Health at Every Size: What It Gets Right, What the Evidence Says, and Where GLP-1s Fit

If you take a GLP-1 medicine such as Zepbound, Mounjaro or Wegovy and Health at Every Size also speaks to you, you might feel caught between two camps. One says higher weight is a disease these medicines treat. The other says chasing weight loss was the problem all along. Both have thoughtful people and real evidence on their side, and we won't tell you which to pick.

One thing up front. Healthcount is a free food journal used by people on these medicines, and plenty of HAES practitioners would question food tracking at all. More on that near the end.

What does "Health at Every Size" mean?

Health at Every Size is an approach to health care that doesn't use weight loss as the goal. The 2011 review that took it into the medical journals described the aim as better health habits "for people of all sizes without using weight as a mediator; weight loss may or may not be a side effect" (Bacon and Aphramor, 2011).

The common misreading is in the name: health at every size, not healthy at every size. ASDAH, the Association for Size Diversity and Health, which owns the name, lists "Health at Every Size® means all fat people are healthy" as a myth, and answers it: "There are 'healthy' and 'unhealthy' people at all points on the size spectrum" (ASDAH). The actual claim is that care, respect and helpful habits shouldn't depend on your size or on losing weight. Researchers call this a "weight-inclusive" approach, as opposed to a "weight-normative" one that treats weight as a main driver of health (Tylka et al., 2014).

A note on words: ASDAH uses "fat" as a neutral description, medical papers say "obesity", and we say "higher-weight people".

What are the HAES principles now?

Since 2024 there have been four. ASDAH revised them after rounds of community surveys and focus groups, and added a 10-part Framework of Care (ASDAH). Word for word, as they read on 16 October 2026:

1. "Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum."
2. "Wellbeing, care, and healing are resources that are both collective and deeply personal."
3. "Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind."
4. "Health is a sociopolitical construct that reflects the values of society."

Under the first, ASDAH says access to care "should not depend on obtaining a certain BMI, pursuing weight loss, and/or holding health as a value or pursuit." Under the second: "Each person is the expert of their own body" (ASDAH).

The 2013 version had five principles, including "flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure" and enjoyable movement (ASDAH, 2013 principles). In 2024 those two became "tools" instead. As Ani Janzen, ASDAH's operations and projects leader, put it on the Burnt Toast podcast in June 2024, "no one has to pursue eating for wellbeing or life-enhancing movement in any way, shape, or form" (Burnt Toast, 2024).

The framework centres bodily autonomy and informed consent, calls refusing care until someone loses weight a violation of patient autonomy "in most cases", and commits providers to "abolishing the BMI, dismantling the Medical Industrial Complex" (ASDAH). Intuitive eating overlaps with the old eating principle, though the 2011 review warned that intuitive eating promoted for weight loss "is inconsistent with a HAES approach" (Bacon and Aphramor, 2011). We look at intuitive eating on a GLP-1 separately.

Who created Health at Every Size?

No single person. The ideas grew out of US fat activism: Bill Fabrey, a young New York engineer, founded what is now the National Association to Advance Fat Acceptance in 1969, and by 1973 the Fat Underground, a group of California feminists, had released a Fat Liberation Manifesto (NAAFA). ASDAH says the approach was named Health at Every Size in the late 1990s. It formed in 2003 and wrote the first principles (ASDAH), then trademarked the name in 2011 and "HAES" in 2012, worried "that weight-loss companies would attempt to coopt HAES terminology" (ASDAH history). Only providers it approves may call themselves HAES-aligned (ASDAH trademark guidelines).

The best-known book, Health at Every Size: The Surprising Truth About Your Weight, came out in 2008 under the name Linda Bacon, and Bacon wrote the 2011 review with Lucy Aphramor, an English dietitian (ASDAH history). Lindo Bacon, as they are now known, uses they/them pronouns (Lindo Bacon). In 2022 ASDAH publicly opposed a revised edition, saying it would do harm "by continuing to center white, thin voices in the movement" (ASDAH, 2022), and Bacon retired from HAES work, saying they "ultimately faced cancellation" (Bacon, 2022). We won't referee that.

Is Health at Every Size true? What the trials found

The modest claim, that habits can improve health whether or not weight changes, has reasonable support from small trials. Some bigger claims made in HAES's name don't, and those come up with the critics.

HAES started from a real problem: a 2007 review of long-term diet studies found that "one third to two thirds of dieters regain more weight than they lost on their diets" (Mann et al., 2007). That was about diets, before GLP-1s, and our piece on why the body pushes back after weight loss covers the biology.

In the best-known HAES trial, 78 white women aged 30 to 45, all long-term dieters, were randomly assigned to a HAES programme or a diet. In the first six months about 4 in 10 of the diet group dropped out, against fewer than 1 in 10 of the HAES group. At two years, with half of each group back, the HAES group had kept its weight steady and held on to its improvements, while the diet group had regained weight and kept little (Bacon et al., 2005). It was small, everyone in it was a white woman, half went missing, and the lead author was Bacon, then HAES's best-known advocate.

Other trials are more mixed. In a Quebec trial, 144 women were split between a HAES programme, a social support group and no programme, and HAES did no better than plain group support (Provencher et al., 2009).

The reviews broadly agree. A 2019 meta-analysis of 8 randomised trials found no significant difference in blood pressure or cholesterol between "health, not weight loss" programmes and weight-loss programmes after one to two years, while body satisfaction and restrained eating improved more with the health-focused ones. Its authors warned that "firm conclusions cannot be drawn from small studies with high losses to follow-up" (Khasteganan et al., 2019). A 2020 meta-analysis of 10 studies found bigger improvements in bulimia symptoms and no other differences (Dugmore et al., 2020).

Habits seem to count at every size too. In 11,761 US adults followed for about 14 years, four habits (plenty of fruit and vegetables, regular exercise, moderate drinking, not smoking) went with a lower risk of death in every weight group, though a study like that can't prove cause (Matheson et al., 2012).

So the modest version holds up: better eating and body image, fewer drop-outs, and blood pressure and cholesterol on a par with diets. But the trials are small, mostly in women and followed for two years at most, and none measured heart attacks or deaths. A 2018 review called for "large long-term clinical trials" (Ulian et al., 2018).

How does HAES address weight stigma?

By making care free of anti-fat bias one of its four principles, by saying access to care shouldn't depend on BMI or weight loss, and by asking providers to tackle their own bias and the system's (ASDAH). This is HAES's firmest ground, and mainstream obesity medicine now largely agrees.

The numbers are uncomfortable. Of 13,996 adults in a commercial weight-management programme in six countries, including the US, the UK and Australia, between 56% and 61% had experienced weight stigma, and in every country about two-thirds of those had experienced it from doctors. People who had absorbed that bias avoided care more and had fewer check-ups (Puhl et al., 2021). The programme was WW, which funded the study. Across 105 studies with 59,172 people, stigma went with worse mental health, though cause and effect still need testing (Emmer et al., 2020).

Shame doesn't work as motivation either. A 2010 review concluded that "weight stigma is not a beneficial public health tool for reducing obesity" (Puhl and Heuer, 2010), and a 2020 international consensus of obesity experts, whose meeting had travel support from drug companies including Novo Nordisk, called weight stigma "unacceptable in modern societies" (Rubino et al., 2020). If some of that bias has crept into how you talk to yourself, our piece on loosening the rules you live by may help.

What do critics say about Health at Every Size?

The fairest criticisms are about evidence. Two public health researchers in Canada wrote in 2015 that understanding HAES "requires us to move beyond an ideological debate" and run studies "across a range of populations" (Penney and Kirk, 2015). In 2014 Amanda Sainsbury, a University of Sydney researcher who declared she had written diet books, agreed "it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes", but not that people can be, or stay, "truly healthy at every size" (Sainsbury and Hay, 2014).

The biggest dispute is whether weight itself affects health. ASDAH's page says that refusing fat patients care until they lose weight "may account for all of the health disparities seen in fat people, and body size may not have any direct effect on health" (ASDAH). The second half doesn't match the evidence. Mendelian randomisation studies use gene variants that nudge body size, fixed at conception, as a natural experiment that lifestyle and stigma can't easily muddy. Pooled, they link genetically higher body size with type 2 diabetes, 14 heart and circulation conditions and several cancers (and with lower risk of osteoporosis): "The totality of the evidence from MR studies supports a causal role of excess adiposity in a plurality of chronic diseases" (Larsson and Burgess, 2021).

Deaths point the same way, with a wrinkle. The largest analysis, of 239 studies, kept only the 3,951,455 people who had never smoked and had no chronic disease. Of them, 385,879 died, and risk was lowest in the range doctors call a healthy weight, rising above it and below it (Global BMI Mortality Collaboration, 2016). An earlier analysis found slightly lower risk in the "overweight" band, which set off a long argument in the journals (Flegal et al., 2013). A fair reading: on average risk does rise at higher weights, and stigma, dieting and poorer care add harm on top.

The same goes for weight loss and death. ASDAH's page cites a study suggesting women who intentionally lost a lot of weight were more likely to die (ASDAH), but that study measured loss from people's memory of their highest weight, and its abstract doesn't say the loss was intentional (Ingram and Mussolino, 2010). Illness can cause weight loss, so randomised trials are the better test. Across 15 trials of lifestyle weight loss with 17,186 people, there were 264 deaths in the weight-loss groups and 310 in the comparison groups (Kritchevsky et al., 2015). No sign of harm there.

The newest challenge is a Lancet commission from January 2025. Its 58 experts agreed with HAES that "BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health." But they defined "clinical obesity", where excess fat changes how organs or the body work, as "a chronic, systemic illness" (Rubino et al., 2025). Excess fat with organs still working normally ("preclinical obesity") counts as health rather than illness, though with a generally higher risk. Several commissioners, the chair among them, declared fees from drug companies, including Novo Nordisk and Eli Lilly. ASDAH's 2013 principles rejected "pathologizing" any weight (ASDAH, 2013 principles), and Angel Austin, its advocacy and community leader, said in 2024 of classifying obesity as a disease that "there's still so much bias steeped in that work" (Burnt Toast, 2024). We haven't found an ASDAH response to the commission itself.

Money runs through all of it: drug companies pay for the big GLP-1 trials, and the authors of HAES's founding review declared they were paid for HAES speaking and writing. That doesn't make anyone wrong. It's a reason to read past the headline.

Can you take a GLP-1 and still believe in Health at Every Size?

HAES voices disagree, and we couldn't find a formal ASDAH position statement on GLP-1s. Here's who has said what, and when.

In August 2023 the writer Ragen Chastain, of the Weight and Healthcare newsletter, wrote: "it is impossible to be part of Health at Every Size community and to engage in intentional weight loss. They are mutually exclusive concepts." Chastain still called GLP-1s "solid drugs for some people of all sizes with Type 2 Diabetes" (Chastain, 2023).

ASDAH's leaders sounded different in June 2024, on Virginia Sole-Smith's Burnt Toast podcast. Ani Janzen said: "We are here for all fat people to access care, and that includes people who pursue intentional weight loss." And: "there's room for a Health at Every Size professional to prescribe a GLP-1", though some providers might instead "refer that patient somewhere else for weight loss services." The limit: "The thing that there is not room for is pushing weight loss, uplifting weight loss as the solution, or using weight loss or the BMI as a gate to access other forms of care" (Burnt Toast, 2024). In February 2025 Sole-Smith, the author of Fat Talk, said "everyone gets to make their own choices about Ozempic", while still objecting to the industry and to marketing the drugs to children (Burnt Toast, 2025). That year ASDAH also ran a course for professionals that opened with "GLP-1 Basics for Informed Consent" (ASDAH, 2025).

Some doctors who share HAES's worries prescribe anyway. Mara Gordon, a family physician in Camden, New Jersey, wrote for NPR in April 2025: "I prescribe GLP-1s for many of my patients, and lots of them show improvement on metrics like blood glucose, hypertension, and kidney function." Her worry is that "we doctors have returned to a myopic obsession with weight as the definition of health" (Gordon, NPR, 2025). And the informed-consent guide from Medical Students for Size Inclusivity, which doesn't believe weight loss improves health outcomes, still tells readers: "There are many reasons you might want to lose weight, and you have the right to do so" (MSSI, 2026).

A bridge from the heart trial

SELECT, funded by Novo Nordisk, gave semaglutide, the medicine in Wegovy and Ozempic, or a placebo to 17,604 adults aged 45 or over with heart disease and no diabetes (Wegovy label); (Ozempic label). Over an average of 39.8 months, 569 of 8,803 people on semaglutide (6.5%) had a heart attack or stroke or died of cardiovascular causes, against 701 of 8,801 on placebo (8.0%): by our arithmetic, about one event avoided for every 67 people treated for a little over three years. Side effects made 1,461 people on semaglutide (16.6%) stop, against 718 on placebo (8.2%) (Lincoff et al., 2023).

A 2025 analysis found about a third of the benefit was statistically linked to smaller waists, but it didn't track how much weight people had lost by week 20, "suggesting some mechanisms for benefit beyond adiposity reduction" (Deanfield et al., 2025). That's close to the weight-inclusive argument: judge a medicine by what it does for your health, not only by the scale. It only covers people who already had heart disease, and an analysis like this is weaker than a trial's main result.

Where HAES and GLP-1 treatment meet, and where they don't

You don't have to pick a team to use what each side gets right. They overlap more than you'd think.

• Weight stigma harms people and doesn't motivate them. ASDAH and obesity specialists both say so.
• BMI alone is a poor judge of one person's health, as ASDAH and the Lancet commission agree.
• You decide, with full information. ASDAH's framework says "Informed consent must include what we don't know just as much as what we do know" (ASDAH). That covers taking a GLP-1, and not taking one.
• Habits matter whatever the scale does, and so does eating enough.
• Disordered eating is worth watching for. Eating disorder clinicians wrote in 2024 that "it is possible that GLP-1As could exacerbate, or contribute to the development of, ED pathology" (Bartel et al., 2024).

Where they don't

• The goal. Strictly read, weight loss as the aim isn't HAES, and even ASDAH's more open leaders reject it as "the solution".
• Disease. The commission calls excess fat that harms organs an illness to treat. ASDAH rejects treating body size as a disease.
• Children. In February 2023 ASDAH opposed the American Academy of Pediatrics' obesity guideline for children and teens: "There is no non-stigmatizing care in the name of obesity prevention or treatment" (ASDAH, 2023).
• Trust. HAES voices see drug-company money in the trials. Medicine treats trials like SELECT as strong evidence.
• The long haul. When the STEP 1 trial stopped semaglutide, people regained about two-thirds of the weight they had lost within a year, and most heart and metabolic measures drifted back. The authors said this suggests "ongoing treatment is required to maintain improvements in weight and health" (Wilding et al., 2022). Medicine sees a case for long-term treatment. HAES voices see weight cycling: the medical students' guide asks, "What if it results in weight cycling?" (MSSI, 2026)

If stopping is on your mind, what actually happens when people quit GLP-1s goes further.

What can you take from HAES if you're on a GLP-1?

Quite a lot, and none of it depends on settling the arguments. Taking a GLP-1 is a medical decision. It isn't a verdict on your body, and it doesn't cancel your right to be treated with respect.

• Judge how it's going by more than the scale: blood pressure, blood sugar, energy, sleep, mood, and what you can do.
• Eat enough, at regular times, even when you're barely hungry. Small meals by the clock count. Our guide to regular eating explains why.
• Keep the habits that help at any weight, like moving in ways you enjoy.
• Drop the moral language. A meal isn't good or bad, and neither are you for eating it.
• Expect care that doesn't wait for weight loss. In Janzen's words, weight "should not decide whether you get care" (Burnt Toast, 2024).

Questions for your prescriber, some adapted from the Medical Students for Size Inclusivity guide (MSSI, 2026):

• "If I were to set weight aside, what intervention would make the biggest difference in my health?" The guide suggests asking yourself. It works for a prescriber too.
• What would you recommend for someone in a smaller body with the same problem?
• What don't we know about staying on this for years, and what usually happens if I stop?
• Could you refer me to a registered dietitian?
• If you've had an eating disorder or disordered eating: "Can you place a referral for me to see an eating disorder specialist?" The guide suggests asking before you start.

GLP-1s aren't an established treatment for binge eating, either: the 2024 review found "not sufficient evidence to support the use of GLP-1s to treat ED symptoms" (Bartel et al., 2024). The guide also lists changes to raise with your doctor or a dietitian. They aren't a diagnosis:

• "Skipping meals or avoiding certain food groups"
• "Avoiding eating with others"
• "Thinking about food, weight or body more than before"
• "Trying to eat less than recommended or trying to lose more weight than planned"
• "Trouble eating regularly"

If your body has changed faster than your sense of it, our piece on body image after weight loss on a GLP-1 picks that up. And if you're underweight, very unwell or in treatment for an eating disorder, your care team's plan comes first.

Where Healthcount stands

We make a food journal, and plenty of HAES practitioners would see tracking food as part of the problem. We don't call Healthcount HAES-aligned; that label is ASDAH's to give. What we have done is build it with eating disorders in mind. A setting called Food journal only hides every calorie and macro number (weight and measurements stay), and an optional prompt to notice your hunger before and after eating is never scored. Food records aren't only a dieting tool: enhanced CBT for eating disorders asks people to record their eating as it happens, with their thoughts and feelings (Murphy et al., 2010). Our case is in why writing it down works. If logging starts to feed a preoccupation rather than ease one, stopping is a perfectly reasonable choice.

What's solid, what's likely and what's contested

When to get more help

If food, eating or your body has been taking up a lot of room in your head, or any of those changes sound familiar, please talk to a doctor or an eating disorder service. You don't need to be sure it's an eating disorder to ask.

I'll add one personal thing. I've had CBT for an eating disorder, and it's been life changing. Our guide to CBT for eating disorders and our review of Overcoming Binge Eating explain what that treatment involves. A helpline isn't an emergency service: if you're in danger right now, call your local emergency number.

The questions people ask

This is information, not medical advice. Decisions about starting, continuing or stopping a prescribed medicine belong with you and the prescriber who knows your history. If you're being treated for an eating disorder, your care team's plan comes first.

Health at Every Size® and HAES® are registered trademarks of the Association for Size Diversity and Health (ASDAH), used here to describe its work. Healthcount isn't affiliated with or endorsed by ASDAH.