Saturday 4 January 2020

Health at Every Size and the Burden of Proof

Don't bring everybody knowsDebating around Health at Every Size (HAES) is something that has been coming up a lot in e-mails that I’m answering so I decided to just address it here.

Before I get too far into this, a quick reminder that Health at Every Size is a paradigm for health and healthcare (including mental health, personal health, public health, and healthcare) which advocates for weight-neutral health paradigm that includes things like dismantling oppression, and creating equal access. An individual’s personal health, by any definition, isn’t an obligation, barometer of worthiness, entirely within our control, or anyone else’s business unless we ask them to make it our business. And nobody has to practice “health” by any definition to be covered by Size Acceptance, which encompasses the fact that fat people (of any health status) have the right to exist in fat bodies without shame, stigma, bullying, or oppression, and it doesn’t matter why they are fat or if they could or want to become thin.

Also, a reminder that while you are certainly allowed to choose to engage in a discussion/debate/argument etc., you are not obligated to justify your choices to people. You are allowed to make choices about your health and, if people question them, simply say “I’m not interested in discussing this with you, luckily there are lots of things to talk about!” and/or change the subject “Hey, did you know that Cap’n Crunch’s boat is named the S.S. Guppy?” and/or just find a reason to get out of the conversation “Hey, look, bundt cake!” then charge confidently across the room.

If you do decide to debate, you can also set the terms. When I end up in a situation where a weight-loss vs HAES paradigm/intervention is being discussed/debated one-on-one, my first instinct is to give the person I’m discussing it with a ton of research/evidence (this is an excellent source for that research by the way). To me, that’s the clearest way to explain, plus I talk about the studies all the time at speaking gigs, so I have the studies and associated numbers top of mind.

The problem is that the thinner = healthier paradigm is so ingrained in our culture (thanks diet companies!) that people think they can negate a mountain of evidence with an “everybody knows” argument, or with anecdata (my friend’s husband’s second cousins’ babysitter’s mom lost weight blah blah blah.)

I have learned that – especially with someone who is suggesting that I should engage in an intentional weight loss attempt (like, for example, a doctor) – it can be very helpful to put the burden of proof on them, often by saying something like

“My evaluation of the research is that significant, sustained weight loss is the least likely outcome of an intentional weight loss attempt,  with the most unlikely outcome of a weight loss attempt being weight gain. Can you show me the evidence that you have that refutes that?’

In my experience language like this has worked best with healthcare providers, but obviously your mileage may vary, and you might want to take a different track because of what’s comfortable for you, and/or who you are talking to.

Some plainer language:

“My research shows that most of the time diets don’t work, and most people gain back the weight, it sounds like you disagree with that – can you tell me the studies you are basing your option on?”

Or less aggressive language:

“That’s a really interesting recommendation, I’d love to read more about that. What studies do you think would be best to read?”

Spoiler alert – regardless of the language you choose, there isn’t any research that actually refutes it There is no study where more than a tiny fraction of participants maintain significant weight loss long-term (for more than 5 years.)

Note that the conversation is different if someone is suggesting stomach amputation or dangerous diet drugs since in addition to questionable efficacy, these so-called interventions risk one’s life and quality of life. In this case I simply explain that no possible outcome of the surgery is worth risking my life or quality of life.

Perhaps most importantly, remember that we can only ever control whether or not we give someone information, we can never control the reaction or outcome. Even when confronted with research, people can still choose to bring “everybody knows” to an evidence fight.

Was this helpful? If you appreciate the work that I do, you can support my ability to do more of it with a one-time tip or by becoming a member. (Members get special deals on fat-positive stuff, a monthly e-mail keeping them up to date on the work their membership supports, and the ability to ask me questions that I answer in a members-only monthly Q&A Video!)

In case you missed it, my adorable dog and I have a poem to help you resolve (for the first time, or again) to ditch diets. I’m having fun doing videos like this so there will definitely be more – if you want to make sure not to miss future videos, you can subscribe to my YouTube channel!


I mentioned that I want to have more fun with my activism this year. As part of that, I’ll be doing a stand-up comedy set as a guest performer at the FATCH New Year, Same You show on January 10th at 9pm at the Upright Citizens Brigade Theater on Sunset in Los Angeles. Tickets and info can be found here (Accessibility info: there is a fat-friendly bench in the front, the rest of the seating is stadium theater seats with arms up at least one step. The venue is wheelchair accessible, but there is limited space for wheelchairs.)

Like this blog?  Here’s more cool stuff:

Wellness for All Bodies ProgramA simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!
Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Body Love Obstacle Course

This e-course that includes coaching videos, a study guide, and an ebook with the tools you need to create a rock-solid relationship with your body. Our relationships with our bodies don’t happen in a vacuum, so just learning to see our beauty isn’t going to cut it. The world throws obstacles in our way – obstacles that aren’t our fault, but become our problem. Over the course of this program, Ragen Chastain, Jeanette DePatie, and six incredible guest coaches will teach you practical, realistic, proven strategies to go above, around, and through the obstacles that the world puts in front of you when it comes to living an amazing life in the body you have now.
Price: $99.00
($79.00 for DancesWithFat members – register on the member page)

Love It! 234 Inspirations And Activities to Help You Love Your Body
This is filled with thoughtful advice from the authors Jeanette DePatie, Ragen Chastain, and Pia Sciavo-Campo as well as dozens of other notable names from the body love movement, the book is lovingly illustrated with diverse drawings from size-positive artist Toni Tails.
Price: $9.99 softcover, $7.99 Kindle, ($6.95 + free shipping for DancesWithFat Members)

Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRON-distance triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!  (DancesWithFat Members get an even better deal, make sure to make your purchases from the Members Page!)

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m (still!) training for an Iron-distance triathlon! You can follow my journey at .

If you are uncomfortable with my offering things for sale on this site, you are invited to check out this post.

via Dances With Fat