Health At Every Size
HAES Therapists Chicago
Health At Every Size (HAES) and Binge Eating Disorder (BED)
Written by: Bari Rothfeld, LCSW, CADC
Clinical Director & Director of Binge Eating Services
Our culture’s declared “war on obesity” has resulted in significant harm to folks across the size spectrum. Traditional measures of body weight/size do not accurately reflect an individual’s health status and often lead to ineffective interventions rather than efforts that enhance health. And keep in mind that health cannot simply be characterized as the absence of physical or mental illness, limitation, or disease. Health exists on a continuum that varies with time and circumstance for each individual.
The Health At Every Size (HAES) approach is a continuously evolving alternative to the weight-centered approach of treating patients. It is also a movement working to promote size-acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness. The HAES approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes. The framing for a HAES approach comes out of discussions from progressive healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES model is an approach to both policy and individual decision-making that addresses the more broad forces that support health.
Think of HAES as a weight-neutral approach to health care. A HAES provider may promote the pursuit of healthful behaviors (like eating vegetables, moving your body, getting enough protein, etc.) but it would not be for the intention of weight loss, and more so for the inherent health benefits of those behaviors.
Accept and respect the inherent diversity of body shapes and sizes, and reject
the idealizing or pathologizing of specific weights.
Support health policies that improve and equalize access to information and
services, and personal practices that improve human well-being, including
attention to individual physical, economic, social, spiritual, emotional and other needs.
Eating for Well-Being:
Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
Life Enhancing Movement:
Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose
Binge Eating Disorder (BED) is the most common, yet least understood eating disorder that exists. It is estimated that ~3% of the US population struggles with BED at any given time. A 2007 study published in Biological Psychiatry captured 9,282 English-speaking Americans and revealed that 3.5% of women and 2% of men struggle with BED in their lifetime, making it 3x more common than anorexia and bulimia combined. Worse, it’s estimated that only ~43.6% of those struggling will receive help.
Despite BED’s prevalence, this disease continues to fly under the radar. The lack of awareness among those struggling, their friends/family, society, and the health/mental health care community is astounding. The American Psychiatric Association didn’t even recognize BED as a legitimate diagnosis in the Diagnostic Statistical Manual (DSM) until 2013, yet its existence precedes that date by decades.
According to DSM-5, the key diagnostic criteria include:
Recurrent and persistent episodes of binge eating
Binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of being embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
Marked distress regarding binge eating
Absence of regular compensatory behaviors (such as purging)
It’s important to debunk the myths that surround this disease because they fuel the stereotypes that discourage people from accessing help. I’m hopeful that the harder we work to understand what BED is, and isn’t, the more accessible and less pathologized support for BED will be. See below for some of the most common BED myths circulating:
BED is just overeating
False. BED is complex—it is compounded by various factors related to both nature (our genetics) and nurture (our environment), and it is fueled by guilt, shame, trauma, a desire to self-soothe, and ridiculously unattainable body ideals. Within those complexities lies a very common misconception: that BED is “just overeating.” The reality though is that restriction is one of the most central aspects of BED! The confusion and lack of accurate information available is rampant and even the name undervalues the fact that BED is actually a disease of undereating. The restrict-binge cycle is vicious, and the 72-billion-dollar (and growing) diet industry has brainwashed many of us to believe that restriction is “good” or “healthy.” Oftentimes we’re unaware we’re even doing it. Or worse, we’re praising ourselves for restricting, completely unaware that it’s triggering our next binge. We are trained to seek help for the binge behavior but fail to see the problem with the restrictive nature of the disease.
2. You have to be “overweight” or live in a larger body to be diagnosed with BED
False. Not all people with BED live in larger bodies, and similarly, not all people who live in larger bodies have BED. Yes, this eating disorder is characterized by an intense focus on food, but as we learned above, the focus is not on eating food. There is also an intense focus on attempting to and succeeding at restricting food. Those with BED do binge and that absolutely can result in weight gain, but it doesn’t always. The more we circulate this misconception, the less accessible care for BED will be. Uninformed health/mental health care providers will continue to overlook BED in thin or “average-bodied” folx, and thin or “average-bodied” folx will continue to not access care.
3. Dieting is how you recover from BED
False. Dieting is actually a catalyst for bingeing, so it certainly won’t help in recovery from it. Amy Pershing, LMSW, ACSW, founder of Bodywise BED Recovery Program describes the problem with dieting best:
“Despite this research, sales of diet programs remain brisk. The Boston Medical Research Center indicates that approximately 45 million Americans diet each year, with an average of five attempts per dieter. Diet companies begin grooming new dieters by targeting people as young as age 8. And yet, diets fail at an astonishing rate. This isn’t breaking news; doctors and researchers know that the holy trinity of “obesity” treatments—diet, exercise, and medication—don’t work. They also know that yo-yo dieting (which is almost unavoidable given the failure rate) is linked to, among other things, heart disease, insulin resistance, higher blood pressure, inflammation, and, ironically, long-term weight gain. Still, they push the same ineffective treatments, insisting that they will make you not just thinner, but healthier. In reality, 97 percent of dieters regain everything they lost and then some within three years. Your chance of keeping weight off for five years or more is about the same as your chance of surviving metastatic lung cancer: approximately 5 percent. “Obesity” research fails to reflect this truth, in part because it rarely follows people for more than 18 months. This makes most weight-loss studies disingenuous at best and downright deceptive at worst. To add insult to injury, dieters blame themselves, not dieting, for their virtually inevitable string of “failures.” This reinforces already present trauma narratives of unworthiness and unlovability.”
If you want to recover from BED, challenging diet culture and making peace with food is crucial. Our bodies are biologically unaware of the difference between dieting and famine. We are wired to become obsessive about food when we’re hungry- that’s biology, not a disorder. In addition, bodies don’t like to change, and dieting is inherently a request for change. Your body will fight to resist because nourishment is linked to survival and weight loss will always feel like a threat. Not that weight is relevant to a BED diagnosis, but one thing is for sure, attempts at weight loss will almost certainly result in weight gain. We can’t focus on weight loss in BED recovery if weight gain wasn’t the problem in the first place.
4. Only adults can have BED
False. Although, the majority of individuals who struggle with BED are diagnosed in
adulthood, BED impacts ~1.6% of children between 6-18yo. It is imperative that parents,
educators, and health/mental health care providers keep a close eye on children if they
suspect binge eating symptoms are present. But just as weight shouldn’t be the determining factor in diagnosing BED in adults, it most certainly shouldn’t be for children either. Growth spurts and the need for additional nutrients through development will inevitably create variations in children’s weight as they age, so creating the narrative that weight gain is to be feared will only create greater problems down the road.
5. BED isn’t that big of a deal
False. Nothing about BED is insignificant—it is a serious mental health condition that warrants and necessitates appropriate treatment. Eating disorders have the second highest mortality rate of all mental health conditions next to opioid addiction and are so commonly associated with other mood disorders like anxiety, depression, and PTSD. Untreated, BED can and will lead to long-term physical, emotional and social consequences.
BED may have played a role in your past, and even your present, but it does not have to play a role in your future. Eating disorders, especially BED, are so often bred in secrecy and isolation, meaning that the antidote is openness and support. As society, and most notably the health/mental health care community deepens its understanding of this complex disease, it is my hope that those struggling will more easily recognize the symptoms and that appropriate care will be more accessible.
HAES and BED Resources
*The Anti-Diet, Christy Harrison
*My Body Is Not An Apology: The Power of Radical Self-Love, Sonya Renee Taylor
*Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, Linda Bacon
*The F*ck It Diet, Caroline Dooner
*Body Kindness, Rebecca Scritchfield
*Beyond Beautiful, Anuschka Rees
*Just Eat It, Laura Thomas
*Fearing the Black Body: The Racial Origins of Fat Phobia, Sabrina Strings
*Hunger, Roxane Gay
*What We Don’t Talk About When We Talk About Fat, Aubrey Gordon
*Broken Mirror, Katharine A Phillips (body dysmorphia)
*Guidelines for Therapists Who Treat Fat Clients
*Everything You Know About Obesity Is Wrong https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/
*Weight Loss May Not Make You Healthier
*But I Like My Body
*Weight Science: Evaluating The Evidence For a Paradigm Shift…
*The Health Impact of Weight Stigma https://www.todaysdietitian.com/newarchives/0118p24.shtml
*The Weight Inclusive vs Weight Normative Approach to Health…
*Dangers of Clean Eating in Recovery
*EDs During Holidays (Fasting):
*Brain Scan/Menstrual Cycle
*What To Do When Everyone Around You is Talking About Diets
*Positive Body Talk (Parenting) https://parenting.nytimes.com/feeding/body-image-kids
*The Voice of an Eating Disorder and 7 Ways to Shut It Up https://blogs.psychcentral.com/weightless/2010/03/the-voice-of-an-eating-disorder-7-ways-to-shut-it-up/
*HAES Health Sheets for diagnoses that medical professionals may harmfully end up prescribing “weight loss”
*The Body Love Society
Weight Gain Fear video 1: http://thebodylovesociety.com/wtf1/
Weight Gain Fear video 2: http://thebodylovesociety.com/wtf2/
Weight Gain Fear video 3: http://thebodylovesociety.com/wtf3/
Weight Gain Fear video 4: http://thebodylovesociety.com/wtf4/
Weight Gain Fear video 5: http://thebodylovesociety.com/wtf5/
*The Love of Food
*Healthism & Fat Phobia with Hilary Kinavey
*The Body Love Project Fearless Rebelle Radio
*Maintenance Phase-Aubrey Gordon
*Tabitha Farrar: https://www.youtube.com/channel/UCa7G1P5WQopVMc9qTSP_lgA
*Weight Loss Myths: https://www.youtube.com/watch?v=F94IY408Q4E&list=WL&index=11
Our HAES Therapists at Cityscape Counseling in Chicago are ready to help you!