What Health at Every Size® Actually Means – And What It Doesn’t

Conversations about our weight, health, and bodies are everywhere – from doctor’s offices to social media feeds, dinner tables, and wellness ads. In the midst of this noise, the phrase Health at Every Size (often shortened to HAES^®) comes up again and again. Sometimes it’s used as a rallying cry for inclusivity. Other times it’s dismissed as “promoting obesity” or “ignoring science.”

The truth? Both of those extremes miss the mark. Health at Every Size (HAES) isn’t about denying the realities of health, nor is it a free pass to ignore medical concerns. Instead, it’s a research-informed framework that challenges weight stigma and focuses on health-promoting behaviors that can benefit people across the size spectrum.
This post unpacks what HAES actually means – and just as importantly, what it doesn’t. We will explore common misconceptions, review the evidence, and consider what this approach looks like in clinical care.

The Origins of HAES

The Health at Every Size framework emerged as a response to longstanding problems in how medicine and society treat people in larger bodies. Weight has often been framed as the single most important indicator of health. Patients in larger bodies are frequently told that weight loss is the only solution to their medical concerns, whether they come in with knee pain, a sinus infection, or depression.

But decades of research show that intentional weight loss, while sometimes achievable in the short term, rarely leads to sustained long-term weight reduction for most people ^1-2. In fact, most individuals regain lost weight within a few years, and many end up in weight cycling patterns – losing and regaining repeatedly – which is associated with poorer cardiometabolic health, increased inflammation, and psychological distress ^3-6.

HAES was developed to offer an alternative: an evidence-based, compassionate, and weight-inclusive way to approach health. It shifts the focus from body size to behaviors, social context, and systems of care.

The Five Core Principles of HAES

The HAES framework is grounded in five key principles:

1. Weight Inclusivity – Accept and respect the inherent diversity of body shapes and sizes. Reject the idealization or pathologizing of specific weights.
2. Health Enhancement – Support health policies and practices that improve and equalize access to information and services, while also working to address broader determinants of health such as poverty, discrimination, and healthcare access.
3. Respectful Care – Acknowledge biases, end weight discrimination, and work to provide respectful, evidence-based care to people of all sizes.
4. Eating for Well-being – Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than external rules about weight control.
5. Life-Enhancing Movement – Encourage physical activity for all people, regardless of size, by focusing on enjoyment and accessibility, not just calorie burning or weight loss.

These principles are not just philosophical; they have practical applications in medical practice, mental health care, public health, and nutrition counseling.

What HAES Does Mean

It Means Shifting the Focus from Weight to Behaviors

For decades, weight has been treated as a proxy for health, but this oversimplification overlooks the many factors that contribute to well-being. Two people with the same BMI can have very different health outcomes, just as two people in different-sized bodies may share similar lab values, fitness levels, and disease risks.

HAES reframes the conversation by centering on behaviors that truly matter: eating patterns, movement, stress management, medication adherence, sleep quality, and social support. For example, encouraging a patient to add more vegetables, find an enjoyable form of movement, or establish a consistent bedtime routine can have measurable health impacts – whether or not their weight changes.

This behavioral focus helps dismantle the myth that only thin bodies are healthy bodies. It gives people actionable steps they can actually control and sustain, while avoiding the frustration and shame of failed weight-loss attempts. Instead of prescribing “lose 20 pounds” – an outcome that is difficult to control – providers may suggest “let’s work on lowering your blood pressure by incorporating a few small, realistic shifts into your meals and activity.”
When health care emphasizes what people do instead of what they weigh, patients are more likely to see progress, feel empowered, and engage consistently with their care.

It Means Recognizing Social Determinants of Health

Health is never just about personal choices. Where people live, the food they can afford, whether they feel safe walking outside, their stress load from work or caregiving – all of these social determinants matter as much, if not more, than individual behaviors.

HAES brings these systemic realities into focus. Instead of assuming that a person’s body size reflects willpower or “discipline,” a HAES perspective acknowledges barriers like:

• Food access: Limited grocery store availability, high food prices, or lack of culturally relevant foods
• Movement opportunities: Unsafe neighborhoods, lack of parks, or gyms that aren’t financially or socially accessible
• Healthcare inequities: Bias, discrimination, and lack of insurance coverage that create major gaps in preventive care
• Stress and discrimination: Experiences of racism, sexism, weight stigma, and other forms of bias all impact hormonal regulation, sleep, and long-term health outcomes

By naming these realities, clinicians can partner with patients to identify realistic steps within their context. For example, instead of suggesting a gym membership, a provider might ask, “Do you have a safe place to walk nearby, or would you prefer we brainstorm some at-home movement options?”

Recognizing social determinants doesn’t remove individual responsibility; it simply creates a more compassionate, realistic foundation for change.

It Means Practicing Respectful, Evidence-Based Care

Respectful care is at the heart of the HAES approach. For many people in larger bodies, the medical system has been a source of shame, dismissal, and trauma. Patients in larger bodies often report avoiding healthcare because of negative past experiences ^7-8: being shamed, dismissed, or told to lose weight before their concerns are even investigated. This avoidance can worsen health outcomes – not because of weight itself, but because people aren’t getting the timely care they deserve.

Practicing respectful, evidence-based care means recognizing that health concerns can’t be addressed through shame, blame, or assumptions. It also means being intentional about the language we use. Words matter. The way clinicians frame conversations about health and body size can either open the door to collaboration – or shut it completely.

Examples of respectful, stigma-reducing language include:

• Say “people in larger bodies” rather than labeling someone as “overweight” or “obese.” These medicalized terms can feel dehumanizing and carry a heavy history of stigma.
• Focus on behaviors, not numbers. Instead of saying “You need to lose weight to improve your blood pressure,” try, “Let’s talk about strategies – like stress management, nutrition, and activity – that can help lower your blood pressure.”
• Ask permission before discussing weight. For example, “Would you like to talk about how weight may or may not be affecting your health today?” This respects autonomy and reduces surprise or defensiveness.
• Affirm the person, not the problem. Use phrases like, “Your body deserves care and respect at every stage,” or “Health comes in many shapes and sizes.”
• Highlight strengths. If a patient is already walking regularly, cooking more meals at home, or improving sleep routines, acknowledge these behaviors as valuable health-promoting actions – regardless of weight change.

By using inclusive, respectful language, healthcare providers can create an environment where patients feel safe, seen, and motivated to engage in care. The research is clear: when people feel respected, they are more likely to attend follow-ups, adopt healthy habits, and trust their providers.

It Means Supporting Sustainable, Enjoyable Habits

Crash diets and punishing workout regimens often lead to short-term change followed by burnout, frustration, and weight regain. The HAES framework recognizes that sustainable, enjoyable habits are what actually support long-term health.

This might mean encouraging a patient to try a joyful form of movement – dancing, gardening, swimming, or walking with a friend – rather than prescribing a rigid exercise program that feels like punishment. Similarly, instead of rigid meal plans or calorie counting, HAES-informed nutrition care emphasizes flexibility, satiety, and satisfaction.

Importantly, sustainability is personal. What works for one person may not work for another. A HAES approach invites curiosity rather than judgment: “Which of these habits feels realistic for you right now?” or “How can we make this enjoyable, so it’s something you want to keep doing?”

By focusing on habits that are both health-promoting and pleasant, HAES helps people break the cycle of restriction and guilt. Instead, individuals can build routines they actually look forward to – and that’s what makes them stick.

It Means Valuing Mental and Emotional Health

Physical health doesn’t exist in a vacuum. Stress, depression, anxiety, and body image struggles all affect the body as much as diet or exercise do. HAES acknowledges that mental and emotional well-being are integral parts of health.

For people in larger bodies, weight stigma itself can be a chronic stressor, raising cortisol levels and increasing the risk of health problems. Diet cycling and feelings of failure after weight regain can also erode self-esteem and increase risk of disordered eating.

HAES counters this by validating patients’ lived experiences and offering compassionate, nonjudgmental care. This may include:

• Encouraging self-compassion practices to reduce shame
• Referring to therapy or support groups that specialize in body image and eating concerns
• Reassuring patients that their worth and identity are not tied to a number on a scale
• Framing health goals around energy, mobility, or stress relief rather than size

When emotional well-being is prioritized alongside physical health, patients are more likely to feel resilient, empowered, and capable of sustaining positive change.

What HAES Does Not Mean

Because HAES is often misunderstood – or misrepresented – it’s just as important to clarify what it does not mean.

It Does Not Mean “Everyone is Healthy at Every Size”

The name Health at Every Size can be misleading at first glance. HAES is not claiming that every person, at every body weight, is automatically healthy. That would be inaccurate and dismissive of the complex realities of health conditions. What HAES emphasizes instead is that health is possible in a wide range of body sizes, and that weight alone is not a reliable or sufficient measure of someone’s well-being.

Consider two patients: one in a smaller body with high cholesterol, high blood pressure, and smoking habits, and another in a larger body who eats balanced meals, moves regularly, and has normal lab values. By weight alone, the first person might be assumed “healthy” while the second is assumed “unhealthy” – and both assumptions would be wrong. HAES rejects this oversimplification, encouraging clinicians to assess the whole health picture: lab work, lifestyle, genetics, social context, and emotional well-being.

So while not everyone is healthy at every size, everyone deserves the opportunity to pursue health and receive respectful, stigma-free care.

It Does Not Mean “Ignore Medical Conditions”

Some critics of HAES mistakenly believe it asks providers to overlook health issues that may be more common in larger-bodied patients, like sleep apnea, joint pain, or type 2 diabetes. In reality, HAES-informed care takes these conditions seriously – it simply treats them directly rather than prescribing weight loss as the primary solution.

For example, in the case of type 2 diabetes, a weight-centered provider might say, “You need to lose weight to get your blood sugar under control.” A HAES provider, by contrast, would focus on blood sugar management behaviors: building satisfying, balanced meals; promoting enjoyable physical activity that improves insulin sensitivity; helping the patient access affordable medication; and addressing stress and sleep. These interventions can improve outcomes whether weight changes or not.

By treating the actual condition rather than using weight as a proxy, HAES makes care more targeted, respectful, and effective.

It Does Not Mean “Promote Obesity”

A common misconception is that HAES “celebrates” or “encourages” people to gain weight or ignore health risks. This is not the case. HAES is not about prescribing a certain body size, whether large or small. It is about removing stigma and making sure all people can access healthcare and pursue well-being.

Think of it this way: just as promoting smoking cessation is not the same as stigmatizing smokers, promoting body respect is not the same as encouraging unhealthy behaviors. HAES simply calls for dignity and evidence-based care at all sizes.
In fact, stigma itself is a health risk. Research shows that people who experience weight discrimination are more likely to avoid medical care, experience higher stress, and even have increased risk for conditions like hypertension and cardiovascular disease ^7-8. By dismantling shame, HAES creates a safer environment for health improvements.

It Does Not Mean “Reject Science”

HAES is sometimes caricatured as “anti-science” or “denying health risks,” but the opposite is true. HAES is grounded in decades of research showing ^9-12:

• Intentional weight loss is rarely sustainable long-term, with most people regaining lost weight within three to five years.
• Weight cycling (yo-yo dieting) is linked to negative outcomes, including higher cardiovascular risk and psychological distress.
• Weight-neutral interventions – focusing on behaviors rather than the scale – can improve blood pressure, cholesterol, blood sugar regulation, fitness, and self-esteem.

HAES also aligns with broader evidence in public health: social determinants like poverty, stress, discrimination, and access to care are just as critical to health outcomes as individual choices.

Far from rejecting science, HAES simply insists on interpreting the data accurately: correlation is not causation, and focusing solely on weight has not improved population health in the ways once promised.

It Does Not Mean “Never Talk About Weight”

Some assume that HAES requires clinicians to avoid the topic of weight altogether. That isn’t accurate. Instead, HAES encourages careful, consensual, and contextual conversations about weight. Weight may still be relevant – for example, in medication dosing, surgical considerations, or certain risk discussions. But a HAES framework asks providers to approach this with sensitivity, transparency, and without assuming that “smaller is always better.”

A key concept here is set point theory. This theory suggests that each person’s body tends to maintain a relatively stable weight range, regulated by genetics, hormones, and metabolism. When someone loses weight through restriction, the body often adapts – slowing metabolism, increasing hunger signals, and defending its preferred range. This helps explain why long-term weight loss is so difficult to sustain.

HAES-informed clinicians use set point theory to reframe weight conversations. Rather than telling a patient to fight their biology with endless diets, they might say, “Your body may have a weight range it naturally returns to. Instead of focusing on changing that number, let’s focus on behaviors that improve your health and quality of life regardless of your body size.”

By doing so, weight becomes one part of the health picture – not the only one – and patients are freed from the cycle of shame and frustration that weight-centered care often perpetuates.

The Clinical Evidence for HAES

Several studies have tested weight-neutral interventions based on HAES principles:

• The HAES Randomized Controlled Trial ¹³ found that women in the HAES group showed sustained improvements in blood pressure, cholesterol, eating behaviors, and psychological well-being compared to women in a weight-loss-focused group.
• Follow-up studies ^14-15 have shown that weight-neutral approaches reduce disordered eating behaviors and improve physical activity participation.
• Systematic reviews ^9-11 suggest that HAES-based interventions may lead to better psychological outcomes and at least equivalent (if not better) physical health outcomes compared with weight-loss interventions – without the harms of weight cycling.

While research is still growing, the evidence base supports HAES as a legitimate, beneficial healthcare framework.

A Clinical Perspective: What This Looks Like in Practice

Imagine two patients, both with prediabetes:

• Patient A visits a clinic where the advice is simply “lose weight.” They’re given a calorie-restricted diet plan, with little discussion of their lifestyle, stress, or access to resources. They may initially lose some weight, but over time, they regain it, feel discouraged, and avoid follow-up care.
• Patient B visits a HAES-informed clinic. Their provider discussed meal patterns, energy levels, sleep, movement, and stress. They work together to set realistic goals, like adding a vegetable to most dinners or walking after work three times a week. Over time, Patient B’s blood sugar stabilizes, they feel more confident, and they continue regular care.

Both patients have the same diagnosis, but the approach to care – and likely the long-term outcomes – are very different.

Addressing the Criticisms

“But higher weight is linked to health risks.”

Yes, research shows correlations between higher body mass index (BMI) and conditions like type 2 diabetes, sleep apnea, and hypertension ^16-18. But correlation does not equal causation. Weight may be a marker, not a cause – or it may interact with other factors like genetics, stigma, or healthcare access. HAES doesn’t deny these links; it challenges simplistic explanations.

“But shouldn’t we encourage people to lose weight if it’s healthier?”

The problem is that sustained weight loss is extremely difficult to achieve for most people ^1-2. If a treatment works less than 5% of the time long-term, should it be the default recommendation? HAES emphasizes approaches that improve health regardless of whether weight changes.

“But won’t people use HAES as an excuse to ignore their health?”

In practice, HAES encourages more engagement with health, not less. Patients who feel respected and not shamed are more likely to seek care, follow medical advice, and adopt healthy habits.

Beyond the Clinic: HAES and Society

Weight stigma isn’t confined to healthcare. It shows up in workplaces, schools, media, and even family conversations. People in larger bodies are more likely to face discrimination in hiring, wages, and even medical treatment. These experiences contribute to chronic stress, which in turn impacts physical health.

By promoting respect, inclusivity, and evidence-based care, HAES has the potential to create not only healthier individuals but also healthier communities.

Key Takeaways

• Health is possible across the size spectrum. People can pursue well-being in bodies of many different shapes and sizes, and weight alone doesn’t define their health story.
• A behavior-focused approach creates more opportunities for health. By centering on habits, access, and care rather than the number on the scale, HAES opens the door to more sustainable and meaningful health improvements.
• Evidence supports weight-inclusive care. Research shows that weight-neutral approaches can enhance physical health, improve eating patterns, and strengthen psychological well-being.
• Compassionate, respectful care benefits everyone. When providers reduce stigma and focus on the whole person, patients feel heard, supported, and empowered to engage in health-promoting changes.

HAES promotes dignity and equity. By creating space for people of all sizes to access quality healthcare and resources, HAES fosters healthier individuals and healthier communities.

Final Thoughts

Health at Every Size is not a fad, nor is it a free-for-all. It’s a framework designed to make healthcare more effective, compassionate, and realistic. For patients, it means being seen and treated as a whole person – not a number on a scale. For clinicians, it means embracing evidence, reducing bias, and focusing on what truly improves health outcomes.

If we can move past the misconceptions, HAES offers a way forward: one that prioritizes dignity, equity, and genuine well-being for people in all kinds of bodies.

Sources: 

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