- Weight stigma refers to the weight- and size-based discrimination woven into many aspects of our society.
- In healthcare settings, weight stigma can result in missed diagnoses and poor quality of care for higher-weight patients.
- The Health at Every Size (HAES) paradigm helps providers challenge weight biases and create size-inclusive healthcare settings.
- Becoming HAES-aligned involves ongoing education, challenging one's beliefs about body size, and honoring body diversity.
Content Warning: descriptions of weight stigma in healthcare settings.
As health providers, we have a responsibility to treat our patients with dignity and respect. Many of us got into our profession out of a genuine desire to help others and alleviate pain and suffering. We are trusted to care for people at their most vulnerable, so the last thing we’d want to do is to make someone feel dismissed or invalidated over any aspect of their identity or background. We strive to educate ourselves and “do no harm.”
Unfortunately, sensitive and non-judgmental healthcare has not been the experience for many people in larger bodies. Many health providers have been taught to associate higher-weight bodies with being “unhealthy” and thinner or visibly muscular bodies with being “healthy.” Additionally, we’re taught that weight and size are the results of our choices, and therefore if someone is in a larger body it is a reflection of their habits.
Not only is this inaccurate (body size is impacted by various complex genetic, environmental, behavioral, and socio-economic factors, diet and exercise being only a small piece of the equation), but these associations perpetuate harmful stereotypes and can result in missed diagnoses, misdiagnoses, and poor-quality healthcare. Studies show that healthcare providers are more likely to view higher-weight patients as less self-disciplined and uncooperative, spend less time with higher-weight patients during appointments, and report less desire to help them than thinner patients. These beliefs are rooted in weight stigma, or the weight- and size-based discrimination woven into many aspects of our society.
Health at Every Size (HAES) is a framework that divorces health from weight, and promotes dignity and respect for all bodies. Named for a book of the same title by Lindo Bacon, Ph.D., the HAES movement promotes justice and inclusion for all bodies, across the spectrums of weight, age, gender, sexuality, race, and ability. It respects autonomy and recognizes that health is subjective.
Committing to being a HAES-aligned provider can help prospective patients find safer places to seek treatment, knowing that we as providers are at least making a concerted effort to avoid judgment and discrimination. This is especially important for patients who have been dismissed or minimized by health providers in the past.
As a provider living in a thin body, I do not have the lived experience of being shamed, discriminated against, or judged for my body size. I certainly do not claim to be an expert on the HAES model, but I know that my work has only deepened since learning and incorporating it into my personal and professional identities. Here is some wisdom I have picked up along the way, that I hope will help you reflect.
Actively Learning (and Unlearning)
As a health professional, the HAES philosophy may be different from what you were taught about health and body weight. Many of us were trained in a biased, weight-centric paradigm of healthcare. Plus, we live in a society where negative stereotypes and beliefs about larger bodies pervade, so even if we have learned accurate weight science, we may still hold implicit biases about body size.
It's our responsibility as healthcare professionals to reduce the harm we cause to those we treat. This means gaining an understanding of the weight science, thinking critically about what we have been taught, and doing our best to treat everyone with compassion, dignity, and respect.
Assume your education is never complete. None of us will ever be completely free from preconceived notions about body size. However, we can actively work to unlearn and challenge internalized fatphobia and weight biases. This applies to everything from the language we use when talking about bodies, to the ways we set up our built environment and office spaces.
Honoring Body Diversity
An essential part of becoming a HAES provider means recognizing and respecting body diversity, or the awareness that bodies differ across our species. This includes size diversity, meaning that even if everyone ate exactly the same and moved exactly the same, there would still be a wide variety of body shapes and sizes.
Size diversity is natural and not something we need to fight. Researchers estimate that between 40 and 70 percent of our height and body mass are determined by genetics. On top of that, our resting metabolic rate (the energy we burn when not physically active) accounts for about 70 percent of the fuel we burn each day, and it’s estimated that our metabolic rate is 80 percent determined by genetics.
It's also important to recognize that there are several psychological and social factors that affect our bodies, like trauma, stress, and experiences of discrimination. Our race, income, and level of privilege also significantly impact our body size, since they play a large role in determining our access to healthy food, exercise, and medical care.
Being HAES-aligned means recognizing that body size is not solely within one’s control, and that even if it were, we still would not be justified in trying to force someone’s body to be a different size. Diversity makes our species stronger, and that is definitely worth celebrating!
You cannot tell anything about someone’s health based on their body size. Weight is not a behavior, and body size does not reliably reflect a person’s habits or health metrics (blood pressure, cholesterol, blood sugar, and so forth).
Studies linking being higher-weight to heart disease, diabetes, and other medical conditions demonstrate a correlation between weight and health status, but there is no good evidence demonstrating causality. When genetic, social, behavioral, and environmental factors are controlled for (e.g., trauma, community support, socioeconomic status, substance abuse, nutrient intake, experiences of discrimination, and disordered eating, to name just a few), the correlation between higher weight and poor health either disappears entirely or becomes statistically insignificant.
Additionally, even if you do know that someone’s health status is linked to their habits or their size, judging them for any reason is a cruel and unhelpful thing to do. Since we know that stigma and discrimination are linked to poor health outcomes, stigmatizing someone for their body size is likely to be far more harmful to their health than their body size alone could ever be. Nobody deserves to be shamed for their size or their health status, and nobody is morally obligated to invest in their health in any particular way.
Body autonomy includes the right to decide what health means to you, if it matters to you at all. The ways in which a person chooses to (or chooses not to) pursue health are not reflective of their moral character and should not be treated as such. Although our culture at large tends to define “health” as diet and exercise, there are many other health-promoting values and behaviors someone might choose to prioritize.
If all of this aligns with your values as a provider, you can begin to implement HAES strategies into your practice. Together, we can make healthcare safer and more effective for everybody!
Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1), 9. https://doi.org/10.1186/1475-2891-10-9
Burgard, D. (2010). What’s Weight Got to Do with It? Treatment of Eating Disorders, 17–35. https://doi.org/10.1016/b978-0-12-375668-8.10002-6
Matz, J., & Frankel, E. (2014). Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating, and Emotional Overeating (2nd ed.). Routledge.
Stunkard, A. J., Harris, J. R., Pedersen, N. L., & McClearn, G. E. (1990). The Body-Mass Index of Twins Who Have Been Reared Apart. New England Journal of Medicine, 322(21), 1483–1487. https://doi.org/10.1056/nejm199005243222102