Sunday, October 26, 2008

Health at Every Size

Right now I am reading Health at Every Size by Linda Bacon. Apparently Health at Every Size (HAES) is a general movement, of which Bacon is a part. The book essentially argues that you are unlikely to succeed at intentional weight loss over the long term, and that trying to do so might harm rather than improve your health, but that you can improve your health regardless of your size by other measures.

I haven't finished the book, so I won't try a full review, but although it's written at a fairly low level (similar to diet books in general) and is slightly polemical, I have only minor quibbles with what I've read so far. Bacon is an actual researcher with the kind of credentials you'd want to see. There are hundreds of citations throughout the text so that if she asserts something, you can easily investigate if you're so inclined. I think the book is worth reading whether you end up agreeing with its conclusions or not.

Bacon and some other researchers who are much more supportive of weight loss did a study in which they enrolled 78 (I think) overweight women and put them into two groups. Both groups met once per week for six months (divided into smaller support groups of 9 or 10 people), and then once a month for six months. One group followed a HAES approach and the other was a standard diet and exercise group.

After two years, neither group had lost any weight, but the HAES group had several measurable health improvements (things like fitness, cholesterol levels, and blood pressure), while the only statistically significant change among the dieting group was self-esteem, which went down.

This was, of course, only one study.

Overall, I find this approach appealing. I have lost a lot of weight (over 60 lbs) intentionally in the past, but I've regained a lot of it over time. I know that the key to maintaining the loss is to get a lot of exercise and maintain a constant focus on it, and I can't seem to do that at all right now - especially the "maintain focus" part. I can't seem to do anything systematic about my weight for more than about a week at a time.

What I can do (and I'm just starting the actual recommendations part of the book, so I'm now just writing about my own experience) is exercise and include more fruits and vegetables in my diet regardless of what or how much I am eating in general. And for now that's working out pretty well. I've got Ed going to the gym with me three times a week (which I generally enjoy a lot even though it's easier not to go) and I'm regularly eating pretty high amounts of fruits and veggies. (I'd say I average about 5 or 6 servings a day, which is not super high, but is at least within recommendations.)

I don't know. If I continue to inexorably gain weight I may have to revisit the idea of intentional weight loss. But if I can maintain some weight or other and increase my fitness to a normal level while eating a somewhat healthy diet, that might be a better approach for me.


Sally said...

I hope you post again and let us know what the specific recommendations of a HAES approach is.

I'm always curious when I read that some study compared a "standard" approach to their own pet approach in setting up a program; to what extent is there a sort of sabotage of the standard approach, however unintended?

I appreciate your reluctance to put a lot of confidence in a single study. I was struck when researching workplace diet and exercise programs for a class how poorly any given study indicated what was generally believed to be "true" when looking at either meta-studies (that statistically consider a bunch of studies at once) or just seeing how many studies support versus disconfirm a particular hypothesis.

One thing I wonder about the whole "diets don't work because people regain the weight" idea is whether if the people didn't try to lose weight, they would instead be even fatter a couple of years on? I can see arguments for either outcome. I assume the answer to this question is known (empirically), just not to me.

Tam said...

I wondered about the sabotage issue too, but she addressed it in the book by noting that the diet side of the study was run by her pro-dieting colleagues. (Her former thesis advisor, who was the lead researcher, was so concerned about the HAES approach that she made Bacon agree that if either side of the study showed negative effects after some number of weeks, they would stop the study.) She also noted that the enthusiasm, competence, etc., of the group leaders on each side was rated similarly by the participants.

I've wondered the same thing about "even fatter."

Susan Williams said...

This sounds really interesting and I tried to find this at the library, but they don't have it. I will keep my eye out for it and hope to read it someday.