Summertime means less covering up, swimsuits, beach time…and for a lot of folks, this is hard. Because I’m guessing no one needs to tell you that our culture is obsessed with health, wellness, and fitness. “Fit” is often code for thin or skinny. Body size has been an obsession for eons, and our culture often looks at health as something that can be measured by weight or body size alone.
Health care providers – professionals who have immersed themselves in the science of wellness – are not immune to this distortion, unfortunately. I have clients who dread going to the doctor and even completely avoid going because a) they’ll be weighed and b) they’ll get a lecture from their provider that basically says their health issues (anything from high blood pressure to fertility to stress and depression) can be “fixed” by losing weight. There’s a real assumption that health may improve with weight loss.
The Health at Every Size (HAES) framework challenges that assumption and offers a wholly different way to understand wellbeing, one that prioritizes access to care, respectful treatment, and sustainable health behaviors over weight-based judgments.
At Wolcott Counseling & Wellness, we approach care through a lens that recognizes the complexity of health and the deep harm that can come from weight stigma, especially for individuals with eating disorders or trauma histories. We see how size and weight ideals are yet another form of oppression, and we gently help clients free themselves from this framework. We help clients approach themselves with self-compassion and arm them with real, evidence-based research around health and wellness.
Defining “Health at Every Size”
So what is Health at Every Size (HAES)? HAES is a weight-inclusive framework that supports people in engaging in health-promoting behaviors without focusing on weight loss as an outcome or requirement.
Rather than assuming that body size determines health, HAES emphasizes:
- Sustainable self-care behaviors
- Access to compassionate, non-discriminatory healthcare
- Respect for body diversity
- Psychological and emotional well-being alongside physical health
Healthcare simply can’t be reduced to body size or weight control practices. It’s not that simple… and the assumption that it is, in itself, leads to poor health outcomes. The mental distress alone that comes with constantly measuring yourself against unrealistic, unattainable ideas is damaging to our mental health. Not to mention the toll that the stress of exercise bulimia, orthorexia, or extreme dieting takes on the body.
Then there’s the stress that shows up in long-term anxiety, depression or OCD as a result of trying to be what culture tells you to be – it’s an extremely narrow definition of beauty and health.
And finally, the metabolic, cardiovascular, endocrine, musculoskeletal, digestive, and immune distress that can be augmented by all of the above. To say, for example, that someone’s high blood pressure is due to their weight is laughably oversimplified – yet this is what patients hear over and over. It’s truly a cruel and vicious cycle.
A Brief History of HAES
The HAES movement emerged in the late 20th century as a response to dieting culture, weight stigma, and the substantial limitations of weight-centric healthcare models.
Psychologists, dieticians and advocates like Deb Burgard, Claudia Clark, Paul Ernsberger and (Gainesville, Florida’s own) Karin Kratina organized conferences and laid the groundwork for de-shaming around larger body size and size diversity as an ethical approach to wellness.
These early advocates and researchers taught us that:
- Dieting is actually very ineffective long-term for sustained weight loss
- Weight stigma itself is associated with negative health outcomes
- Many people improve their health without significant or lasting weight change
Over time, HAES evolved into a structured framework supported by public health research, clinical practice guidelines, and organizations such as the Association for Size Diversity and Health (ASDAH).
The Core Principles of HAES
While different organizations may phrase them slightly differently, HAES is commonly grounded in five core principles:
1. Weight Inclusivity
Accepting and respecting body diversity and rejecting the use of weight as a proxy for health.
2. Health Enhancement
Supporting access to healthcare, self-care, and resources that improve wellbeing for people across all body sizes.
3. Respectful Care
Recognizing that individuals deserve respectful, bias-free care regardless of weight, health status, or appearance.
4. Eating for Wellbeing
Encouraging flexible, attuned eating based on hunger, satiety, and satisfaction rather than rigid diet rules.
5. Life-Enhancing Movement
Supporting physical movement that is accessible, enjoyable, and sustainable rather than punitive or weight-focused.
HAES and Eating Disorders
For individuals experiencing or recovering from an eating disorder, traditional weight-focused approaches can reinforce harmful cycles, including restriction, bingeing, guilt, and body distress.
A size-inclusive, HAES-informed approach to eating disorder care emphasizes flexible nutrition, reduced focus on weight control, and attention to the psychological harms of diet culture. This is a significant departure from restrictive or weight-centered frameworks. It shifts the focus away from weight as the primary indicator of health and it emphasizes:
- Stable eating patterns
- Removing the “good” and “bad” labels from food, adopting a neutral stance
- Reducing shame and rigidity around food
- Supporting body trust and interoceptive awareness
- Addressing co-occurring mental health conditions
- Restoring autonomy and flexibility in eating and movement
HAES isn’t a “one-size-fits-all” philosophy. For some individuals suffering with a severe enough eating disorder, medical stabilization or acute treatment and structured nutritional support is going to be necessary. No matter what, a trauma-informed, individualized approach is always essential.
Addressing Common Concerns
There are some common questions and concerns we often hear in the wellness field. Maybe you have some of these same thoughts and questions.
“Is HAES saying weight doesn’t matter at all?”
HAES does not claim that weight is irrelevant in every clinical context. It argues that weight alone is not a reliable or sufficient measure of health and should not be the primary target of care.
“Does HAES ignore health risks?”
No. It shifts the focus toward behaviors, labs, symptoms, and lived experience rather than assuming weight change is the solution.
“What about people who want to lose weight?”
HAES-informed care does not center intentional weight loss as a treatment goal, particularly due to limited long-term evidence for sustained weight reduction and concerns about harm from dieting cycles. The focus remains on sustainable, health-supportive behaviors regardless of weight change.
Read more about common myths about HAES.
Why This Matters in Clinical Practice
As a therapist, I worry when I hear my clients avoiding going to the doctor because of past experiences with doctors and medical practices who engage in weight stigma. I completely get it that they want to avoid the pain of shaming (more below on how we teach clients to advocate for themselves as well as find medical care that treats them well). As a culture, we have a way to go in addressing weight stigma in healthcare. That stigma is well-documented, and it absolutely leads to:
- Delayed or avoided medical care
- Misdiagnosis or underdiagnosis
- Increased psychological distress
- Reinforcement of disordered eating patterns
A HAES-informed counseling environment aims to reduce these barriers by prioritizing:
- Psychological safety
- Collaborative treatment planning
- Respect for body diversity
- Movement away from oppression and towards freedom
- Evidence-based, non-weight-focused interventions
Our Approach at Wolcott Counseling & Wellness
At Wolcott Counseling & Wellness, we integrate HAES principles into our therapeutic work in several ways. We encourage clients to question their assumptions that they must have a smaller or lighter body. We encourage a critical lens to examine the assumptions, demands, and shaming by a society that privileges small bodies and does not honor body diversity. We explicitly honor diversity. And we further integrate a holistic view of health by:
- Providing weight-neutral, trauma-informed counseling
- Supporting clients with eating concerns without diet culture frameworks
- Addressing shame, body image distress, and identity concerns
- Collaborating with clients to define health in ways that are personally meaningful
- Encouraging group therapy to disrupt negative narratives and promote new options
- Recognizing the impact of systemic weight bias and working to reduce its effects in care
We support clients in building a relationship with food, body, and self that feels stable, flexible, and sustainable. We aim to help clients free themselves psychologically by looking at culture through a critical lens and questioning what they’ve been taught, implicitly and explicitly, through our diet and thinness culture. We demonstrate that wellness is achievable through a diversity of means and available to a diversity of bodies. We don’t all have to fit into one culturally approved size! And we all deserve respect and the highest quality care, no matter what size our bodies are.
Finally, we help clients advocate for themselves. Through referral to HAES-informed providers, through coaching the possibilities of rejecting, for example, unnecessary weigh-ins at every single health appointment, through speaking with their doctors directly about these concerns, through empowering them to ask for what they need and arming them with the information that helps–these are some of the ways we approach our work with our beloved clients.
Discovering Multidimensional Health at Wolcott Counseling
For many individuals, especially those with histories of dieting, body shame, or disordered eating, health conversations can feel loaded or invalidating. A HAES-informed approach is not about minimizing those concerns, but about removing unnecessary harm from how health is discussed and treated.
Health is multidimensional. It includes physical, emotional, and social well-being, and it exists across all body sizes. For trauma-informed counseling in Gainesville or through telehealth, contact Wolcott Counseling & Wellness today for an appointment with a caring, informed therapist. We are here for you!.
Resources
https://www.nationaleatingdisorders.org/size-diversity-and-eating-disorders/
https://www.chhs.colostate.edu/krnc/monthly-blog/common-health-at-every-size-myths/
