Health at every size is a concept embraced by some fat and size acceptance activists. For those not familiar with it, it was developed popularised (see comments) by Linda Bacon, and simply put, it suggests that there’s a wide variation of bodies and that people should focus on what makes their bodies healthy, rather than on eating and exercising for weight control. There are a number of components of health at every size, including ‘intuitive eating’ and the concept of ‘joyful movement.’

When I initially heard about HAES back in my nascent days of exploring fat, size, and my relationship with my own body, I was excited about it. I’d been reading a lot of stories about the false beliefs about fat and health, and I liked the idea of a movement specifically reinforcing the idea that being fat doesn’t make you unhealthy, since one of the most common charges levied against us fat folks is that we are unhealthy because we are fat, that fat makes people unhealthy.

But then I got sick. Very, very sick. And I lost a lot of weight, and people praised me for it, and I started thinking about the dichotomies being set up with health at every size, and who was being left out of this equation: People who are unhealthy. Many people are unhealthy and also fat, many people are fat and disabled, and the framing of health at every size excludes them.

It’s hard to eat intuitively when you have allergies, or when you have conditions that require you to be very careful about what you eat for other reasons. When you’ve got to plan out your meals and you can’t afford to be ‘intuitive,’ to decide to skip a meal when you don’t feel like eating. It’s hard to eat intuitively also when you have limited energy for cooking and you might not be able to eat when you want, when you want. Or when you’re so sick that the thought of eating at all is nauseating.

As for ‘joyful exercise,’ well, not all bodies want to  move, and not all bodies move joyfully. I know that I personally tend to feel better, emotionally, when I do yoga regularly. Which is great, for me. But I’m not going to tell other people to do yoga; some people find the poses difficult to hold or the experience uncomfortable or just plain don’t like it. For people who like to move and want to move, finding the ways that their bodies move comfortably and joyfully is awesome, but not everyone wants that, and not everyone can reach that. Should someone who can’t exercise be drummed out of the fat acceptance movement?

I want to be clear that not all fat/size activists embrace this concept, and that some of those who do think of it as a framework that works for some people, and not for others, that people need to navigate their own relationships with their bodies rather than being forced to think about them in a particular way, acknowledging the variation of human experience and emphasising the fact that people should not be told how to feel about their bodies. But, for those who accept it as a blanket, one size fits all (so to speak) philosophy, there tends to be an erasure of people with disabilities from the size acceptance movement; we’re not healthy, so right there, we’ve gone and shot a big hole in health at every size, no matter why we are unhealthy, no matter what the intersections (or lack thereof) between our health and weight may be.

Which is unfortunate, because size acceptance needs to work for us, too. Many of the FWD contributors, just for example, are fat to varying degrees, and I know we have a lot of fat readers. Our fat bodies need to be accepted and embraced too and we need to be able to talk about our relationships with our bodies; how, for example, people with poor thermoregulation experience chub rub on a whole new and very uncomfortable level. We need to talk about what it’s like to not be healthy at every size.

I’m not advocating for throwing out HAES. There are a lot of people who clearly benefit a lot from this model and for whom it has played an important role in thinking about their bodies and their relationship with the world. But we also need to find a way to create a space for discussions about fat and disability, for what it’s like to be happy and fat, happy and disabled, sad and fat, sad and disabled.

Hardline HAES advocacy plays directly into the good fatty/bad fatty dichotomy that looms so large in the minds of many of us. The stereotypes about ‘lazy fatties’ take on a new dimension when they are weaponised against people with disabilities who need to use mobility aids, who can’t hop off the couch and start cycling for fun, who experience feelings of guilt and inadequacy about being unable (or unwilling!) to exercise.

A huge part of fat acceptance is the idea that there are no ‘perfect’ bodies and that bodies naturally come in a wide range of sizes, colours, shapes. But bodies also naturally come in a wide range of degrees of disability and health, and that intersects directly with fatness, with social attitudes, with acceptance of the body.

Michelle at The Fat Nutritionist has written about the concept of being obligated to be healthy, pushing back against certain aspects of the HAES narrative:

It is sad that this even needs to be said, but given the fact that we essentially live in a health meritocracy, let me be the first to announce:

You are under no obligation to be healthy.

And, as an addendum: even if you were, eating “well” and exercising wouldn’t guarantee your success. There. I’ve said it. And as much as this might chap the ass of every health promoter out there, I feel that personal agency and a basic sense of privacy are sorely missing from most conversations of health promotion, and from conversations of Health at Every Size.

I’d recommend reading her whole post, as she talks about issues like varying definitions of ‘health’ and the pressure on members of society to be healthy, and poke around her blog a bit if you haven’t already, because this is not her only piece on the obligation to be healthy. Michelle’s work has done a lot for me personally in terms of reframing the way I think about fat and health, and I’m really excited that she’s tried to start a conversation about fat, health, and the shortcomings of HAES; let’s try to keep that conversation going.