Not everything that counts can be measured. Not everything that can be measured counts.- Albert Einstein

This post is a reply the  recent post “Why HAES will never go mainstream” post by Dr. Yoni Freedhoff, a family doctor and founder of Ottawa’s Bariatric Medical Institute.

I begin with replying to a specific comment by “Norma”

I also wonder about the use of “ANY” size…it apparently actually means only LARGER/obese size. Does HAES advocate that extremely thin people can be healthy? That anorexics, despite their mental illness, are “healthy”? Is a 5’10”, 107 lb couture model healthy? I know, I know; the HAES crowd ALL eat clean whole foods and exercise, but their metabolisms are slow and this is the way nature intended them to be…none of them eat any Chinese food or pastries or watch much TV. They’re all very conscious, portion-controlled, home cooking type eaters who walk the dog for miles a day and do Jillian  Michaels shred.  I’ve read their blogs. It must be true!
My reply:

Norma, the healthy anorexic is an oxymoron and I would HIGHLY doubt that any practitioner who is using HAES in their practice would categorize purging, over exercising, excessive weight loss, metabolic abnormalities and electrolyte imbalance which are often fatal, as ‘healthy’. HAES states that all size can be healthy and that making assumption that someone is healthy or unhealthy based completely on weight alone (re:skinny or fat) is a fallacy. Yes, the thinner individuals can be healthy but they can also be unhealthy-independently of a mental illness. HAES promotes a holistic model of health which looks beyond weight and asks patients: “how are you managing stress?, do you have social support?, do you have access to food? How are your sleeping patterns? etc.?.”

As a nutrition practitioner, I’ve observed many patients and even colleagues experience food disconnection primarily because food is seen as calories and its these calories that make you fat and, fatness is ugly and unhealthy. And this food disconnection is not a “fat person” or “anorexic” issue, this is a societal issue. The assumption that fat=bad automatically generates a medical intervention (re: weight loss) . While Yoni states “despite regularly telling my otherwise healthy overweight and moderately obese patients that their weights aren’t likely contributing much if anything to them in the way of medical risk” unfortunately this way of thinking is not the norm in medicine. This is why, as a practitioner, I encourage and promote HAES within my practice. HAES advocates against the assumption that fat individuals  are merely gluttonous and straining the health care system with their self-induced chronic illnesses. This promise that weight loss will lead to better health outcomes is not strongly supported by science; which is confirmed by Yoni: “healthy”, and “weight”, are not mutually inclusive or exclusive terms.

As nutrition practitioner, I apply the HAES philosophy by using alternative, more sensitive health indicators other than weight such as such as blood pressure, blood lipids, blood sugars etc). The reason is because weight loss may or may not happen with the adoption of  healthy lifestyle choices and without weight loss, people often continue to feel life failures regardless of their lifestyle successes (i.e. such as moving more, managing stress, engaging in social gatherings, included more veg and fruits. This overcasting shadow of shame and blame disrupts their healing process and may exacerbate underlying social and psychological issues.

Yoni criticized the movement using 1 article while using several studies to defend the supposedly, misinformation used by HAES researchers. This approach is disheartening to me because as a proponent of HAES, the comments and posts have generalized this group of practitioners and individuals as ignorant, radical and untrustworthy.

HAES promotes empathy (not to be mistaken with “feeling sorry for someone”) between practitioner and patient (regardless of weight) with the purpose of rebuilding and reconnecting people with their body, minds and spirit; something foreign in conventional medical practices. This leads me to my concluding (but not last) point:

I would encourage Yoni, the blog commenters and readers to expand their knowledge of HAES. What i’ve provided here is one perspective and application of HAES in practice.  While “showing the data” is an important piece to inform practice, not all successes can be captured with the medical measuring sticks and thus, this is likely why HAES is having difficulties “penetrating mainstream medicine”.  HAES acknolwedges that disconnections between weight and the HEALTH FOCUS that HAES attempts to reintegrate into medicine i.e. intuitive eating, self-esteem, body satisfactions doesn;t fancy the measurable-calculated-quantifiable scientifc rigor medicine justify’s iteself with.

Not everything that counts can be measured. Not everything that can be measured counts.- Albert Einstein