Cover Story

Since she was 7, Susan Hersfeld had tried one diet or another.

"I tried the 'hot dog, banana and egg' diet, WeightWatchers, the Susan Powter diet—you name it," the 52-year-old retiree recalls. She attributes the dieting—and the binging that followed—to her lack of self-acceptance, fueled by an early message from home that she was not OK as she was.

Three years ago, Hersfeld landed in a program, Bodywise in Ann Arbor, Mich., that uses a non-diet approach to optimizing health. Called "Health at Every Size," the model emphasizes accepting your body as it is and helps people develop approaches to eating, exercise and social support that promote health and joy.

Today, Hersfeld feels liberated from a confining and boring relationship with food—and feels freer in other parts of her life as well, she says.

"When I used to go into a restaurant, it was always about, 'What can I have that's on this menu?'" she remembers. "Now, I look at the whole menu and say, 'What do I feel like having?'"

She's also doing exercise she actually enjoys—swimming and walking, instead of forcing herself to go to the gym—and she's wearing a bathing suit for the first time in 30 years, despite having gained a little weight.

"If someone told me I'd be wearing a bathing suit, I'd have said they were out of their mind," she chuckles.

What the model says

Hersfeld is one of a growing number of women seeing psychologists and other counselors who use the "Health at Every Size" approach in their practices. Launched in the late 1980s by like-minded mental health professionals, medical professionals, fitness experts and "fat activists," the model has percolated into the national consciousness as an approach for anyone who struggles with dieting and weight issues, says psychologist Deb Burgard, PhD, an eating-disorders specialist in Los Altos, Calif., and one of the movement's founders.

"Health at Every Size" is a treatment philosophy rather than a commercial program, Burgard emphasizes, and it differs from so-called "non-dieting" or "intuitive eating" programs in that it encompasses not only food-related decisions, but a wide range of lifestyle choices as well.

The aim is to empower women to claim their natural body size and enjoy the full spectrum of life through counseling that employs research about what fosters good health and what doesn't. For starters, "Health at Every Size" takes the focus off weight, since research shows that diets often fail and that yo-yo dieting can lead to additional weight gain and health problems, Burgard says. It also acknowledges that weight is an unhealthy preoccupation for many women across the weight spectrum.

"A huge tenet of [the model] is weight neutrality," Burgard says. "We're not against people losing weight. We're against the focus being on the pursuit of weight loss."

To this end, "Health at Every Size" practitioners help women learn to enjoy eating again instead of seeing it through a lens of deprivation. That means having access to all kinds of foods, both "healthy" ones, like broccoli and brown rice, and pleasurable ones, like hot fudge sundaes. When women feel free to enjoy the whole dietary smorgasbord, "they can let go of identifying as 'good girls' or 'bad girls' and become adults who care about both good fuel and good taste," Burgard says.

The model's practitioners also help women listen to internal cues of hunger and fullness—something many have lost through years of dieting, binging and trying to follow external messages about weight and beauty, says social worker Amy Pershing, Hersfeld's counselor and director of Bodywise in Ann Arbor.

Practitioners also encourage women to appreciate the natural diversity of body sizes and shapes and to recognize that each of us has a set point that our bodies would naturally go to if we followed our internal cues. Using the approach, some women gain weight, others lose it, and some remain about the same, Pershing says.

"Health at Every Size" also helps women reclaim physical activity as joyful, says Burgard. "It should be paced for your kind of body, and there should be enough diversity and opportunities so that you get a chance to feel physical mastery and competence," she says.

An early inspiration for her was discovering West African dance, which she found exuberant, dignified and inclusive of all body types, she says.

The model also encourages women to form social networks, which the literature shows is especially good for overall health and well-being, Burgard notes.

"This approach is really about changing the cultural milieu itself as a way to support people's health, not just about making recommendations about the health practices of individuals," she says.

Empirical support

Research on "Health at Any Size" is beginning to show health, if not weight, benefits.

A study reported in the June 2005 Journal of the American Dietetic Association (Vol. 105, No. 6), by University of California at Davis nutrition researcher Linda Bacon, PhD, and colleagues randomly assigned 78 obese women who were chronic dieters either to a "Health at Any Size" condition or to a diet condition that used standard behavioral weight-loss approaches, including helping people to restrict fat and calories intake, monitor their diets and do regular aerobic exercise. The women all received six months of the intervention, followed by six months of group support. The team evaluated them at six months and again at two years. At the end of six months, both groups showed health and psychological improvements, and only the diet group had lost weight. But two years later, the picture had changed. "Health at Any Size" participants retained the same weight they held at the beginning of the study, and they showed a range of psychological and physical benefits including higher self-esteem, less depression, lower cholesterol and blood-pressure levels, and fewer eating-disordered behaviors such as binging and purging. The diet group members, though, not only regained most of the weight they had lost, but lost the health improvements they had made and showed significant drops in self-esteem.

"The results of the diet group are completely consistent with the literature," says Bacon, author of "Health at Every Size: The Surprising Truth about Your Weight" (2008, BenBella Books). "No matter how we repackage diets, long-term studies show the same results: weight regain and feelings of failure." The study is now being replicated by psychologist Janell Mensinger, PhD, of the Reading Hospital and Medical Center in Reading, Pa.

For Burgard, the most gratifying part of the approach is giving women back the time they wasted thinking about food and dieting.

"If people weren't worrying about this stuff, we'd be able to get on with the real creative work of life," she says. "I want the culture to stop creating eating disorders."

Tori DeAngelis is a writer in Syracuse, N.Y.

Further reading, resources

  • Mann, T., et al. (2007). Medicare's search for effective obesity treatments: Diets are not the answer. American Psychologist, 62 (1), 220–230.

  • Web site of the Association for Size Diversity and Health, the main organization for professionals interested in the Health at Every Size approach.

  • A Web site developed by "Health at Every Size" psychologist Deb Burgard, PhD, devoted to body-image issues.

  • HAESCommunity.Org: A social networking site developed by Health at Every Size researcher and author Linda Bacon, PhD.

  • A Web site featuring the Ann Arbor, Mich., program Bodywise, which uses the Health at Every Size approach.