Despite an increase in dieting among theAmerican public, the prevalence of obesity continues to rise (Bacon et al. 854;Gaesser 91).
Traditional obesitytreatment programs have assumed that the only method for reducing disease riskin the obese is though weight loss. Moreimportantly, traditional programs assume that everyone is capable of weightloss and successful weight maintenance (Miller, “Health” 37; Miller, “WeightLoss” 89). These programs have promotedthe weight-loss-at-any-cost mindset that has permeated the medical model ofobesity treatment (Miller, “Weight Loss” 91).
Despite efforts to promote weight loss among obese subjects, TraditionalWeight Loss (TWL) programs have been found largely ineffective at promotinglong-term weight loss, with an overallfailure rate often cited as 90-95% (Gaesser 92) or even as high as 98% (Miller,”Health” 38). Even when programs aresuccessful in promoting short-term weight loss, the majority of weight is regainedwithin four to five years (Gaesser 92; Miller, “Fitness” 207). Despite the lack of supporting evidence,traditional treatment programs continue to focus on weight loss as the onlymethod of improving the health of obese individuals. However, a new paradigm has been proposed tocounter the traditional model: the Size Acceptance, or Health at Every Size,paradigm (“Health”).Health at Every Size (HAES) is based uponrecent research demonstrating that physical activity can improve healthindependently of weight loss and was developed out of frustration with thegeneral failure of TWL programs. Thisresearch has lead to the conclusion that an individual’s level of fitness is abetter indicator of health risk than level of fatness (Barlow 41; Miller, “Fitness”208; Stevens 832). If exercise training has been shown to havebeneficial effects on health measures such as lipid and carbohydratemetabolism, blood pressure, and insulin resistance independently of weight loss(Brown 1549; Friedman et al. 20; Tremblay et al.
1326), and even in thepresence of weight gain (Friedman et al. 21), then why should healthprofessionals continue to emphasize weight loss as the only measure of successin obesity treatment?Proponents of the HAES paradigm suggest insteadthat focus should be transferred away from weight loss and toward healthylifestyle behavior change, including physical activity and a healthful,balanced diet. HAES posits that dietingand the resultant obsession with weight is unhealthy and seeks instead topromote acceptance of all bodies, regardless of size or shape, acknowledgingand respecting the natural diversity of human bodies in direct opposition toWestern society’s obsession with thinness (McFarlane, Polivy, and McCabe 262;Miller, “Weight Loss” 93). In contrastto the traditional model, which focuses on weight as the sole measure ofhealth, HAES recognizes many factors that contribute to health and totalwell-being: physical, social, spiritual, occupational, emotional, andintellectual (King 272; Miller, “Health” 44; Robison, Putnam, and McKibbon185). Whereas the traditional model ofobesity focuses only on weight, HAES focuses on the entire person.
The majority of HAESstudies measure psychological aspects of health including self-esteem,depression, body image, body dissatisfaction, anxiety, and restraint in eating,as well as binge eating (Mellin and Minihane 1133). Many studies have incorporated cognitivebehavioral methods to improve these aspects of psychological health; thus, definitionsof success would include improvements within these psychological measures. Improvement was quantified by pre- andpost-treatment changes on validated psychological measures such as theRosenberg Self Esteem Scale (Rosenberg 250), the Beck Depression Inventory(Beck et al. 50), the Eating Inventory (Stunkard and Messick 100), and theState-Trait Anxiety Inventory (Spielberger et al.
50), among others.