Despite Traditional obesity treatment programs have assumed that

Despite an increase in dieting among the
American public, the prevalence of obesity continues to rise (Bacon et al. 854;
Gaesser 91).  Traditional obesity
treatment programs have assumed that the only method for reducing disease risk
in the obese is though weight loss.  More
importantly, traditional programs assume that everyone is capable of weight
loss and successful weight maintenance (Miller, “Health” 37; Miller, “Weight
Loss” 89).  These programs have promoted
the weight-loss-at-any-cost mindset that has permeated the medical model of
obesity treatment (Miller, “Weight Loss” 91). 
Despite efforts to promote weight loss among obese subjects, Traditional
Weight Loss (TWL) programs have been found largely ineffective at promoting
long-term weight loss,  with an overall
failure rate often cited as 90-95% (Gaesser 92) or even as high as 98% (Miller,
“Health” 38).  Even when programs are
successful in promoting short-term weight loss, the majority of weight is regained
within 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 only
method of improving the health of obese individuals.  However, a new paradigm has been proposed to
counter the traditional model: the Size Acceptance, or Health at Every Size,
paradigm (“Health”).

Health at Every Size (HAES) is based upon
recent research demonstrating that physical activity can improve health
independently of weight loss and was developed out of frustration with the
general failure of TWL programs.  This
research has lead to the conclusion that an individual’s level of fitness is a
better indicator of health risk than level of fatness (Barlow 41; Miller, “Fitness”
208; Stevens 832).  If



exercise training has been shown to have
beneficial effects on health measures such as lipid and carbohydrate
metabolism, blood pressure, and insulin resistance independently of weight loss
(Brown 1549; Friedman et al. 20; Tremblay et al. 1326), and even in the
presence of weight gain (Friedman et al. 21), then why should health
professionals continue to emphasize weight loss as the only measure of success
in obesity treatment?

Proponents of the HAES paradigm suggest instead
that focus should be transferred away from weight loss and toward healthy
lifestyle behavior change, including physical activity and a healthful,
balanced diet.  HAES posits that dieting
and the resultant obsession with weight is unhealthy and seeks instead to
promote acceptance of all bodies, regardless of size or shape, acknowledging
and respecting the natural diversity of human bodies in direct opposition to
Western society’s obsession with thinness (McFarlane, Polivy, and McCabe 262;
Miller, “Weight Loss” 93).  In contrast
to the traditional model, which focuses on weight as the sole measure of
health, HAES recognizes many factors that contribute to health and total
well-being: physical, social, spiritual, occupational, emotional, and
intellectual (King 272; Miller, “Health” 44; Robison, Putnam, and McKibbon
185).  Whereas the traditional model of
obesity focuses only on weight, HAES focuses on the entire person. 

The majority of HAES
studies 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 cognitive
behavioral methods to improve these aspects of psychological health; thus, definitions
of success would include improvements within these psychological measures.  Improvement was quantified by pre- and
post-treatment changes on validated psychological measures such as the
Rosenberg Self Esteem Scale (Rosenberg 250), the Beck Depression Inventory
(Beck et al. 50), the Eating Inventory (Stunkard and Messick 100), and the
State-Trait Anxiety Inventory (Spielberger et al. 50), among others.  


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