PCOS through a HAES lens

PCOS is commonly associated with higher body weight and a predisposition to weight gain. As a result, people with PCOS are often advised to diet and lose weight. However, research has shown that focusing on weight loss can be more harmful than helpful.

Instead of falling into the diet trap, we can support ourselves by focusing on health supporting behaviors. When we do this, our body will naturally fall into its healthy weight. It's also important to remember that a healthy weight looks different for every body and your healthy weight won’t look the same as the person next to you. That is why viewing PCOS through a Health at Every Size (HAES) lens, enables us to focus on what really matters. 

In this article we’ll be discussing topics like:

• Defining Health at Every Size (HAES)
• HAES and PCOS
• Health promoting behaviors to focus on
• Resources for the HAES model
  

Defining Health at Every Size (HAES)

The Health At Every Size (HAES) model acknowledges that the use of body weight / size does not represent health status, and works to promote size-acceptance, end weight discrimination, and lessen cultural obsession with weight loss.

HAES is made up of five principles that were defined by the Association for Size Diversity and Health (ASDAH) in 2003. With these five principles, ADASH aims to mitigate the harm that has been done and continues to be done due to weight stigmatization. Below you will find a list of the five HAES principles from ADASH, along with a brief description of each one (1). 

HAES Principles

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose

-The Association for Size Diversity and Health (ASDAH): The Health at Every Size® (HAES®) Approach

What HAES may mean for my PCOS management

You might be wondering, “I have PCOS and I've always been told to lose weight- so how does this relate to me?” 

Oftentimes people with PCOS are instructed to lose weight in order to improve their symptoms. However, this recommendation is not supported by the research and can actually do more harm than good. In addition to being a reproductive syndrome, PCOS is a metabolic syndrome and 70% of people with PCOS develop insulin resistance. This can lead to weight gain and difficulty losing weight in people with PCOS.

You may be thinking that because PCOS causes people to gain weight, the solution is to lose weight. The truth is, when we do this we are focusing on the outcome rather than the root cause. Instead, if we focus on determining the type of PCOS and the proper treatment for it we will have far better outcomes.

Additionally, hyper-focusing on weight is stressful and ineffective. Weight-focused interventions have been shown to contribute to weight cycling (2), increased risk for osteoporosis (3), chronic psychological stress (4), increased cortisol production (4), anxiety around weight (5), and disordered eating (5). So, dieting can actually aggravate problems associated with PCOS!

On the other hand, research shows that following the HAES model can be supportive and highly effective. Across several studies, the HAES/non-diet groups experienced improved physiological measures (i.e. blood pressure, blood lipids), improved health behaviors (i.e. physical activity, eating disorder pathology), and improved psychosocial outcomes (i.e., mood, self-esteem, body image) (6).

Health-promoting behaviors to focus on

A “healthy weight”, as defined by medical standards, is not a good marker for health. Other markers such as fasting insulin, glucose, HbA1c, and blood pressure are more indicative of true health status. That's why we find it more helpful to focus on health promoting behaviors when treating PCOS. 

So what can you do to improve these actual markers of helath?

• Get enough fuel and ensure you are eating enough for your body. Under-eating can lead to more stress and even insulin resistance. 
• Eat consistently throughout the day to prevent dips in blood sugar and improve insulin levels. 
• Increase protein intake by incorporating protein at every meal and snack.
• Incorporate fiber from whole grains, fruits and vegetables. This will help decrease the glycemic impact of the meal/snack.
• Check in with yourself. Are you being mindful of your eating patterns? Are you aware of why you eat and hunger / satiety cues? 
• Find mindful movement that feels good in your body and brings you joy. 

Conclusion

When we stop focusing on weight and start focusing on health-promoting behaviors, we are able to tap into our bodies true healing power. Diet culture tells us that we need to aim for a certain weight, that foods are "good" or "bad," and that we need to over-exercise to lose weight. But we know and the research tells us that this is not effective and can lead to more stress and worse health outcomes.

By following the HAES model we stop focusing on weight, view all foods as acceptable, choose movement that is fun and enjoyable, and allow our body to seek its natural healthy weight. We understand that our weight / size does not determine our health status and shift our focus to the interventions that help us heal. 

HAES resources

Organizations that promote HAES and fight against size discrimination:

National Association to Advance Fat Acceptance (NAAFA)

Association for Size Diversity and Health (ASDAH)

Society for Nutrition Education and Behavior

Sources

1. ADASH - HAES Approach
2. Strohacker & McFarlin, 2010
3. Van Loan & Keim, 2000 
4. Tomiyama et al, 2010
5. NEDA - Research and Statistics
6. Bacon et al, 2002; Bacon et al, 2005; Ciliska, 1998; Goodrick et al, 1998; Provencher et al, 2007

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