Why the Health at Every Size Principles Matter

During my training as a dietetic professional, I began to notice a pattern in the way my

education was delivered, often reinforcing weight bias. Conversations about health were

frequently coupled with assumptions about body size, regardless of relevance to the lesson.

During the final semester of my undergraduate program, I was introduced to Health at Every

Size (HAES) by a professor who used this approach in her private practice. Learning these new ideas shifted my perspective and became deeply important to me as I graduated and began to work in the eating disorder field.

The HAES principles proved to be foundational to eating disorder care and were crucial in my

client interactions.

The first set of principles was released by the Association for Size Diversity

and Health (ASDAH) in 2003 and updated in 2013.

HAES Principles (2013 Revision):

1. Accepting and respecting the diversity of body shapes and sizes

2. Recognizing that health and well-being are multi-dimensional and that they include

physical, social, spiritual, occupational, emotional, and intellectual aspects

3. Promoting all aspects of health and well-being for people of all sizes

4. Promoting eating in a manner that balances individual nutritional needs, hunger,

satiety, appetite, and pleasure

5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than

exercise that is focused on a goal of weight loss

These 2013 principles crucially challenged anti-fat narratives that were rampant at the time,

offering a more compassionate and patient-centered approach to health and wellness.

In 2024, ASDAH updated the HAES principles once again, to reflect an even broader

understanding of health:

HAES Principles (2024 Revision):

1. Healthcare as a human right for people of all sizes, including those at the highest end of

the spectrum

2. Wellbeing, care, and healing are resources that are both collective and deeply personal

3. Care is provided only when free from anti-fat bias and offered with all sizes in mind

4. Health is a sociopolitical construct that reflects the values of society

These updates feel especially relevant in today’s political and cultural climate, with ongoing

uncertainty around healthcare access, shifting public health initiatives, and increased weight

stigma associated with the rise of GLP-1 medications for weight loss. One of the biggest shifts

in the updated principles is the movement away from an individualistic mindset about health.

While the earlier principles emphasized important behaviors like intuitive eating and enjoyable

movement, they can be interpreted as placing sole responsibility on the individual. This

unintentionally reinforces the idea that health outcomes or body size are purely a result of

personal choice.

The 2024 principles challenge that individualistic notion, by highlighting the structural, political, and social factors that influence health. These new principles do not invalidate the previous ones but instead deepen an

d give greater context to them. Most notable about the updated HAES principles is their acknowledgment that health is not experienced equally and looks different to each person due to individual circumstances and resources. Healthcare disparities are real and ignoring this does a disservice to both patients and providers. When we dismiss these disparities, patients are left feeling unseen, and consequently, trust in healthcare is eroded. As a healthcare professional, recognizing these differences allows me to provide more compassionate and comprehensive care, and to consider the broader context of a person’s life instead of focusing solely on behaviors or body size.

It is important to recognize that both versions of the HAES principles have value. The earlier

principles provide actionable and person-centered guidance that aids in behavior change, but

the updated version pushes us to address the systemic barriers that make those behaviors

accessible. In short, the newer principles provide the foundation needed to achieve the original goals.

For some, these updated principles may challenge the way they feel about or practice

healthcare. This is because healthcare has long been shaped by a weight-centered and anti-fat framework. Questioning these ideas can be uncomfortable, but discomfort is often where growth begins.

The fields of nutrition and healthcare are constantly evolving.

Through revising these principals, we are reminded that health is not fixed; it is fluid, shaped by culture, research, and lived experiences. These principles will likely be revised again, which is a reflection of what makes nutrition and healthcare so meaningful and dynamic. We are working with complex, diverse human experiences. Embracing each individual’s complexities is not only necessary but also allows us to provide and receive care that is truly equitable and effective.

So what does this mean for you: healthcare professionals and clients seeking nutrition

care?

Both sets of principles offer important reminders about moving away from weight-centered,

anti-fat approaches to healthcare. For providers, this means understanding that there are

varied definitions of health, as well as a multitude of factors that influence a patient’s behaviors, health status, circumstances, and life. Considering the full context is imperative in creating a space where clients feel respected and supported. For those seeking care, this means that you deserve support that is tailored to your unique circumstances and someone who helps you define what health means for you.

People are not one-size-fits-all, and neither is health and nutrition care.