Healthcare Providers Should Make the Switch to HAES

Far too many medical professionals believe weight directly correlates with health. For the well-being of everyone, healthcare providers must leave this notion behind and adopt the health at every size (HAES) approach.

Weight-centered healthcare perpetuates weight stigma, or negative attitudes toward individuals based on their body size. The National Library of Medicine reports 42 percent of people who are overweight feel uncomfortable talking to their general practitioners about their weight, and only 26 percent report being treated with respect in the doctor’s office. This drives people away from seeking the care they need. If healthcare professionals truly want to do their job, taking the HAES approach is essential. 

Many people, including doctors, believe that if overweight people want to be healthy, they must first lose weight. These individuals will often cite higher mortality rates and more cases of hypertension among people who are overweight. 

The HAES approach focuses on life-enhancing tools such as respectful healthcare, meditation, physical activity and nutritious, balanced eating. All of these improve blood pressure and heart rate, independent of weight loss. Since mental health is closely intertwined with physical health, the HAES approach can lead to improved general well-being. 

While taking the HAES approach in healthcare is necessary, it will also be difficult. Medical News Today reported that about 40 percent of medical professionals have a negative bias toward bigger people. Sarah Johnson-Palomaki, an associate professor in sociology, recounts this common weight stigma in the doctor’s office. “There are people of all genders — but especially women — who are facing medical issues [that] get dismissed as being an issue of weight.” 

Weight-centric treatment also restricts healthcare for many people. In early 2024, an article was published in Stat10 about surgeons refusing to operate on patients unless they dropped weight, and insurance companies declining surgeries to those with body mass index (BMI) over 40. The defending argument for weight-centric treatment is that people with higher BMI are more likely to run into complications. 

Granted, this is generally true. According to a 2024 article by Stat10, bigger people might have worse post-operative results for many reasons, including medical comorbidities that worsen long-term outcomes. In late 2023, the American College of Surgeons reported a link between those with a BMI over 40 and higher rates of post-surgery wound infection, blood clots and kidney failure.

However, refusing treatment based on weight is counterproductive to the patient’s health. The very issue that patients are seeking surgery for, such as damaged knees or hips, can hinder the patient’s weight loss and push them further away from getting the treatment they need. 

There is often little to no review of these patients' cardiometabolic health — that is, the health of the heart and metabolism — or history of physical activity. 

The HAES approach considers everything: genetics, nutrient intake, rate of exercise, physical ability, body composition — for example, body fat versus lean muscle — access to treatment and socioeconomic status. All of these factors play a role in weight and disease. 

Johnson-Palomaki advocates for an individualized view of healthcare. “If we have a more nuanced view of the association between weight and health, that’s probably going to be most beneficial to those who are most stigmatized by the current system that we have,” she said. “Recognizing that medical needs can exist outside of weight is essential to delivering good healthcare.”

The HAES approach rejects the use of weight-centric measurements such as the BMI scale. The approach aims to improve physical ability and adaptability rather than encouraging people to shed weight.

HAES also extends further than just the doctor’s office. Specifically in sports and athletics, if dietitians focused on general well-being rather than the number on the scale, it could improve athletic performance more than any weight loss regimen.

Mia Clarke, a pre-nursing student and former sprint-kayaker, recalled her coaches pressuring her to be thin when she rowed competitively from ages 14 to 18. “You have to be skinny so your boat’s lighter, so you can paddle faster,” Clarke said. “I wouldn’t eat. I would just go hungry.” 

Restrictive dieting combined with rigorous exercise can cause serious health consequences. Healthline reported hormone imbalances resulting in reduced bone mass, an impaired immune system resulting in higher risks of infection and reduced fertility, especially in women. 

We must adopt the HAES approach in healthcare if we truly want to cater to every patient and help them feel better rather than prescribing weight loss as a cure-all. If more medical professionals align themselves with HAES, it will also help to decrease weight stigma in the medical field, which will massively benefit the mental health of bigger patients, and in turn will more effectively treat the issue they’re seeking help for. It will be difficult, but hard things tend to be worth it.