Health at Every SIze and Eating Disorder Recovery
Written by: Allyson Inez Ford, MA, LPCC | Founder of ED and OCD Therapy
What is HAES?
If you've spent any time in eating disorder recovery spaces, you've probably heard the term Health at Every Size (HAES) thrown around. Maybe you've seen it on a therapist's website, heard it on a podcast or had a provider mention it as part of their approach. But what does it actually mean?
And why do so many of us who work in eating disorder and body image care center it in our work?
We’re going to get into all of that- but first, let's clear something up:
HAES stands for Health at Every Size not "Healthy at Every Size." This is a common misconception that makes a lot of heads spin and defenses spike up. The framework does not claim that every body is inherently healthy, or that health status doesn't vary across bodies. That would be kind of ridiculous, since disability and chronic illness exists across the body size spectrum (and doesn’t make a person more or less worthy).
Rather, HAES is a social justice movement that claims that all bodies deserve access to weight stigma free healthcare and that weight is not a reliable or ethical proxy for health.
Health is comprised of so much more than weight, it’s actually more about a variety of health behaviors and social determinants of health, than it is about weight or BMI (the infamous, archaic, racist measure that was never meant to be a marker of individual health- but I digress).
Where did HAES come from?
The ideas and research that became Health at Every Size trace back to the civil rights movement of the 1960s, when fat activists began pushing back on the ways fat people were being harmed in the name of healthcare. By the late 1990s, the approach had a name. When ASDAH (the Association for Size Diversity and Health) formed in 2003, they developed the first formal set of HAES principles, which have since been revised in 2013 and again in 2024 to more fully reflect liberatory values and the evolving science on health and weight.
The framework continues to evolve and deepen and that's a good thing.
So what does HAES actually Stand For?
At its core, HAES holds a few foundational beliefs:
1) Healthcare is a human right regardless of body size. People deserve access to compassionate, comprehensive care without being required to lose weight first, meet a certain BMI threshold or prove they're pursuing weight loss. Refusing or limiting care based on size causes long lasting harm both psychologically and physically. We’ve sadly seen this play out in the eating disorder field- though it is getting better, slowly.
2) Weight is not a reliable marker of health. What we've been taught, that you can look at a person's body size and draw conclusions about their health, is not supported by the evidence. What we eat and how we move our bodies is one small piece of the health puzzle (roughly only 30% of the overall picture of what constitutes a person’s health). Social determinants of health: access to resources, stress, sleep, relationships, systemic oppression, all of this shapes health in ways that body size simply does not capture.
3) Intentional weight loss doesn't work the way we've been told. Decades of research show that while people can lose weight in the short term, the vast majority regain it within a few years, often more than they initially lost. And the pursuit of weight loss is not benign. Some research has found that significant intentional weight loss in people with larger bodies is associated with increased mortality risk.
The diet industry KNOWS this and uses it to gain profit. I imagine them thinking like this: sell people the idea that they can lose weight if they try hard enough and follow ‘x’ diet, then when they inevitably regain the weight, tell them it’s because they didn’t try hard enough and need start all over, on the next diet. This pattern plays out sometimes for an entire lifetime, and for many people it triggers a full blown eating disorder. It’s a horrifying but profitable business model worth 90 billion dollars in the U.S. alone.
4) Anti-fat bias causes harm, often in the very room with your doctor where you are trying to seek help. This one is important and often underestimated. Weight stigma in healthcare settings leads people in larger bodies to avoid care. And when they do receive care, it tends to be lower quality and full of weight based discrimination. HAES-aligned providers work to actively dismantle this, both personally and systemically.
5) Each person is the expert on their own body. Autonomy is central to the HAES framework. People get to decide what health means to them, how much they prioritize it and what pursuing it looks like in their own lives. That is not the provider's call to make- and your health status is not a determinant of your worth as a human being.
Why does this matter specifically in eating disorder and body image work?
This is where things get personal for me and probably for many of you reading this.
Eating disorders thrive in environments where bodies are scrutinized and assigned worth based on size and shape. Weight-focused healthcare doesn't just fail to prevent eating disorders; in many cases it actively contributes to them. Here are examples of this I hear over and over in my work as an eating disorder therapist:
Someone develops anorexia after a doctor commented on their weight and encouraged them to try fasting.
The binge-purge cycle that follows a period of avoiding “bad” foods in the name of “health.”
A client puts off seeking eating disorder treatment because they're afraid they'll be told they need to lose weight qualify for an intensive program or higher level of care (residential, inpatient).
When clinicians and providers operate from a place of anti-fat bias, we are working against recovery before we even begin. We are part of the problem.
HAES gives us a different foundation.
One where a client's body is not a problem to be solved. Where the goal is not reaching a certain size but developing a relationship with food and movement that is nourishing to the body and soul. A relationship that is compassionate, values-driven, culturally affirming and free from punishment. Where we can support someone's wellbeing without reinforcing the very diet-culture messages that helped fuel their eating disorder in the first place.
This is especially critical when we think about who gets taken seriously in eating disorder treatment and who doesn't. Fat people with restrictive eating disorders are routinely dismissed, under treated or actively encouraged to keep restricting because the restriction is producing a body size the healthcare system approves of. This is one of the clearest examples of how weight-centered care causes direct harm. HAES challenges this. Severity is not determined by body size and access to care shouldn’t be either.
Body image healing requires this framework too. You cannot genuinely support someone in accepting their body while simultaneously sending the message that their body is bad or wrong. These two things are incompatible. HAES doesn't ask us to convince anyone their body is perfect or that health is easy or even accessible to everyone. It asks us to stop weaponizing bodies against people- to center wellbeing, autonomy and dignity instead.
A note on what HAES is not
HAES is not a claim that health status is a moral virtue, equally accessible or that body size never affects anything.
What it is: a framework that says people deserve care regardless of size, that weight stigma causes measurable harm, that the pursuit of weight loss is not the ethical cornerstone of healthcare it's been made out to be. And finally, that true health-supporting care has to be grounded in liberation, autonomy and equity.
For those of us doing eating disorder and body image work, HAES must be the foundational ground we stand on.
If you want to learn more about the HAES principles and the framework of care, ASDAH (the Association for Size Diversity and Health) is the place to start: asdah.org as well as the research articles linked throughout this blog post or in our resource hub under the research articles tab.
How Can a HAES Informed Eating Disorder Therapist Help?
Working with a HAES aligned eating disorder therapist can help you heal your relationship to food and your body. At our practice, therapy helps you get to the root of your food and body image struggles through a liberation based lens. We work with clients of all body sizes with eating disorders and actively push back against anti-fat bias both in and outside the therapy room. We have lived experience with our own eating disorder healing journeys- which will be different than yours, but also gives us deep empathy for how hard this struggle is!
Connect with Us
If you’re looking for an eating disorder or OCD therapist in San Diego, CA or a virtual recovery coach worldwide, the first step is to schedule a free phone consultation call with us to explore your goals, our services and see which one of therapists you would be a good fit for!
