citation evaluation

Despite an increase in dieting among the American public, the prevalence of obesity continues to rise (Bacon et al. 854; Gaesser 91). Traditional obesity treatment programs have assumed that the only method for reducing disease risk in the obese is though weight loss. More importantly, traditional programs assume that everyone is capable of weight loss and successful weight maintenance (Miller, “Health” 37; Miller, “Weight Loss” 89). These programs have promoted the weight-loss-at-any-cost mindset that has permeated the medical model of obesity treatment (Miller, “Weight Loss” 91). Despite efforts to promote weight loss among obese subjects, Traditional Weight Loss (TWL) programs have been found largely ineffective at promoting long-term weight loss, with an overall failure rate often cited as 90-95% (Gaesser 92) or even as high as 98% (Miller, “Health” 38). Even when programs are successful in promoting short-term weight loss, the majority of weight is regained within four to five years (Gaesser 92; Miller, “Fitness” 207). Despite the lack of supporting evidence, traditional treatment programs continue to focus on weight loss as the only method of improving the health of obese individuals. However, a new paradigm has been proposed to counter the traditional model: the Size Acceptance, or Health at Every Size, paradigm (“Health”).

Health at Every Size (HAES) is based upon recent research demonstrating that physical activity can improve health independently of weight loss and was developed out of frustration with the general failure of TWL programs. This research has lead to the conclusion that an individual’s level of fitness is a better indicator of health risk than level of fatness (Barlow 41; Miller, “Fitness” 208; Stevens 832). If exercise training has been shown to have beneficial effects on health measures such as lipid and carbohydrate metabolism, blood pressure, and insulin resistance independently of weight loss (Brown 1549; Friedman et al. 20; Tremblay et al. 1326), and even in the presence of weight gain (Friedman et al. 21), then why should health professionals continue to emphasize weight loss as the only measure of success in obesity treatment?

Proponents of the HAES paradigm suggest instead that focus should be transferred away from weight loss and toward healthy lifestyle behavior change, including physical activity and a healthful, balanced diet. HAES posits that dieting and the resultant obsession with weight is unhealthy and seeks instead to promote acceptance of all bodies, regardless of size or shape, acknowledging and respecting the natural diversity of human bodies in direct opposition to Western society’s obsession with thinness (McFarlane, Polivy, and McCabe 262; Miller, “Weight Loss” 93). In contrast to the traditional model, which focuses on weight as the sole measure of health, HAES recognizes many factors that contribute to health and total well-being: physical, social, spiritual, occupational, emotional, and intellectual (King 272; Miller, “Health” 44; Robison, Putnam, and McKibbon 185). Whereas the traditional model of obesity focuses only on weight, HAES focuses on the entire person.

The majority of HAES studies measure psychological aspects of health including self-esteem, depression, body image, body dissatisfaction, anxiety, and restraint in eating, as well as binge eating (Mellin and Minihane 1133). Many studies have incorporated cognitive behavioral methods to improve these aspects of psychological health; thus, definitions of success would include improvements within these psychological measures. Improvement was quantified by pre- and post-treatment changes on validated psychological measures such as the Rosenberg Self Esteem Scale (Rosenberg 250), the Beck Depression Inventory (Beck et al. 50), the Eating Inventory (Stunkard and Messick 100), and the State-Trait Anxiety Inventory (Spielberger et al. 50), among others.