, people are more prone to injuries when they increase the intensity and duration of their workouts without building up slowly—something more common in people who want to make up for lost time.  

One of the main reasons for gym injuries is trying to ramp up too quickly—especially in exercises on machines designed to strengthen abdominal and lateral (side) muscles.  This can lead to injuries of the lower back and even cause respiratory problems by straining the muscles in the chest.

You should ramp your overall activity level by no more than 10% per week.  This means you may increase ONE aspect of your workout by 10% per week.  You can increase the distance or duration (distance traveled or number of minutes exercised) the intensity (walking pace, heart rate) OR the frequency (number of workouts per week) by 10% per week. 

A 10% increase doesn’t seem like a lot, but it’s cumulative and it adds up.  After one New Year’s eve resolution, I started walking about 6 miles per week.  By increasing my distance by just 10% per week,  I was able to complete a marathon by the end of the year!  Had I started out much more aggressively I probably would have gotten injured and never finished.  It pays to be the tortoise and not the hare.

3.  Listen to your body.  Your body is a finely tuned instrument.  When it’s not working at an optimal level, it will let you know.  Aches, pains and other symptoms are like your body’s dashboard indicators.  And these indicators are very important.

Most of us, treasure our cars. We wouldn’t think of ignoring a “check engine” light on the dashboard. We wouldn’t continue to try to drive on a flat tire. We wouldn’t drive blithely by with a loud thumping noise under the hood. But how many of us, ignore the signals our bodies give us as we’re trying to exercise? If you’ve ever stretched something too far, or popped something out of place, you’ve probably experienced either severe muscle tension or pain. This pain is the proverbial thumping noise under the hood. If you experience pain, you need to STOP, pull the car over and figure out what the heck is going on. Here are some warning signs you should never ignore as you work out.:

• Feeling of dizziness or lightheadedness
• Feeling of tightness or pain in chest, trunk, back or jaw
• Extreme breathlessness
• Unusual fatigue
• Nausea
• Loss of muscle control
• Allergic reactions—hives or rash
• Blurred vision

Let me summarize, it’s normal to feel fatigue or a slight ache after exercise.  But generally speaking, if it hurts, don’t do it!

That’s it!  Remember, you don’t have to succumb to the national, annual B.S.  You don’t have to be a weekend warrior.  Just follow those three simple rules and you will be exercising safely and happily through January, past Valentine’s Day and through the entire year.   

Along with the increasing public recognition of the Health at Every Size® model, there is some confusion about what the HAES ^SMmodel is and is not.  Some discussions of the HAES approach are omitting or distorting aspects that are critical to its practitioners.  There are several renditions of the model’s tenets (listed at the end), but first I would like to offer some critical questions to ask when you see it being discussed in the media. 

If you can answer “yes” to these questions, you may be reading an inaccurate or at least incomplete presentation of the model. 

Does the account you are reading:

Perpetuate the Pursuit of Weight Loss, e.g.:

• Promise weight loss?
• Fail to recognize the harms for people of all sizes of the existing interventions for changing weight?
• Create a new set of “rules” about how to eat?
• Shame some aspect of our inner selves by trying to “get rid of it, starve it, cut it out, imprison it”?

Perpetuate Healthism, e.g.:

• Present only fat people who are healthy as “poster children”?
• Create a class of “Good Fatties” vs. “Bad Fatties”?
• Collude with the notion that healthier people are morally better?
• Fail to demand quality medical treatment for fat people with health challenges?
• Fail to critique the moral corruptness of trying to eliminate health costs by eliminating people with health challenges?

Reduce the model to Individual Choices, leaving out the critique of Weight Stigma, e.g.:

• Omit any reference to the environmental sources of ill health, especially weight stigma?
• Fail to propose any policy or institutional solutions to the problem of weight stigma?
• Propose that individuals solve the problem of institutionalized weight stigma and shaming by losing weight and leaving the stigmatized group?
• Fail to connect the dots with weight loss efforts of people across the weight spectrum, including people who have disordered eating from the pursuit of weight loss?

Perpetuate the Misclassification of Diversity as Disease, e.g.:

• Explicitly or implicitly condone the use of BMI categories to classify people?
• View higher-weight people as “diseased” based solely on weight?
• Attribute any health problems at higher weights to being at a higher weight, and fail to treat health problems regardless of weight?
• Overlook the health problems or fail to consider the health status of lower-weight people?
• Assume that thinner is healthier?

Perpetuate a Short-Term vs. Sustainability Focus, e.g.:

• Present as a “makeover”?
• Fail to incorporate the question of what is sustainable for unique individuals?
• Focus on outcomes rather than the quality of day-to-day life?
• Reduce the profound idea of body acceptance to the notion of “confidence”?

Perpetuate “Expertism,” e.g.

• Fail to include the input from members of the community itself, especially members who are trying to change institutionalized weight stigma?
• Place “expert” knowledge above people’s felt, embodied experience?
• Propose a specific eating regimen for all people that fails to incorporate the individual’s physical and psychological experience of food and eating?
• Fail to expose public policy and medical practice to the test of whether they themselves promote weight stigma?
• Present a “one-size-fits-all” perspective that is closed to update and revision, especially to the lived experiences of the community members?

Perpetuate a War with the Body, e.g.:

• Place more confidence in the mind’s ability to regulate eating and weight (ie “discipline”) than the body’s?
• Label normal body processes as diseased?
• Propose as “cure” the disruption of normal functioning of healthy organs?
• Fail to appreciate the biological value of having some members of our species be fatter/more fuel-efficient?
• Prescribe a particular body size that is not attainable through healthy living?

The people who have developed the Health at Every Size model have integrated decades of experimental and epidemiological research and clinical practice, as well as the lessons of many social justice and civil rights movements, to find a path that reconnects us with our bodies, our life purposes, and each other.  We ask that presentations of the HAES® model be as complete and nuanced as possible, and avoid the aforementioned pitfalls and mischaracterizations.

Additional sources of information on the HAES Tenets:

• http://www.sizediversityandhealth.org/content.asp?id=76
• http://usc-au.academia.edu/LilyOHara/Papers/146628/The_war_on_obesity_a_social_determinant_of_health
• http://www.aweighout.com/about-emotional-binge-eating/what-is-haes
• http://www.bodypositive.com/HAES.htm
• Burgard, D. (2009) “What is Health at Every Size?” in Rothblum, E., and Solovay, S. (Eds), The Fat Studies Reader. New York: NYU Press. 
• http://www.haescommunity.org/  See also the extended discussion in Linda’s book, “HAES: The Surprising Truth about Your Weight” at  and in Bacon, L., & Aphramor, L. Weight Science: Evaluating the Evidence for a Paradigm Shift, Nutrition Journal, 2011, 10(9).
• http://www.fatnutritionist.com/index.php/health-at-every-size-is-not-a-new-diet/

The Children’s Health Alliance of Atlanta has launched a campaign using short 30 second videos with chubby children talking into the camera sharing their shame and fear of being a fat person. 

Yes Tina, it is hard to be among the one million fat kids in Georgia.  And we agree with Jaden that it’s no fun getting picked on because you’re fat.  But the Strong4Life folks in Georgia decided that instead of building a community that supports healthy behaviors in children of all sizes they have chosen to build a community of stigma. 

Instead of working within their communities to provide access to fresh foods and safe places to play, they choose to encourage a culture of bullying.

Instead of using funds to challenge kids’ imaginations and encourage them to explore and create, they chose to fund fear.

Instead of standing on the side of compassion, they chose to stand on the side of cruelty.

Health comes in all shapes and sizes.  Being physically active and eating nutritious foods will generate health.  Convincing children that they are sick or failures because of their body size will not.

Bias. Stereotyping. Prejudice. Discrimination. Bullying.                  

These ugly words describe a serious problem weight stigma. Our culture is entrenched in the belief that fat is bad, people with fat are bad, people who exceed a BMI of 25 are unhealthy, and that only a narrow range of body sizes are beautiful. Billions of dollars are spent trying to attain the cultural ideal, but the more we diet, the further we move from it.

Whether subtle or blatant, weight stigma is broadcast into our living rooms and shows up in our classrooms, break rooms, and exam rooms. For many of us, weight stigma hits even closer to home: right between our ears!

 Making the invisible, visible

 What beliefs about weight have you internalized? Are those beliefs helping you or harming you?

 By internalizing this cultural bias, we condemn ourselves to living within its limitations. We allow the bully to move into our brains.

 I’m not letting the bullies off the hook, but if you believe them, you become them.

 What is the reality you are creating for yourself?

 You can only change what you are aware of. Without awareness, you may repeat old, even painful, patterns simply because they are familiar. In other words, you create your own reality.

For example, you may have old tapes that sound something like this: 

• I’m too embarrassed to be seen exercising.
• I can’t go to the gym until I’ve lost some weight.
• I’m trying to eat healthy but I’m not losing weight—it doesn’t matter what I eat.
• I’ll get diabetes because I can’t lose weight, so why change the way I eat?
• I can’t eat what I love in public, so I’ll binge later in private.
• I’ll never look like I did in high school, so why bother with healthy eating and exercise?
• I don’t deserve someone who loves me because I’m too fat.
• I don’t feel sexy because of my weight.
• I don’t see how my partner can think I’m sexy so I thwart his/her attempts.
• I don’t believe my husband when he tells me I’m beautiful.
• I don’t want to go to the doctor because I regained the weight I lost.
• I don’t take my blood pressure medicine because I know I should lose weight instead.
• I won’t buy new clothes until I reach my goal weight.
• If I was thinner, I would ask for that promotion.
• I’d love to travel but I want to lose weight first.
• I love to dance but I’m too embarrassed.

Making the impossible, possible

 What if? What if you booted the bully from your brain? Ask yourself, “How could my life be different if I didn’t buy into those limitations?” See how the bullying thoughts above would change if you dropped the stigma. 

• I’m exercising.
• I go to the gym.
• I’m trying to eat healthy.
• I’m at risk for diabetes so I’m changing the way I eat.
• I’ll never look like I did in high school. I’m eating healthier and exercising.
• I eat what I love.
• I deserve someone who loves me.
• I feel sexy.
• My partner thinks I’m sexy.
• My husband tells me I’m beautiful.
• I go to the doctor.
• I take my blood pressure medicine.
• I buy new clothes.
• I’m going to ask for that promotion.
• I love to travel.
• I love to dance so I do.

Boot the Bully from the Block

 Take your power back. Boot the bully from your brain and embrace the Health at Every Size® paradigm! Then help us boot the bully from the block! To learn more: visit ASDAH’s website.

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Dear Pat,

It sounds like you had a pretty upsetting visit to the doctor, and the first thing I want to do is give that guy a kick in the pants! I don’t think he’s giving you good medical advice, and I definitely don’t think he should have made you feel bad about your weight or your body. I find his suggestion that you “just try a little harder” to lose weight especially infuriating, since I have never in my life met someone with more willpower and self-discipline than you.

But I know you didn’t write for a pep talk. You wrote because you know I’m taking a nutrition class this semester and you want my advice on losing weight. Well, here’s my advice: I don’t think you should lose weight. For one thing, you’re gorgeous, and for another, I don’t agree with your doctor that body fat is necessarily dangerous to your health. However, I do believe dieting is dangerous, to both your physical health and your spirit. 

I know, the doctor said you were obese and pointed to the scary number on the BMI chart and told you about all the diseases you’re at risk for, but I’m not buying it. Who came up with that chart anyway? A bunch of doctors and researchers funded by weight loss drug companies and lap band manufacturers? (Don’t even get me started on those!) And how do they come up with these numbers that affect our insurance rates, our rapport with our doctors and our sense of self-worth? Who knows! Consider this: in June, 1998, the National Institute of Health’s Obesity Task Force adjusted the standards of the BMI. As a result, 29 million Americans went to bed with average figures and woke up ‘overweight.’ None of them had gained a pound, but all were now at “higher risk” for Type 2 diabetes, atherosclerosis, and hypertension.

It’s true that, in general, fat people are at higher risk for these diseases. But there is no evidence that being fat is the primary cause for these diseases. My nutrition teacher explains it this way: there is a well-known correlation between baldness and heart disease in men. But we don’t think the baldness causes heart disease. In fact, the heart disease and baldness are related to high levels of testosterone. In the same way, body fat and diabetes may be correlated, but that doesn’t mean body fat causes diabetes. Fat people may be more likely than thin people to have diabetes because fat people are also more likely to be older, poorer, more sedentary and to lack access to decent medical care and grocery stores carrying nutritious foods, not to mention safe places to exercise and play. There is even evidence that the stress of being told that you look bad/ugly/unacceptable all the time takes a toll on the body and can increase risk of disease.

Now maybe you’re thinking, ok, body fat might not be that bad for me, but I still don’t like the way I look. So give me some diet tips already! Well, I won’t, because diets don’t work. Yeah, I know you’ve lost weight on diets before, and that’s because at first, diets do work. Let’s consider a nice, “healthy,” gradual diet and program of exercise. No crazy cayenne pepper cleanses or hot yoga marathons here — you’re just going to cut back on sweets and start power walking for 30 minutes a day. And let’s say that, on average, you need to eat 2000 calories each day to fuel your body. Suppose those sweets you’ve given up equal 200 calories a day and the walking is burning an extra 200 calories a day. That means you’re using up 2200 calories worth of energy a day, but only taking in 1800. Your body has to get the 400 calories it needs from somewhere, and, yup, it’s going to get them from fat stores.

So you’ve been on this diet and exercise program for three weeks, and you’ve lost some weight. Six weeks pass — still losing weight. You buy a pair of $160 jeans. You RSVP yes to your college reunion.

Six months pass. You haven’t lost much weight in the past month. Nothing about your diet has changed. You don’t even crave sugar anymore, and you’re still exercising. Month seven, you step on the scale and realize you’ve gained a pound. After a year, you’ve regained half the weight you lost in the first five months. Two years later, and you’ve regained it all, plus five bonus pounds. And all this time, you never stopped dieting and you kept up the exercise. And then you go into your doctor’s office, and he tells you you’re obese and need to . . . diet and exercise to lose weight.

I know you recognize this scenario, because we’ve talked so many times over the years about this painful, frustrating cycle. But now I know why you keep gaining the weight back. You know what homeostasis is, right? When you get hot, you sweat to cool down; when you get cold, you shiver to warm up. Your body turns these mechanisms on and off automatically, without any conscious input from you, because it is invested in maintaining a body temperature that allows all its vital functions to go on functioning. It turns out your body is every bit as invested in maintaining a healthy body weight, and will see to it that you maintain that weight whether you like it or not. We all have what’s called a set point, which is really a range of weights at which your body feels comfortable and safe. Get below your set point, and your body wants you to gain weight. Get above your set point, and your body wants you to lose weight. But because back in cave people days there was no risk to having extra body fat (and a lot of benefits!) and a HUGE risk to having too little body fat, the mechanisms that prevent you from losing weight are stronger in most people than the ones that prevent you from gaining weight. These mechanisms are slow, gradual, and out of your control. For example, your body might lower your body temperature slightly so you burn fewer calories. It might make you a bit more tired and sluggish, so you move less. It might become extra efficient at wringing every last calorie out of every piece of food you eat. And it might make a wider array of foods appealing to you, especially fatty, sugary, calorie-dense foods. Over time, all these small effects add up to you burning fewer calories and storing more, in spite of the fact that you’re still eating less. And the real kicker is, the more you diet, the more conservative your body becomes in terms of its fat storage. “You’re starving me again?” Your body says. “Well, I’d better sock away some more fat to get us through these scary lean times.” By dieting and making your “thrifty genes” even thriftier, you can actually bump up your set point.

So you can see why I think your doctor gave you crummy advice. He’s operating on popular but scientifically unsubstantiated claims about the risk of body fat and his prescription —weight loss— is not only impossible for the vast majority of people to achieve in the long term, but actually leads to increased weight gain and is damaging to health!

 What I really want to tell you, my dear Pat, is to focus your considerable energy on the things that actually impact your health, and let this weight business go. You have so many healthy habits already. You swing dance; you have a million friends; you cook dinner every night; you’ve started using meat – how did you put it? “As a condiment?” You already know what to do. Trust yourself, and trust that bod.

I don’t want you to take my word for any of this. I’ve included a few links to different resources including some info on something called intuitive eating. I also encourage you to check out the counter arguments (a lot of companies stand to gain from the notion that people can lose weight, so they shouldn’t be hard to find!). If you can find studies that support successful, salutary, long-term weight loss for a significant number of the participants, send them to me. We can comb through them together.

I hope this letter answers your question in a way that feels satisfying, or at least intriguing. I totally understand if it also feels annoying, frustrating and upsetting. I don’t for a minute think that what I’m sharing with you is easy to hear. But it is the best advice I know how to give, to someone who deserves nothing but the best.

 Yours in fondness and solidarity,

Molly

 Molly Breen is nutrition student, author, blogger, and green grocer at Other Avenues, a food co-op in San Francisco.