To the Academy of Nutrition and Dietetics Adult Weight Management Evidence Analysis Library team:
We are writing to you as the leaders of the Association of Size Diversity and Health, the organization that holds the Health at Every Size® and HAES® trademarks.
After reviewing the recent proposed recommendation 4.6 of the Adult Weight Management Guideline (For adults with overweight or obesity, it is suggested that RDNs or international equivalents not use a Health at Every Size® or Non-Diet approach to improve BMI and other cardiometabolic outcomes or quality of life (2D)) of the Adult Weight Management Guidelines, we are concerned about its inclusion in the Adult Weight Management Guideline.
The review conducted is based on a mischaracterization of Health at Every Size® (HAES®). First and foremost, the HAES® principles are not intended to assist with three of the outcomes evaluated (reduction in BMI, percent body weight lost, and reduction in waist circumference). HAES® principles reject the use of reduction in BMI, percent body weight lost, and reduction in waist circumference as measures of health based on the current evidence. None of the studies reviewed were designed with the aim to reduce BMI, reduce weight, or reduce waist circumference. It is unsurprising that your review showed weak effects on these three outcome measures, however, it is most concerning that the review and proposed recommendation mischaracterize Health at Every Size®.
Second, Health at Every Size® is not a singular program or approach to health. The principles are a result of extensive and ongoing review and interpretation of the existing evidence on weight and health showing that fat people are not inherently unhealthy and that there are paths to health for fat people that do not center on weight changes. A Health at Every Size® dietitian’s approach to a fat person with a family history of type 2 diabetes who is interested in behavior change to prevent diabetes, for example, might focus on increasing fiber, increasing fruits and vegetables, and increasing physical activity. By only including studies that specified a Health at Every Size® approach, you left out huge components of what the HAES® principles align with, and limited the review to a mere seven studies.
Finally, by making a recommendation that HAES® approaches not be used, it is reasonable to interpret that the review found evidence of harm, which it did not. In fact, no papers were found that included adverse effects in their studies. Further, every paper reviewed showed either improvements or no significant difference in the reported health outcome measures for the HAES® groups. None of the reported outcome measures worsened in the papers your team reviewed. We recognize that there are many unhealthy and extreme weight loss methods in existence, some of which dietitians actively promote, but none of those methods were called out in the recommendations as methods specifically to avoid.
In sum, the review is based on a mischaracterization of Health at Every Size® principles and as such contributes to consumer confusion about HAES®. We ask that you remove the proposed recommendation 4.6 from the Adult Weight Management Guideline. Additionally, we ask that all future statements and reviews regarding Health at Every Size® and HAES® involve the Association for Size Diversity and Health leadership team to ensure the principles are accurately represented.
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