HEALTH AT EVERY SIZE® 

The Association for Size Diversity and Health (ASDAH) and Size Inclusive Health Australia affirm a holistic definition of health, which cannot be characterised as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES® model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES® approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.

In 2003, when ASDAH formed, the first version of the Health at Every Size® Principles was created based on existing related frameworks. The principles were revised in 2013 and again most recently in 2024. The Health at Every Size® Framework of Care was created in 2024 by ASDAH.

Health at Every Size® is an ever-evolving model and HAES®-aligned Providers are committed to the continuous learning to stay up-to-date.

The Health At Every Size® Principles are:

1. Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum: People of all sizes, including those at the largest end of the size spectrum, have the right to healthcare without exception. Fat people’s access to compassionate & comprehensive healthcare should not depend on obtaining a certain BMI, pursuing weight loss, and/or holding health as a value or pursuit. 
   
   
2. Wellbeing, care, and healing are resources that are both collective and deeply personal: Because health exists on a continuum that varies with time and circumstance for each individual, Health at Every Size® aims to focus on wellbeing, care, and healing. These are resources from which we can all pull to meet our needs. And we get to have others pour those resources into us and vice versa. Community care and mutual aid is key. Health at Every Size® providers and advocates must work to promote and create the conditions that support wellbeing i.e. environmental care, clear air & water, equitable access to food, and more. Each person is the expert of their own body and should have the right to make autonomous decisions about their health and wellbeing, including how they value or prioritize health among all the other important aspects that make up a life.
   
   
3. Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind: Anti-fat bias, and fatphobia are detrimental to the health and wellbeing of all people, especially fat people. When health research, health policy, health education, and the provision of care does not include the full human size spectrum, it harms people of all sizes and is the antithesis to Health at Every Size®. Those who provide Health at Every Size®-aligned care must strive to dismantle anti-fat bias personally and systemically in order to provide care for all bodies.                   
4. Health is a sociopolitical construct that reflects the values of society: How our society currently defines health is rooted in white supremacy, anti-Black racism, ableism, and healthism. As the values of our society become more rooted in collective liberation, we have the opportunity to critically examine and redefine health, disease, and illness. Regardless of the definition of health, however, access to care must never depend on an individual’s or community’s health status, pursuit of health, or compliance with health recommendations.
   

Health at Every Size® Framework of Care

The Heath at Every Size® Framework of Care was developed by ASDAH from 2022-2024 to serve as a roadmap for Healthcare Providers to become Health at Every Size®-aligned. These core elements are equally necessary in the provision of Health at Every Size®-aligned care, and while they are numbered for ease of referencing each item, there is no hierarchy. They can be thought of as trusses of a bridge, each one vital for the stability of the framework. Without any one of these, Health at Every Size®-aligned care is not possible. None of these are static. Ongoing learning is required to stay up-to-date and continuously improve HAES®-aligned care.

1. Grounding in liberatory frameworks: Health at Every Size® is not a liberatory framework or social justice movement in and of itself, but rather aims to align with other movements in order to further the journey towards liberation for all. We remain committed to the ongoing learning from liberation thought-leaders in Black liberation, fat liberation, crip/disability justice, queer liberation, womanism, intersectional feminism, and many more known and not-yet-known movements working towards the liberation of all people. Without this commitment, our work risks contributing to the oppression of the most marginalized in the pursuit of a false sense of liberation for the few.

2. Patient Bodily Autonomy: While this concept is more readily applied in healthcare settings as a patient’s right to refuse medical procedures, it is less commonly applied to a patient’s right to choose how they proceed with a treatment plan after being provided with all options and informed of known (and unknown) risks and benefits. Most restrictions based on BMI and the pervasive practice of refusing care until some other criteria is met (e.g. weight loss, trying ‘lifestyle’ intervention first, trying a certain treatment before considering other options, etc.) are violations of patient autonomy in most cases. Health at Every Size®-aligned providers honour patient autonomy in the broadest possible way when ethical to do so.

3. Informed Consent: Patients have the right to informed consent. This concept is also common in the current healthcare system, but is not practiced through the lens of liberation for all. Informed consent must include what we don’t know just as much as what we do know. For example, researchers often exclude people in certain BMI ranges from studies on treatment effectiveness, leading to gaps in our medical knowledge. Fatphobic and healthist ideas influence what we believe is the best course of treatment, or even whether or not providers share certain information. Instead, informed consent must be provided without bias and with a focus on patient autonomy.

5. Critical analysis, application, and execution of research & medical recommendations related to weight: Anti-fat bias has played a profound role in shaping the medical research and recommendations widely used in today’s healthcare system. One of the main roots of the current Health at Every Size® community was a group of fat activists known collectively as the Fat Underground who began questioning their healthcare experiences and the advice they received from healthcare professionals. They discovered the research on health and weight was not aligned with the recommendations from their healthcare professionals. The issues they brought to light persist today, and in many cases have worsened. Providers must consider the way weight bias has influenced the research design and interpretation of studies underlying their training, clinical recommendations, and policy that impacts fat people.

6. Skills and equipment to provide compassionate and comprehensive care for fat people’s bodies: Developing empathy for others is only one part of providing compassionate care. Providers must also develop the skills to provide care in compassionate and comprehensive ways and provide equipment designed for the full range of fat bodies. From learning appropriate ways to handle asking for a weight to physical exams on larger bodies to skills for administering various treatments on larger bodies, providers must learn what is necessary for Health at Every Size®-aligned care that their training did not cover.

9. Addressing Your Anti-Fat Bias: Providers must examine their internalised and externalised biases related to weight, including fat providers. Everyone holds biases, and addressing our beliefs, attitudes, and practices that may be rooted in bias is critical for making space for a Health at Every Size®-aligned practice.

10. Addressing Systemic Anti-Fat Bias: Health at Every Size® Providers are committed to the ongoing work of addressing systemic anti-fat bias. From our colleagues to workplace and government policy, we must be committed to abolishing the BMI, dismantling the Medical Industrial Complex, and creating the conditions for care of all people to be fully realised.