What is the “Health At Every Size” movement?
Many of you have probably heard “Health At Every Size” before, or maybe this is the first time. Nevertheless, it is important to uncover what this movement really is, what it means and dispel some of the myths and misconceptions, especially from the broader medical community.
PART I: What makes Doctor Gaudiani different from other medical doctors?
Jennifer L. Gaudiani, MD, CEDS, FAED is a pioneer advocate and an incredible force in the eating disorder field, especially when it comes to the “Health At Every Size” or HAES movement. She is an internal medicine doctor with an entirely different area of expertise when it comes to treating eating disorders, an entirely different way of looking at the problem. Doctor Gaudiani is the founder of the Gaudiani Clinic, which is based in Denver Colorado. Her clinic does telemedicine, which is able to treat people from all over the country using technology.
Kirsten: What is an internal medicine doctor and what happens during treatments?
Jennifer: An Internist is a medical doctor who does not see pregnant people, does not take care of kids, and does not do surgery. Instead, we take care of patients wholly. In 2016, I started my clinic to provide sub-specialty care, or even just primary care to people of all genders, ages and body shapes and sizes from around the United States. We take care of the physical side of eating disorders as well as the measurable and immeasurable medical problems that happen in peoples’ bodies.
Kirsten: What is sub-specialty care? And how does it differ from what doctors do?
Jennifer: Most medical doctors do not know much about eating disorders. In fact, I actually regard doctors as being a potential oppressor class who may unintentionally harm people with eating disorders. People of all different shapes and sizes may go to the doctor and say, “I’m struggling with food and body image,” only to be met with well-meaning people who say, “really?
You don’t look like you have an eating disorder.” And that reality harms people. Personally, I only see individuals with eating disorders. This has become my passion and pride.
Kirsten: What are the immeasurable, particularly those that relate to blood work? Talk about the importance of immeasurable and how doctors could be better educated on this topic.
Jennifer: This is one of the most interesting aspects of what I do. People with eating disorders have such a strong mind-body connection that they may develop medical problems due to undernourishment, purging or just medical problems unrelated to their disorder. These could keep them from recovering, and usually, western medicine does not know how to measure them.
Unfortunately, when doctors do not know how to measure something, they often say it is not real. They may tell patients that they are not sick enough. That is why I called my book “Sick Enough: A guide to the medical complications of eating disorders.” Anyone with an eating disorder or disordered eating is sick enough to get help and to seek recovery.
We need to gain a holistic perspective, knowing ultimately how a person is interacting with themselves, their loved ones, their values, profession, school, and food. That is what it is all about, not limited to just what medicine can measure.
Kirsten: Do you think there is a general sense that doctors need more education on eating disorders? Is there already a growing conversation about fat stigma and weight stigma?
Jennifer: We have a long way to go. I used to sit on the board of the International Association of Eating Disorder Professionals, and I was part of an effort to create four webinars on medical, psychological, psychiatric and nutritional topics. We tried to disseminate those at a bare minimum.
However, I got zero training in my medical school experience. I went to Harvard University, Boston University, and Yale, but still zero training. My hope is for a new generation which is much more aware of mental health and size stigma.
Kirsten: Do you think size bias is something that exists even among therapists and clinicians?
Jennifer: I believe that there is still an incredible amount of internalized size bias in all of us. That means that we unconsciously absorb messages from society, maybe from families of origin or from media, and have parts of us that secretly believe that thinness equals health. That thinness means someone is desirable. Unless we are aware of that, we cannot actively combat it.
PART II: The “Health at Every Size” movement
Kirsten: Now diving into the “Health at Every Size” movement, who founded the movement? Was it Doctor Linda Bacon?
Jennifer: Doctor Linda Bacon is a phenomenal professional who wrote a book by this name. But the “Health at Every Size” movement emerged out of a bunch of vital activists, therapists and other eating disorder clinicians in the 90’s. They felt that there had to be a different way to look at body size, shape, health care, social justice, and ableism.
Kirsten: What is the “Health at Every Size” movement?
Jennifer: The “Health at Every Size” movement involves respect, celebrating body diversity and honoring differences in size, age, race, ethnicity, gender, ability or disability, sexual orientation, religion, class, and other human attributes. It is a movement that advocates critical awareness and compassionate self-care. It values body, knowledge and lived experiences while challenging scientific and cultural assumptions.
It is all about finding joy in moving one’s body and being physically active. This movement celebrates eating in a flexible and attuned manner that values pleasure and honors internal cues of hunger, satiety, and appetite while respecting the social conditions that frame eating disorders.
Kirsten: Zeroing in on respect and celebrating body diversity, what is it about the obesity crisis that freaks people out so much that they completely disown anything like ‘Health at Every Size” or eating disorder as a concept? Why can’t these two theories easily co-exist in society?
Jennifer: This is an interesting yet complicated topic. I personally disavow the concept of an obesity crisis or an obesity epidemic. I do not use the words obesity or overweight because it is implied that there is a medical diagnosis and a medical problem associated simply with one’s body weight and height.
If only people could be more aware of their internalized size stigma and keep an open mind, the idea is that there are so many things that influence people’s bodies. For instance, other societal problems like poverty, racism, sexism, heterosexism could very well contribute to one’s body size and shape that is essentially written in genetics. Beyond that, there is no such thing as dieting or wanting to change your body size and shape in order to create a healthier self if you are just thinking about changing food or movement.
Routinely, doctors everywhere believe that in order to lose weight, people just need to eat less and move more. They often speak from thin privilege or white privilege. The problem with this classic medical perspective is that it does not work.
It shames patients who have been told, not only by doctors but also by society, that if they are in larger bodies, there is something dangerous and something shamefully wrong with them. We need a new method of understanding food, movement, size, and health.
Kirsten: You mentioned the phrase “thin privilege,” could you explain what that is?
Jennifer: There are certain traits that people are born into that allow doors to open for them in society, doors that do not necessarily open for other people. Some traits could be being white, thin, pretty, healthy, able, married, having children and being financially secure and educated. All of these make me privileged, and because I occupy those spaces, it would be easy for me to think that this is how everybody else lives. It is a matter of being aware of such privileges and think of ways to make use of them to benefit and help marginalized people.
Kirsten: What do you say to people and doctors, who believe that there is a weight that is unhealthy, specifically based on body mass index (BMI), which is an inaccurate representation of health?
Jennifer: One of the misconceptions about “Health at Every Size” is that it means everyone at every size is healthy. That is not true. What it means is that we have to unhook an assumption of ‘health equaling thinness.’ We need to unhook body size from an assumption of health or illness because we serve people better when we do not make assumptions.
I have patients who walk around in bodies that could be the object of magazine covers yet have multiple organ failure and are miserable. At the same time, I have patients who are in larger bodies and do not have a single thing wrong with them. I never even weigh my patients unless I am watching them medically re-nourish and gain weight as they recover.
We need to find a way to make eating consistently joyful and nourishing. We need to find ways for people to take care of their mental health because, with behavioral health change, medical health improves.
Kirsten: There is great research on positive reinforcements, rather than shaming, having quantifiable results in helping people transform and recover. What does that look like in your practice?
Jennifer: My personal bedside manner with patients is always to be their biggest cheerleader, radiating affection and positivity. To remind them that they are not what their eating disorder tells them they are.
I do that by sharing the medical consequences of their eating disorder, to help breakthrough denial of their disease and help motivate change. My hope is that my patients feel seen and known as a whole person.
Kirsten: What is minority stress and how does it affect people?
Jennifer: Minority stress refers to people who have one or more aspects that are not “privileged.” As a result, they feel that they have to cover up who they are or explain themselves to others. They may not get access to the same services, healthcare, educational care or financial benefits as other people.
This can ultimately drive people into eating disorders. People end up trying to change how they look and how they come across to the outside world in order to make up for some of that societal gap. It is not a body image problem but an “exposure to society” problem. It is not about individual change or fixing your sense of self but recognizing the toxic society into which people have settled.
PART III: Reaching out to the rest of the community
Kirsten: What advice or insight would you give to someone who is part of a community with a destructive social norm or those stuck in a culture that has a toxic view of body ideal?
Jennifer: First of all, I would give the patient the opportunity to say whether or not that is the case for them- whether or not there are things keeping them boxed in or people telling them who they need to be. If they say yes, I would say “I hold that for you because I care about you as a human being and I encourage you to process that with your therapist.”
Kirsten: How do you deal with stories about recovering or recovered persons who do not fit into the narrow physical standard of what it is to have an eating disorder? Are their stories not valid?
Jennifer: That is so important. Atypical anorexia nervosa is vastly more prevalent than the so-called anorexia nervosa. The individuals have the same behaviors, distortions and torments, they just don’t happen to be medically underweight. This is a huge problem. Just the nomenclature reflects the internalized size stigma of the mental health treatment community. Literature still uses words like “obesity” and “overweight,” or they align “overweight” with binge eating disorder.
Everyone’s recovery story is a valid one. We cannot get into a competition of being “sicker” than others. This is part of the comparison culture that goes on in the head of people with an eating disorder. My encouragement is to meet each individual case with compassion and validation despite size, color or gender. We just have to realize that everybody’s recovery story is worthy of respect.
Kirsten: Denise from South Africa says, “I wish we had doctors here in South Africa that thought this way, which are aware of HAES.” What are your thoughts on this? What can you tell someone like Denise?
Jennifer: Frankly, even in the bigger cities, it is difficult to find doctors who follow HAES. Locally and internationally, it is a huge problem. My hope now is for people to read, learn and use my book “Sick Enough.” This is the cutting edge evidence-based way we have to take care of patients.
Kirsten: Lastly, if there is someone out there who feels absolutely horrible in their own body, how would you encourage them?
Jennifer: Be gentle. Be kind. Go slowly with yourself. It is not your body’s fault. You are almost certainly waking up into a sense of dismay about your body because of the words you have heard as a kid, the words you hear from society, or the words you may hear from your doctor.
This is the only body we’ve got, and bodies are miracles. They do so much for us even when we do not treat them kindly. Also, seek help because you do not have to do it alone. There are people out there who can help you make it better than it feels today.
The book Sick Enough by Dr. Jennifer L. Gaudiani is now available. Get yours through the website www.routledge.com.
EDH Weekly Hope interview with Jennifer L. Gaudiani, MD, CEDS, FAED on the EDH Facebook. “Healthy At Every Size? Not Just A Slogan. A Doctor’s Take” held August 22, 2018
Jennifer L. Gaudiani, MD, CEDS, FAED is the Founder and Medical Director of the Gaudiani Clinic. Board Certified in Internal Medicine, she completed her undergraduate degree at Harvard, medical school at Boston University School of Medicine, and her internal medicine residency and chief residency at Yale, where she won numerous clinical awards. Dr. Gaudiani became a nationally recognized internist for her work on the medical complications of eating disorders. She has lectured nationally and internationally and is widely published in the scientific literature as well as on blogs. She is a current member of the editorial board of the International Journal of Eating Disorders and the Academy for Eating Disorders Medical Care Standards Committee and is a former board member of iaedp (International Association of Eating Disorder Professionals).
Kirsten Haglund is the Director of Global Business Development and Digital Media for Eating Disorder Hope and an international speaker, mental health advocate, and digital media strategist. Through her media and communications company, En Pointe, she works with a diverse group of clients in both the profit and non-profit sectors increasing social engagement and scalability, social listening, communications training, spokesperson work increasing brand awareness. Kirsten serves as a media spokesperson, speaker, and Director of Global Business Development and Digital Media for Eating Disorder Hope & Addiction Hope. She is also Community Relations Specialist for Timberline Knolls Residential Treatment Centre and is Founder and President of the Kirsten Haglund Foundation. She served as Miss America 2008 and Goodwill Ambassador for Children’s Miracle Network Hospitals. Kirsten graduated from Emory University with a B.A. in Political Science and is currently based in Zürich, Switzerland.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on September 12, 2018.
Reviewed & Approved on September 12, 2018, by Jacquelyn Ekern MS, LPC
Published on EatingDisorderHope.com