Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon | Book Review
Updated: Mar 22, 2021
Disclosure: I am biased against the Health at Every Size, fat acceptance, and body positivity movements. Though I believe parts of them are helpful, I also think they have gone too far.
Why review a book that came out in 2010 (revised and updated)? Though the Health at Every Size movement started in the 1960s, Experts often credited Linda Bacon with making it popular in the 21st century because of her book Health at Every Size: The Surprising Truth About Your Weight. This book triggered the modern-day Fat Acceptance Movement and Body Positivity Movement. Dr. Bacon is recognized for starting the movements.
The three major points or takeaways from Health at Every Size are that HAES is one extreme, the movement should focus more on developing healthy habits, and the book often reads like a religious text.
Health at Every Size is One Extreme
Diet culture dominated the 90s and early 2000s, damaging millions of millennials' health and wellness. I include myself in that group of millennials. Culture told me being skinny would give me friends and make me popular, so I developed an eating disorder that took me ten years to work through.
In 2021, the pendulum swung in the opposite direction: body acceptance and fat glorification are prevalent. Plus-size models like Tess Holiday gloss the cover of magazines, and plus-size singers like Lizzo dominate the music charts. Being affected by the culture, I have learned not to listen to the world, so I haven't gotten caught up in any body acceptance movement.
I believe the pendulum will settle in the middle. We won't glorify too skinny individuals or extremely obese people. The public will have a healthier view of weight and wellness. Recognizing that HAES is an extreme helps us understand what the HAES, body positivity, and fat acceptance movements are and their ramifications.
Linda Bacon Misses an Opportunity to Promote Healthy Habits
Reading this book, I kept thinking that Bacon missed a significant opportunity: to promote healthy habits and a balanced lifestyle. Instead, Bacon focuses on making fat acceptable through changing social norms. She blames America's obesity situation on culture, biology, science, and medicine. She suggests the solution to weight problems is to stop paying attention to them.
Passages about healthy habits and balance:
"Sound science supports that when we enjoy a variety of foods and trust our bodies, we naturally get the nutrients we need to keep us healthy." pg. 100
"An abundance of studies indicate improvement through nutrition or activity habits, independent of weight loss." pg. 141
"Let's switch our emphasis to encouraging health-promoting behaviors for all, and let the fat fall where it may. Everyone, fat and thin, can reduce their risk for health problems by making good lifestyle choices. It's time for a new peace movement: one that supports people in developing healthy lifestyle habits, regardless of their size. It's called Health at Every Size." pg. 157
Passages about fat acceptance and changing social norms:
"You don't have to worry about your weight." pg. 66
"Thin people may think they stay thin because they are morally superior. The data suggests it is more likely that they're genetically lucky (in this time when thinness is valued). The most direct route to thinness is to choose your parents well." pg. 142
"The epidemic exists only because we have defined it to exist. The epidemic will vanish as soon as we stop pathologizing weight and relegating people into baseless and arbitrary categories like overweight and obese. While I am not arguing that we encourage weight gain in order to improve health or that bodyweight is irrelevant to health, it is clear that the threat posed by our weight and the benefits of weight loss have been misinterpreted and exaggerated." pg. 156
"Your struggle with weight is an inevitable result of our modern culture and lifestyle, not your own shortcomings or lack of willpower." pg. 161
"We need to stop making weight an official concern." pg. 259
Instead of pushing healthy habits and how they are the most significant factor in health, Bacon promotes fat glorification and cultural changes that aren't helpful to an individual's health. Bacon presents a lot of data about health and how weight isn't the only factor in health, but doesn't talk about being healthy at every size. She says that your weight doesn't matter. She wants to normalize being fat.
"Weight fluctuation is strongly associated with increased risk for diabetes, hypertension, and cardiovascular diseases, independent of body weight. In other words, the recommendation to the diet may be causing the very diseases it is purported to prevent!" pg. 141
"Size is a sloppy and unscientific way to judge someone's health or character, and the social and medical imperative for a thin body is not only misguided, it has caused much damage. "Normal weight" is neither normal (most people exceed it) nor ideal in terms of health. All that can be determined by judging people based on their weight is one's own level of prejudice." pg. 157
Health at Every Size Could Be a Religion
Health at Every Size can read like a religion. Religion is a system of designated practices, behaviors, texts, worldviews, prophecies, and ethics. Though not all religions are the same, many have literature they live by, beliefs they stick to, and traditions they uphold.
The appendix of Health at Every Size contains pledges, manifestos, cover letters, educational materials, messages for specific groups of people, and resource guides. These materials are similar to the texts of religion like the Bible or Quran. They shape the values of those in the fat acceptance and HAES movement.
I do not deny the science in this book, though many others have questioned the studies; I'm saying the way Bacon has interpreted the science and tried to use it is similar to the value system of religion. Bacon used these studies, valid or not, to create beliefs around body fat that don't reflect decades of research.
Value 1: It is society's fault you are overweight.
"Your struggle with weight is an inevitable result of our modern culture and lifestyle, not your own shortcomings or lack of willpower." pg. 161
Value 2: You say how beautiful you are.
"Creating your own values around appearance means deciding for yourself what's important to you and what beauty looks like to you. It also means being able to separate your own needs from social expectations." pg. 179
Value 3: Bring other people into the movement.
"Even as you move toward a greater appreciation of your body, many of you will continue to struggle against cultural images, and friends and family who continue to tell you that "No, you aren't okay." Trust me here when I say it can be done. My research proves it. And you can teach those who love you to see you differently and to treat your body with respect." pg. 191
Value 4: Children are affected by cultural prejudice; parents should teach them otherwise.
"Given our cultural fear of fat, you may be tempted to limit or withhold food if you have a pudgy kid. Don't. Kids of all sizes need to learn how to regulate their food intake. Pudgy kids will be feeling plenty of cultural prejudice. They don't need more hassling from youーthey need your support. Better to shore up their self-esteem: reinforce the idea that kids come in a wide range of sizes and that everybody is a good body."
Value 5: Weight stigma causes health problems.
"The only way to solve the weight problem is to stop making weight a problem一to stop judging ourselves and others by our size. Weight is not an effective measure of attractiveness, moral character, or health. The real enemy is weight stigma, for it is the stigmatization and fear of fat that causes the damage and defects attention from true threats to our health and well-being." pg. 258
Value 6: Weight is not a health concern.
"We need to stop making weight an official concern. Health officials, researchers, physicians, dietitians: Lay off the fat people. It is time for the health-industrial complex to acknowledge that science and reason do not support the value of a weight focus. We need to practice evidence-based medicine and use it as a basis for determining public health policy." pg. 259
Value 7: Science has brainwashed you into thinking fat is bad.
"Denial and resistance are understandable. People reach for denial when an intolerable situation has been pointed out to them, but the means for change are hard to grasp, and the penalties for contributing to that change are high. Myths about weight are so deeply entrenched that it may be difficult to imagine an alternative and to have the courage and means to move toward it." pg. 261
Those morals determine how a person in this movement should act. HAES advocates have many rules around size and health that they want to implement to eliminate the cultural stigmas. For example: "We can support this by adding weight as a protected category under anti-discrimination laws. Fat people deserve full personhood and the right to legal protection when that personhood is denied; the high prevalence of weight-based discrimination and the lack of recourse when it occurs are simply shameful." pg. 259
Today the morality around HAES has gone even further, evidenced in the following videos:
Other problems:
Bacon often uses the word "dieting" as a blanket term for every eating pattern. It makes specific claims confusing and untrue. Diet has many definitions. The base definition is "food and drinks regularly provided or consumed." Merriam-Webster also defines diet as "the kind and amount of food prescribed for a person or animal for a special reason" and "a regimen of eating and drinking sparingly so as to reduce one's weight."
A diet can refer to a crash diet, weight-loss diet, or special diet. Any eating plan to reduce an individual's weight is called a weight-loss diet. Examples are the ketogenic diet or intermittent fasting. Any diet that cuts out major food groups for a short period to lose a significant amount of weight is a crash diet like a cleanse. Someone can follow a specialty diet if they are allergic to certain foods or choose to do so for moral reasons. Examples are a gluten-free diet for celiacs or vegans.
Depending on what diet Bacon is referring to, it changes the context of the passage. For example, on page 46, Bacon says, "Biology is so powerful it can "make" you break that diet." Biology isn't going to make a celiac break their gluten-free disease!
Many of the studies are skeptical at best. Some of them are just on rats; rats and humans aren't a one-to-one comparison. Some studies are too small or don't have a control group. Bacon often misses the whole picture when presenting evidence and studies. She discusses one aspect of health and misses the nuance that the entire body contributes to physiology. The videos and articles below address the skeptical studies included in Health at Every Size.
Further Watching:
Further Reading:
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