Health at every size is a concept embraced by some fat and size acceptance activists. For those not familiar with it, it was popularised by Linda Bacon, and simply put, it suggests that there’s a wide variation of bodies and that people should focus on what makes their bodies healthy, rather than on eating and exercising for weight control. There are a number of components of health at every size, including ‘intuitive eating’ and the concept of ‘joyful movement.’
When I initially heard about HAES back in my nascent days of exploring fat, size, and my relationship with my own body, I was excited about it. I’d been reading a lot of stories about the false beliefs about fat and health, and I liked the idea of a movement specifically reinforcing the idea that being fat doesn’t make you unhealthy, since one of the most common charges levied against us fat folks is that we are unhealthy because we are fat, that fat makes people unhealthy.
But then I got sick. Very, very sick. And I lost a lot of weight, and people praised me for it, and I started thinking about the dichotomies being set up with health at every size, and who was being left out of this equation: People who are unhealthy. Many people are unhealthy and also fat, many people are fat and disabled, and the framing of health at every size can exclude them.
It’s hard to eat intuitively when you have allergies, or when you have conditions that require you to be very careful about what you eat for other reasons. When you’ve got to plan out your meals and you can’t afford to be ‘intuitive,’ to decide to skip a meal when you don’t feel like eating. It’s hard to eat intuitively also when you have limited energy for cooking and you might not be able to eat when you want, when you want. Or when you’re so sick that the thought of eating at all is nauseating.
…for those who accept [HAES] as a blanket, one size fits all (so to speak) philosophy, there tends to be an erasure of people with disabilities from the size acceptance movement
As for ‘joyful exercise,’ well, not all bodies want to move, and not all bodies move joyfully. I know that I personally tend to feel better, emotionally, when I do yoga regularly. Which is great, for me. But I’m not going to tell other people to do yoga; some people find the poses difficult to hold or the experience uncomfortable or just plain don’t like it. For people who like to move and want to move, finding the ways that their bodies move comfortably and joyfully is awesome, but not everyone wants that, and not everyone can reach that. Should someone who can’t exercise be drummed out of the fat acceptance movement?
I want to be clear that not all fat/size activists embrace this concept, and that some of those who do think of it as a framework that works for some people, and not for others, that people need to navigate their own relationships with their bodies rather than being forced to think about them in a particular way, acknowledging the variation of human experience and emphasising the fact that people should not be told how to feel about their bodies. But, for those who accept it as a blanket, one size fits all (so to speak) philosophy, there tends to be an erasure of people with disabilities from the size acceptance movement; we’re not healthy, so right there, we’ve gone and shot a big hole in health at every size, no matter why we are unhealthy, no matter what the intersections (or lack thereof) between our health and weight may be.
Which is unfortunate, because size acceptance needs to work for us, too. Many of the FWD contributors, just for example, are fat to varying degrees, and I know we have a lot of fat readers. Our fat bodies need to be accepted and embraced too and we need to be able to talk about our relationships with our bodies; how, for example, people with poor thermoregulation experience chub rub on a whole new and very uncomfortable level. We need to talk about what it’s like to not be healthy at every size.
I’m not advocating for throwing out HAES. There are a lot of people who clearly benefit a lot from this model and for whom it has played an important role in thinking about their bodies and their relationship with the world. But we also need to find a way to create a space for discussions about fat and disability, for what it’s like to be happy and fat, happy and disabled, sad and fat, sad and disabled.
Hardline HAES advocacy plays directly into the good fatty/bad fatty dichotomy that looms so large in the minds of many of us. The stereotypes about ‘lazy fatties’ take on a new dimension when they are weaponised against people with disabilities who need to use mobility aids, who can’t hop off the couch and start cycling for fun, who experience feelings of guilt and inadequacy about being unable (or unwilling!) to exercise.
A huge part of fat acceptance is the idea that there are no ‘perfect’ bodies and that bodies naturally come in a wide range of sizes, colours, shapes. But bodies also naturally come in a wide range of degrees of disability and health, and that intersects directly with fatness, with social attitudes, with acceptance of the body.
Michelle at The Fat Nutritionist has written about the concept of being obligated to be healthy, pushing back against certain aspects of the HAES narrative:
It is sad that this even needs to be said, but given the fact that we essentially live in a health meritocracy, let me be the first to announce:
You are under no obligation to be healthy.
And, as an addendum: even if you were, eating “well” and exercising wouldn’t guarantee your success. There. I’ve said it. And as much as this might chap the ass of every health promoter out there, I feel that personal agency and a basic sense of privacy are sorely missing from most conversations of health promotion, and from conversations of Health at Every Size.
On the one hand, I believe that health is a human right and all people deserve an opportunity to be healthy and to live in a way that they find personally healthful and rewarding. All people deserve access to fresh food and other dietary needs, and all people deserve the right to be able to exercise in comfort and in the way they want. No one should ever be judged for the type of exercise she does or where she does it; a fat women should be able to join a gym or a yoga class or any other exercise environment without being treated rudely, and without being pressured to pursue weight loss. We need to live in a world that is supportive of health as a basic human right.
But we also need to live in a world where health is not viewed as an obligation, and here is where I begin to be troubled by HAES. While HAES does not push health as an obligation, it is sometimes implied, and this seems to set up a ‘good fatty, bad fatty’ dichotomy, in which those who pursue health are doing fatness ‘right’ and those who do not are doing something wrong. While, of course, many proponents of HAES don’t believe in such a dichotomy and in fact actively fight against it, some aspects of the movement do tend to trend this way, and perceptions of the movement can create negative feelings about it.
While HAES recognises that breaking old habits can be extremely difficult—fighting self-destructive eating patterns in particular can be a huge challenge—it doesn’t always recognise that for some people, ‘health’ is a larger issue. For those of us with complex health problems, the reminder that we should be ‘healthy’ serves as another reminder of our role as social outsiders, because we are people who are not healthy, and will never be healthy, no matter how hard we try. We may not be able to eat intuitively, for a variety of reasons, and we may have difficulty exercising, but we still have value as human beings, and that must be part of a comprehensive fat acceptance movement—but where do we fit in within the HAES framework? How can we be accounted for in a radical social movement that at its roots still stresses ‘health’ and certain assumptions about health and bodies?
…for some of us, our relationship with the movement is more complex, because unintentionally or not, it reminds us of the social expectation that we be healthy and that we perform to certain standards
For those lying at the intersection of fatness and disability, HAES can sometimes be empowering. It can be the tool used to fight back against medical meddling, to develop more autonomy and freedom, to feel more comfortable in a body that does not always behave as desired. But for some of us, our relationship with the movement is more complex, because unintentionally or not, it reminds us of the social expectation that we be healthy and that we perform to certain standards: we must be healthy happy fatties, and we cannot diverge from this mission, or we will be letting the side down.
There is nothing wrong with being fat and unhealthy, whatever the reasons for your ill health, because you do not have an obligation to be healthy. Nor do you have an obligation to provide your good fatty credentials, your excellent cholesterol and fitness assessments and other evidence of being perfectly healthy but also fat. There is something wrong with not being able to access the level of health you want, and while I think this is what HAES is trying to push at, the movement doesn’t always quite get there. These subtleties and complexities require navigating careful ground, and I think many of those within the movement are working on that very ground, but sometimes, I need to take a step back from HAES, because sometimes, it reminds me yet again of the ways I don’t fit in.
Image: Clapagaré, Flickr.