Q: I’ve seen increasing references to the Health at Every Size (HAES) approach to treating eating and body-image issues. That’s not my clinical specialty, but is this framework relevant to my work?
A: When I look back on my 35 years of practice, I recognize important, overarching paradigm shifts that have changed the way we work with clients. Becoming trauma informed, even if we don’t specialize in trauma, and no longer pathologizing people who identify as LGBTQ, are just two examples that come to mind.
Similarly, a paradigm shift around weight and wellness is occurring in our field with the Health at Every Size (HAES) framework. Societal norms regarding weight, health, and eating affect every client we work with, regardless of body size. We’re inundated every day with messages from family, friends, colleagues, media, and even doctors and mental health professionals that prioritize weight over well-being; promise health, happiness, and success to those who can conform to a certain ideal; pressure people to pursue thinness and fear fat at all costs; presume that people have control over what they weigh; pose as health promoting, even as they harm; and promote fat shaming and weight stigma. We call these negative messages the six P’s of diet culture.
While therapists often support the pursuit of weight loss as an act of self-care, overwhelming evidence indicates that dieting almost always leads to negative physical and…