r/fatlogic - I read 'Health and Every Size' and it has more sanity than you might expect...

Nope, that wasn’t a clickbait title. I really mean it.

Linda Bacon’s Health at Every Size (2008) is often described as the beginning of the HAES movement (although these ideas have been around since the 1960s). It’s the seminal text that so many fat activists turn to when critiquing diet culture and pressures to be thin. I get books for free thanks to my job, so I decided to read up on Bacon’s HAES and decide for myself what the main messages were.

Reader, I was surprised.

r/fatlogic - I read 'Health and Every Size' and it has more sanity than you might expect...

The first thing to understand about this book is that it is divided in to two parts. My main focus on this review is the first half of the book, which outlines the HAES philosophy and the evidence behind it. This is where a surprising amount of sanity lurks. The second half is dedicated to tips about eating sensibly and enjoying exercise. I’m happy to answer any questions about it, but it’s more about worksheets than theory. It’s also closer to what you might expect from a HAES handbook, advocating the idea that telling someone to lose weight is as bad as telling them to be whiter or straighter (p 190). The eating suggestions don’t involve limiting calories, and the exercise advocated is so mild that it’s not going to do much for peoples’ cardiovascular fitness. No surprises there. The real gems of sanity (and the parts that FAs seem to have missed) are in the front half of this text.

Bacon’s HAES

Let’s get on to a discussion of what’s in the first half of the book and what Bacon is actually trying to achieve.

As regards the title, Bacon is saying they health can and should be your aim no matter what your size. Basically, being active is very good for your physical and mental wellbeing regardless of how fat or thin you may be. Everyone should endeavour to exercise in a way that is sustainable and habitual (p 54). Healthy lifestyle habits are available to everyone (p 157). I think that’s something we can agree with on this sub, especially as many of us are currently over- or underweight.

Importantly, this book is not for people who find it easy to lose weight.

If you are one of the many people on this sub who hasn’t had too much trouble increasing your movement and decreasing your intake, then this book isn’t for you. It’s for those of us who have struggled with CICO and can’t quite understand why. As someone with Binge Eating Disorder, I actually found her approach quite helpful. While I understand CICO, I have trouble adjusting my behaviour accordingly.

One of Bacon’s main arguments is that we are not perfectly rational beings with full control over our appetites. On one level, we can be hijacked by external cues like food advertising and social pressure about when and what to eat. On another level, our body registers how much we have consumed and how much energy we have spent. This has a powerful impact on our hunger cues. We need very high levels of willpower to ignore these cues to eat more during significant caloric deficit. This is why only a minority of people lose weight and maintain weight loss after a crash diet.

So, you’re set if you can say no to external cues to eat like enforced meal times or peer pressure. You have a good chance of losing weight if you are deeply motivated to ignore your body’s many hunger signals and keep ignoring them for extended periods of time. That’s awesome for you, and Bacon and I are a bit jealous. Don’t judge.

If you can’t honestly commit to weight loss via significantly reduced calories, you need to learn how to balance your approach to eating so that it synchronises with how your body works. The good news is that most of us who are trying to lose weight are eating more than our bodies want us to. I think this mindset is actually quite constructive and helpful for people like me with BED, or others who have problems with their willpower or maintaining a diet in their particular social circumstances.

Pro-CICO?

Bacon makes some interesting observations that support CICO. Here are some arguments and observations that are in the book. They may surprise you:

  • “Weight loss is simply a matter of taking in fewer calories than you spend”. In a perfect world, reducing calorie intake by going on a diet and increasing calorie expenditure through exercise would lead to lasting weight loss. Many people fail to achieve this in a long lasting way because we don’t have total conscious control of our body’s cues, which makes following these regimens hard (pp 44-45).

  • Bacon knows that 2000 calories is ideal for a woman of her age and energy needs. She eats roughly this much each day and maintains her weight as a result. Some people will gain weight on this amount. Others will lose weight. It’s all about their personal energy needs (p 45).

  • A big reason why chronic dieters fail despite frequent extreme calorie restriction is the periods of equally extreme indulgence. The more we take part in crash diets or starvation level diets, the more we mess up the hormonal cues that cause hunger. Our body also sends out signals that we need very high-fat foods and lowers our energy so that we feel too lethargic to burn them off with increased activity (pp 48-49).

  • “Many people believe that exercising gives them permission to eat more than they are actually hungry for”. This means that many people never see a significant change in weight when they increase their calorie output (p 53).

  • Our bodies have complex hungry responses impacted by hormonal responses to stress, sleep, and even the viruses in our bloodstream. Pollution hypothetically impacts our hormonal systems as well. There is no healthy way to change your hormones or immune system via pills or other aids. Even drugs that increase metabolism will stop working effectively as your body compensates. Basically, there’s no magic fat burn pill so don’t waste your time (pp 54ff)

  • With modern foods, we can eat high calorie snacks that bypass our natural hunger system due to new ingredients like high fructose corn syrup. The volume of food you consume does not have a direct relationship with your size, as you may be consuming small unsatisfying snacks with low fibre that don’t satiate you. A small snack might have as many calories as a full meal, but will still leave you wanting more (p 69). On this note, the US food industry is insidious, corrupt, and distancing consumers from healthy, fresh produce and natural tastes. This messes with our hunger receptors and can make us eat more than we need to (pp 113ff).

  • Fat around your abdomen is particularly unhealthy. Heavier people are more likely to have insulin resistance, and develop Type II Diabetes as a result. Insulin helps to decrease our appetite, but this goes haywire when we get insulin spikes from too many refined grains (p 77). (FYI: she does explain that fibre can control the sugar hit. So if you crave apple juice, try to satisfy it by eating an actual apple instead).

  • Try not to label food as good or bad. Yep, we certainly see this argument in fatlogic world! But the reality of this statement isn’t so bad. Bacon suggests we allow ourselves any kind of food in moderation without punishing ourselves for being bad or rewarding ourselves with a naughty treat. Instead, we should pay attention to how a ‘bad’ food like a Twinkie feels. Respect your body’s response to the sugar and the taste. Tap in to these signals with an open-mind to see how and when a sugary snack might be good for you. You will probably find that you rarely want or need it if you base your desires on your body’s behaviour during and after the ‘bad’ food (p 94).

The Notorious Set Point Theory

One of the ideas from Bacon that seems to permeate the fatlogic world is the idea of a set point: a natural weight that our body seeks to stabilise at. We’ve all heard people claiming that their set point is 250 pounds and no amount of dieting will change this.

So what does Bacon actually say?

She does argue for a set point, but notes that many people are above their set point of ideal weight because they are bad at recognising when they are hungry, go through binge/starve cycles, or over-eat for emotional reasons (p 28). So, if you want to use Bacon’s argument about set points, you need to keep in mind that fact that many people are below or above their set point due to bad eating choices.

A person who spends all day stuffing their face to address their emotions (lol, like me) cannot be at their set point. Only a healthy eater who pays proper attention to their body’s signals can be at their natural set point. In modern America, such people are a minority.

My interpretation of a set point, in light of this book, is that we all have different physiques. For example, you might have two ladies who are 5’6. One has delicate bone structure, narrow hips, and a flat chest. Realistically, her body will settle on a lower natural weight than a 5’6 lady with a wide pelvis and a big bust size. Or, you might have two men who are 5’9. One has broad shoulders and stocky legs. The other is slim with a narrow physique. You wouldn’t expect these people to have the same BMI. The naturally larger ones will need to eat a little more to sustain their higher natural set point. Their bodies will give them hormonal signals to help them achieve an appropriate intake specific to their own body.

Now, we are talking a difference here of a few kilos and a few hundred calories. The healthy range on a BMI chart isn’t just a single weight, after all. There’s nothing in Bacon’s text that actually condones the idea that 300 pounds is anyone’s set point. Instead, she makes the fairly reasonable claim that all bodies are different with different dietary needs.

It’s also clear that people like me who binge are probably quite a bit above our set point, as Bacon herself was before she put HAES in to action. Bacon actually lost 30 pounds following the HAES model. She also stopped her yo-yo dieting and learned how to relax around food and find a stable intake that worked for her (p xxii). She describes her set point as this lower weight that she obtained once she got in tune with her body’s signals.

Some Critiques

Not everything about the first half of this book is flawless.

There are areas where I disagree with Bacon. She believes that bariatric surgeons routinely exaggerate the danger of obesity in order to sell very dangerous procedures (pp 62ff). I think obesity is life threatening, and I don’t feel bothered by people who need a surgical solution to it (so long as they’re well informed about the permanent lifestyle changes needed to make it work).

Even more problematic is her occasional promotion of studies that ‘prove’ fat and thin people eat the same amount (p 68). Are we talking about the same volume, but thinner people eating fewer calories? Were the studies undertaken in a closed environment that didn’t rely on self-reporting of intake? It’s not clear. These studies can be very problematic, and I don’t think they are used well.

There are also moments were she doesn’t seem to believe in CICO anymore (pp 70, 143)!

The chapter titled ‘We’re Victims of Fat Politics’ has some questionable statements. Bacon disagrees with the idea that overweight people are unhealthy or that obesity shortens our life spans. She argues that the data used in these studies is flawed. I think this chapter is really off, so I haven’t included it in my positive observations above. I’m also not the right kind of doctor to really comment on cardiovascular or metabolic studies. Maybe someone else here can jump in.

Conclusions

I certainly don’t agree with Bacon in on every claim she makes. It’s a book with multiple arguments based on interpretations of different scientific studies and clinical observations. The only books I stand by in full are the two I wrote. (Even then there’s room for argument…).

But, I think it’s important that we get a sense of where fat logic is coming from and how it has developed as an argument if we wish to combat this kind of thinking in our selves and our communities. You don’t get anywhere by ignoring the people you disagree with.

I’m very happy to have read HAES, and there are some real gems of advice that I will be taking on board. It also showed me that Bacon appeals due to her compassion for her readers. She’s an empathetic person who challenges the view that everyone who is fat is an ignorant failure. Maybe that’s something we need to consider more.

If anyone has recommendations for other books you’d like me to read and report back on, I’m happy to do so. I hope you enjoyed this review, and I’d love to hear your thoughts.

(Page numbers correspond to the BenBella 2010 edition.)

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