Researcher advocates Health at Every Size program

LAWRENCE — A proposal that health can be attained at any body size by taking a more holistic approach to wellness is gaining popularity, and a University of Kansas professor is studying its professional use to see how effective it is.

Sonya Satinsky, assistant professor of health, sport and exercise sciences, is studying the Health at Every Size paradigm by surveying professionals who use the approach in various fields of health. The paradigm is a model that shifts focus from weight loss as the way to improve health to improved nutrition and physical activity regardless of weight change. She is asking how people such as mental health providers, dietitians, health promotion specialists, nutritionists and even college professors use the principles in their work.

“A lot of people who use this paradigm are constantly having to fight for it,” Satinsky said. “Given the amount of weight-based prejudice out there, I think it makes sense to view health this way.”

Satinsky is surveying nearly 100 members of the Association for Size Diversity and Health who adhere to the Health at Every Size tenets. She’s looking to find out how they use the principles, what challenges they face, what sort of health professionals are using them and how effective they are. If the paradigm proves efficacious, the goal is to develop advocacy tools for practitioners and an intervention to promote its use in helping people improve their health.

Health at Every Size has five principles.

• Accepting and respecting the diversity of body shapes and sizes
• Recognizing that health and well-being are multidimensional and include physical, social, spiritual, occupational, emotional and intellectual aspects
• Promoting all aspects of health and well-being for people of all sizes
• Promoting eating in a manner that balances individual nutritional needs, hunger, satiety, appetite and pleasure
• Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on weight loss

The paradigm does not argue that weight has no place in health, rather that it should not be the primary focus.

“A lot of the behaviors that people engage in to lose weight are very unhealthy,” Satinsky said. “We know the mechanisms people can use to lose weight, but we do not know the mechanism by which to keep it off for five years or more.”

There is also evidence that weight cycling, or continually losing and regaining weight, is more unhealthy than maintaining a consistent body weight. Satinsky’s research into Health at Every Size has also found examples of people whose doctors have misdiagnosed or altogether missed health problems because they insist the first thing a person needs to do is lose weight. There is also an enormous amount of money in the weight-loss industry that can drive conflicts of interest and ethical problems with its connections to the field of public health.

“There is a lot of pushback when you discuss these principles,” Satinsky said. “And there are a lot of people who are convinced that fat equals unhealthy and they won’t be swayed.”

Evidence is showing that despite claims that this generation will die younger than the previous, people are living longer now than they ever have. Again, Health at Every Size doesn’t dispute that there are persistent health problems in society, but that focusing solely on weight loss as the way to resolve them is both incomplete and can lead to further problems such as eating disorders. The paradigm advocates using a number of health measurements such as blood pressure, nutrient intake, regular physical activity, cholesterol and mental health outcomes.

“If weight loss happens, it happens, but that shouldn’t be the only goal,” Satinsky said. “If that’s the only goal, that’s not being healthy, and body-based shame does not help people get healthy.”

Satinsky has made presentations on Health at Every Size at meetings of the American Public Health Association, and when finished analyzing the data from her current study she will use the findings with the goal of standardizing the paradigm so its efficacy can be studied further. She is also co-editing a textbook on Health at Every Size for use in public health, health education and community health classes.