Tip #135 Health At Every Size ® and the Spirit of Motivational Interviewing

The Health At Every Size (HAES ®) approach to health and weight has been around for several decades. It also has been called the non-diet movement and size acceptance. More and more dietitians are adopting this paradigm.

The basic principles of Health At Every Size® www.sizediversityandhealth.org

  1. Accepting and respecting the diversity of body shapes and sizes.
  2. Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional and intellectual aspects.
  3. Promoting all aspects of health and well-being for people of all sizes.
  4. Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.
  5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.

We can love and accept ourselves
and still work like mad to change ourselves.

Dave Ellis

Beginning today, treat everyone you meet
as if they are going to be dead by midnight.
Extend to them all the care, kindness,
and understanding you can muster,
and do it with no thought of any reward.
Your life will never be the same again. 

Og Mandino

Shifting away from a traditional prescriptive and weight-based approach to nutrition counseling and embracing a HAES model takes commitment, support from colleagues, and practice.  Just as in learning motivational interviewing, repeated feedback and practice are the hallmarks of effective adoption of the new paradigm.

MI and the HAES paradigm are well suited to each other. Both the spirit and the specific skills employed in a motivational interview further the broad goal of health for the client. MI provides us the specific strategies and a way of being with our clients that guide them toward a sustainable lifestyle that maximizes their health. In this Tip, we explore how the spirit of MI supports HAES and vice versa. Future tips will address how the techniques and processes of MI support HAES counseling.

The spirit of MI is captured in four terms:

  • Partnership
  • Acceptance
  • Compassion
  • Evocation

Partnership implies working together, working with and for the client. The old model of being the expert and telling clients what is best for them is one of the things we leave behind when we shift into work with HAES. We partner with our clients to find the ways that they will uniquely walk down the path toward true health. We may have information and advice that may be useful to our clients. But our expertise is secondary to what the clients know about themselves and to the process they will go through on their journey.

To understand acceptance, it can be further broken down:

Worth: A key tenet of MI is a rock-solid belief that clients have value and worth just for being alive. When paired with HAES, this is extended to include that the worth is not tied to weight.

Empathy: This means accurately “getting” our clients, truly see their world as they see it. This part may be a challenge if much of what we hear is rooted in the diet mentality. We can work to carefully hear how clients see the world while also evoking deeper yearnings that come from a broader concept of health.

Autonomy: This means accepting that all people have a right and ability to direct their own lives, make their own choices. Our clients can and will choose the path that seems right to them. If we attempt to force our view and beliefs on them, we will ultimately fail. This includes forcing a non-diet process.

Affirmation: This means intentionally choosing to focus on what is right and what is working. Adopting a strengths perspective is both respectful of our clients and most effective. The HAES model is by its nature strengths-based. It assumes that much of what clients are already doing is health-promoting and it encourages us to build on what is working already to guide the clients toward health and self-esteem.

Compassion is not sympathy. It is being and acting fully for the benefit of the other person. This focus on the best interests of our clients has led many of us to the HAES paradigm. We see it as an approach that takes into account the whole person and all the best interests of that person rather than a narrow focus on weight.

Evocation speaks to both the spirit with which we engage with clients as well as the process. An evocative spirit implies that the majority of the answers are in the client, not in us. By our words and actions we say to our clients that they have what is needed to move toward greater health and that together we will find it.

Posted in Tips