HAES is Not Spooky, but Bad Research Methods Are

What Will you Defend I recently had the opportunity to speak at The University of New Hampshire. I gave a talk to their healthcare and health promotions staff, taught a dance class, and then did two keynotes “Queer Bodies Great and Small” and “Athletes at Every Size.” The morning talk and the dance class went great and I was excited about the evening keynotes.

I was also anticipating some mild form of nonsense because there had been the usual unsuccessful e-mail campaign trying to get my talks cancelled.

As the students filed in, one guy sat in the back row of the auditorium with a tri-fold poster board (the kind that you would use for a 6th grade science fair.) He had written something on it in thin marker, and the lighting wasn’t good in the back so I couldn’t tell if he had just brought a school project with him or if this was some sort of protest. It turns out that he was going to help illustrate a basic error that is often made when it comes to Health at Every Size.

First let me start this like I started my talk. Size Acceptance and Health at Every Size are two different things. Size Acceptance is a civil rights movement, based on the fact that fat people have the right to exist without shame, stigma, bullying, and oppression and it doesn’t matter why we’re fat, what being fat means, or if we could become thin.

Health at Every Size is an evidence-based paradigm for personal health and healthcare where, realizing that “health” is complicated, multi-dimensional, not a barometer of worthiness, not an obligation, and not entirely within our control, the focus is on giving people information and options and respecting their decisions about healthy behaviors, and creating environments that are conducive to health, rather than on manipulating body size as a path to health.

People are allowed to disagree with the research about Health at Every Size, but that disagreement does not affect the facts of Size Acceptance or give people a pass on treating fat people with respect. Fat people don’t have to practice HAES, or any health practice at all in order to deserve to be treated with respect. A health practice is a personal choice and doesn’t make someone better or worse than anyone else. More on this can be found in this post.

After my first talk the dude picked up his science fair board and headed out of the room. Unbeknownst to me he tried to set up a protest, which is not allowed by the University. The staff was awesome and asked him to leave and, when he refused, finally called the police to have him removed (thanks to the officer who checked in on my several times to make sure I felt safe!)

I later found out that his sign said “HAES is Spooky” (so a few points for holiday relevance I guess?) and then said “Obesity causes” and listed a bunch of health issues. At that point I just felt bad that the hill this kid chose to die on was a first-day-of-research-class misunderstanding of correlation and causation.

This idea of insisting that fat causes health problems as a way to support diet culture – or protest the concept of Health at Every Size – is deeply flawed.

First is the the correlation vs. causation issue. There is a reason that “Correlation does not imply causation” is the most basic tenet of research, taught on the first day of every research class. The problem with correlational research is that it only shows that things happen at the same time, it does nothing to prove that one thing causes the other. While having a certain height/weight ration (ie: Obesity) may be correlated with health problems, causation isn’t proven. I explain this fully in this post.

Even if being fat is correlated with health issues, it does not follow that we should try to be thin to solve them. First of all, thin people get all of these issues so being thin can neither be a sure preventative or a sure cure and many fat people don’t have these issues so it’s obviously more complicated than size = health.

The idea that if we can make fat people look like thin people then they’ll have the same health outcomes is also on very shaky ground. Male pattern baldness has a very high correlation with increased risk of cardiac incidences, but getting those bald men to grow hair, (and/or starting a government sponsored “War on Baldness”) won’t decrease their risk of heart attacks. Because even though they are highly correlated, it turns out that they are both caused by a third factor.

There are variables that we cannot tease apart when looking at the difference between thin people and fat people and our health, like the fact that most fat people have a history of chronic dieting, and have a history of living with stigma, bullying and oppression, so when we study the effects of being fat on health, we’re also studying the effects of chronic dieting on health, and the effects of constant stigma on health. It talk more about that here.

Not to mention that there isn’t a single study where more than a tiny fraction of people were able to maintain weight loss long term, and even a tinier fraction that were actually able to change their weight category and maintain it long term so even if we believe that making fat people thin would make them healthier, we have literally no idea how to get that done (and we really need to stop lying about that.)

Enter Health at Every Size. Knowing that health and body size aren’t entirely within our control, people who practice HAES focus on behaviors that support health (things like getting good sleep, nourishing food, joyful movement, high self-esteem and body satisfaction, building strong supportive social networks etc.) See – not so spooky. In fact, not spooky at all. It’s also worth mentioning that HAES is practiced by people of all sizes, not jut fat people. If you’re looking for evidence about HAES you can check out this post.

But there was still a bit more excitement to be had. My special snowflake had left the building (thanks to the campus police,) my next talk was starting and the fabulous Grace was introducing me when the fire alarm suspiciously went off.

As we were standing outside waiting for them to give us the all clear, I thought about how sad it is that our culture’s current irrationality and scientific illiteracy around body size and health meant that some people are willing to risk getting arrested protesting the idea that healthy behaviors support our health (and misunderstanding one of the most basic tenets of research.)

They let us back in, and the fabulous staff at the MUB apologized and told me that they would be happy to stay open late so that I could give my full talk. It actually ended up working in my favor since the controversy piqued people’s interest and more people came to the talk than had originally intended to come.

The talk went well and after I spoke to a number of super cool students who wanted a combination of advice, hugs, and selfies, a student who was covering the event for a journalism class asked me why I do the work that I do. I told him that it’s because I hear from people every day who hate themselves because they don’t know there is another option, people who keep dieting even though they know it doesn’t work because they don’t know there’s another option, and that there are other options and people deserve to hear about them. When I got home from the talk, this e-mail was waiting for me:

Hello,

I was one of the students last night who attended your talks. Actually, I only attended your talk about athletes and body image because, before the fire alarm and spotting protesters, I had no idea the talks were even going on. Well, anyway, I wanted to thank you for the message you sent last night. I have struggled with body image distortion and related issues for so long that they have just become a part of whom I am, but I always appreciate and am inspired by hearing such outspoken people like yourself tearing into everything which you did last night. That’s all I really had to say, so thanks once again and keep singing your song :)

Huge thanks to Maria and Joelle, UNH Health Services, the MUB, and the mentors for all of their work bringing me to campus, to Courtney and Lisa for being so supportive, and to Grace for looking at me when we came back in from the fire alarm and saying, with conviction, “I’m reading your intro again!”

I’m not interested in telling other people what choices they should make for their personal health, but I’m very interested in making sure that people know that there are options besides a life of self-loathing and yo-yo dieting, and you better believe that I’ll keep singing this song!

Here are some pictures from the trip: