Health at Every Size® Framework of Care

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The Heath at Every Size® Framework of Care was developed 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 honor 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.
 

4. Compassionate Care
 

Compassionate care for our patients is about developing empathy (not pity) for the huge range of life experiences that influences an individual’s health status and their relationship to health and the healthcare system. Health at Every Size®-aligned providers seek out stories different from our own to broaden our understanding of the world and the diversity of experiences it contains so that care is provided through the ever-expanding lens of compassion for our patients.
 

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.
 

7. Provider Roles and Responsibilities
 

Health at Every Size®-aligned providers apply ethical and liberatory frameworks to understanding their roles and responsibilities when providing care. This is especially important when the current medical system is set up so that providers hold the keys to accessing many forms of care. Additionally, Health at Every Size®-aligned providers have an ethical framework to guide them in understanding how they will support patients in ways that support harm reduction in a weight biased world.
 

8. Tools that support wellbeing and healing without contributing to oppression
 

Health at Every Size®-aligned providers are equipped with tools that support patient health goals without the pursuit of weight loss. This includes relearning tools co-opted by the weight loss industry like nutrition and physical activity, as well as learning the tools to help our patients reframe their relationship with food and movement in alignment with their values. Health at Every Size®-aligned providers learn about and offer treatments for various health conditions that don’t rely on weight loss.
 

9. Addressing Your Anti-Fat Bias
 

Providers must examine their internalized and externalized 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 realized.