Book Referral: Health at Every Size, Linda Bacon, PhD

Health at Every Size: The Surprising Truth About Your Weight

I was a fat kid for most of my childhood. When I look at old pictures now, I see that the range of my weight fluctuated throughout childhood, but when I was in it I just thought of myself as fat. I ate lots of food with high sugar and fat content and little nutrition. Coordination was a challenge, and often when I played sports I felt humiliated by how terrible I was at them. Until my dad and my Boy Scout Troop got me into hiking, I avoided most physical activities.

I remember in particular a music teacher in my elementary school, who for some reason always seemed to go out of her way to point out that I was fat. One time she was teaching us a particular line dance, and dancing was one of the few activities I’ve always enjoyed. She came up to me while I was practicing and said, with this syrupy sweet patronizing concern, “This is hard, isn’t it?” I wasn’t winded at all, I didn’t feel tired. I had no idea why she was saying this to me except to point out I was fat. I was probably about nine years old. Kids aren’t stupid.

These days, I am not as fat as I was. Others don’t believe I was ever that kid; part of me may never believe I’m not still that kid. I’ve been through lots of phases: wearing too-tight clothes as “motivation” to lose weight, shaming myself for what I ate, feeling guilty for eating “bad” things anyway, calorie restriction, and more. I’ve been recently reflecting on the great irony that some of the most thin, muscular people I know still fixate on their food choices and the specter of becoming fat; while some of the people who most fervently indulge in all their desires struggle with discomfort and dissatisfaction in their bodies. Doesn’t anyone just get to enjoy food and love their bodies?

Upon the urging of several peers and clients, I recently picked up Dr. Bacon’s Health at Every Size (HAES)The introduction alone inspired feelings of deep discomfort and tearfulness. Her approach suggested that the impossible was possible: we could learn to love and trust our bodies to regulate themselves while enjoying food and movement. We could become more deeply acquainted with the body’s instinctive weight-management system and worry less about external measures of what and when we’re supposed to eat. That sounds so wonderful, I thought. And then the fear: But will I be thin?

HAES takes its name from a larger movement of fat acceptance and body positivity, people who are challenging the shame and bad science around body weight and size. This movement questions the idea that being fat is intrinsically an awful, undesirable experience. They point toward the consequences of bariatric surgery and oppression against fat people as greater health risks. Dr. Bacon points to the increase in life expectancy that occurred during the same period as an increase in average body weight in the United States.

Dr. Bacon spends several chapters addressing commonly held beliefs about obesity, diet, and weight loss, and lays out for us the science that undermines and contradicts those beliefs. Instead, she lays out a convincing case that our efforts to manage weight are more harmful, such as: widely practiced dieting habits trigger the body’s instinctive mechanism of putting on more body fat to compensate for famine. One of the things I appreciated, too, was her exploration of all the different biological, social, economic, and genetic mechanisms that contribute to body size and body fat. If anything, this was my greatest challenge with the book: she spends so much time, necessarily, addressing and challenging all of our beliefs that I kept wanting to skip ahead to the part where she tells me what to do. Just tell me what to do!!!

A cursory reading of her approach may leave some thinking she’s saying not to have any concern about exercise and what we eat, but that isn’t what she’s doing with HAES. If anything, this movement is leading us toward a way to honor food and movement while also giving up the “war on obesity.” She provides structured practices and suggestions to follow, all of which help you become more deeply acquainted with your body and its unique needs and signals.

This is not about externally regulating ourselves by eating only these kinds of food, doing X amount of exercises per day, or only eating Y amount of calories. This is about learning your body’s signals for hunger and fullness, and more importantly, respecting them. This is about learning what kinds of movement you enjoy, things that are fun for you. Dr. Bacon argues, with scientific evidence, that taking pleasure in the foods we eat increases our body’s efficiency at absorbing and processing their nutrients. This is not simply about eating foods that taste good; it’s about slowing down and being fully present while eating, truly savoring the food.

When we tune into our bodies, Dr. Bacon suggests, we arrive at our “setpoints,” the body size and weight best for our own health. This means some of us may find ourselves in thinner bodies because we’ve eaten past our setpoints for years, while others may find themselves in fatter bodies because they’ve been under their setpoints. Our bodies have all these wonderful instinctive mechanisms to help us move toward wellness, but the overculture teaches us not to trust them. Instead marketing programs sells us ways to “hack” them, ignore them, overcome and subvert them. We devalue our emotions and then wonder why we’re empty inside. We don’t take naps when we’re sleepy, we drink more coffee and then can’t sleep at night. We deny ourselves when our bodies crave food and then we indulge past the point of fullness.

The approach promoted by HAES resonated deeply with me and my therapeutic approach to lasting change. Shame, in my opinion, is a terrible strategy for creating healthy long-term change. Shame at its worst keeps us stuck in unworkable patterns. As someone who has emotional eating patterns, feeling shame about my eating only leaves me feeling defeated and like “What’s the point? I might as well keep eating even though I feel gross.” Shame says, “I am worthless, so what I do doesn’t matter.” Even when Shame leads us to change a specific habit, often we end up in another unhealthy pattern, like people who exercise to the point of severely harming their bodies. Healthy pride says, “I am worthy, so I will do the things that help me to feel good, energized, attractive, and healthy.” HAES to me speaks to an inside-out relationship to my body: what matters is that I am happy in and with my body, not about how much fat my body has.

HAES has shown me that there’s conditioning that I still need to question and unpack, and yet it also connects with the practices that have helped me to feel good in my life. Years ago I decided it was unhealthy to wear clothes that made me feel unattractive, so I started buying pants that I liked and fit me comfortably. I also started doing the exercises that I enjoyed and changed my food habits away from chips and soda and toward carrot sticks and salads. I went out dancing and had fun. In the end, with all those healthy behaviors, does it matter what number was on the scale? If your answer is “Yes,” then the next question to wrestle with is “Why?”

More Reading

After the Biggest Loser, Their Bodies Fought to Regain Weight” – by Gina Kolata, about the scientific studies that followed former participants in The Biggest Loser, whose bodies demonstrated severe decrease in metabolism.

On ‘tough love’ and your fat friend’s health.” – by Your Fat Friend. An excellent article about living as a fat person subjected to constant unhelpful, oppressive shame and scrutiny.