Dr Gillian Riley

What is weight neutral or HAES aligned care?

You might have heard of health at every size (HAES) care before.  It’s a mainly American movement, which arose out of the civil rights movement, which framed healthcare as a human right and access to health does not rely on – weight, weight loss or health status itself.  

HAES is trademarked, and again has arisen in the context of an American health care system . Although the values are sensible and absolutely translate to the Australian healthcare system for this reason you will most often see Australian clinicians describing themselves as “weight neutral” or “size inclusive”. 

The rise of GLP-1 inhibitors and there ubiquitous creep into guidelines has also made it difficult for physicians to completely cleave to HAES principles (something I plan to discuss later).  (Because of course I have views).  

The evidence around weight neutral care is increasing and expanding as more providers and researchers take an interest in this space.  Essentially, what the data points to is that:

• No intervention for weight loss works long term (and there are few/no studies in humans beyond five years for any intervention)
• Any form of dietary restriction slows the metabolism and this will cause weight gain once normal eating patterns resume 
• In studies that affirm bmi is a risk factor for a disease – it’s hard to determine if it is bmi itself OR behaviour eg lack of exercise or poor nutrition, and many/most/all studies do not make this distinction 
• When these are teased out – bmi itself is often not the issue so much as nutrition/exercise/smoking/alcohol intake
• BMI itself has a poor scientific history 
• Eating disorders and disordered eating is far more prevalent than the data suggests – and occur in larger bodied people despite the stereotypes 
• No one will ever be shamed into losing weight 
• Plenty of human beings with be shamed into feeling terrible and that itself will stop them seeking care.

It’s important to note that Health doesn’t mean Healthy.  It’s not at any stage a concept that if you are unhealthy, have a chronic illness, etc that you are a less worthy bigger person than a person in a larger body who has “normal bloods” and no disease.  

I hear this said so many times – “I’m fat but my bloods are normal”.  Society tells us that we are only worthy in certain bodies if we conform to a certain type  and this is one of them . You can be healthy or unhealthy, big or little.  Everyone deserves care.  Healthcare is a human right .  

I aim to provide compassionate care.  I won’t always get it right – because I’m human and I’m working unfortunately in a system built on the back of weight stigma.  

But I will do my best to try.  

If you think this is a path that would suit you – you can book with me at Manuka 

Or if you’re out in the bush – see me at Gunning.