This curriculum was developed as a joint venture by the Association for Size Diversity and Health (ASDAH), the National Association for the Advancement of Fat Acceptance (NAAFA) and the Society for Nutrition Education and Behavior (SNEB).
Textbooks written for health professionals often provide an exclusively weight-centered approach towards health. The Health At Every Size model is a health-focused approach that is weight neutral.
This curriculum was developed to educate others on adopting a weight neutral approach towards health, thereby filling a void in health curriculum at colleges, universities, and professional training programs.
This curriculum is designed to teach the following Health At Every Size (HAES®) principles:
- Accepting and respecting the diversity of body shapes and sizes
- Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects
- Promoting all aspects of health and well-being for people of all sizes
- Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure
- Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss
While curriculum length can be expanded or shortened to meet the individual needs of the instructor, instructors are discouraged from changing or editing the primary presentation components.
This curriculum is designed for use in higher education including, but not limited to introductory and advanced health and nutrition courses and professional training programs.
The purpose of this curriculum is to educate students in higher education about the Health At Every Size principles.
The curriculum consists of three components: 1) Overview of the Health At Every Size Paradigm, 2) Developing a Healthy Relationship with Food and Exercise and 3) Size Acceptance. Here are the learning objectives for each component:
Overview of the Health At Every Size Paradigm
- Participants will be able to describe the drawbacks of a weight-centered approach to health.
- Participants will be able to recognize the multi-dimensionality of health and the limited role of diet and exercise on health outcomes.
- Participants will be able to define the Health At Every Size paradigm.
- Participants will be able to explain the differences between a diet and a non-diet approach to wellness.
- Participants will be able to examine the scientific research that supports non-diet approaches.
Developing a Healthy Relationship with Food and Exercise
- Participants will be able to describe the differences between internal and external cues to eating.
- Participants will be able to utilize the hunger and fullness scale to guide eating timing and amounts.
- Participants will be able to describe the benefits of mindful eating.
- Participants will be able to apply strategies to eat more mindfully.
- Participants will be able to explain the differences between extrinsic and intrinsic motivators for physical activity.
- Participants will be able to define body image
- Participants will be able to describe characteristics of negative and positive body image.
- Participants will be able to identify the influences of body image.
- Participants will be able to provide examples of size discrimination.
- Participants will be able to list strategies to fight against size discrimination and advocate for size acceptance.
The curriculum consists of complete lectures, a resource list, assignment ideas, exam questions and a survey that can be used by the instructor to gain audience feedback.
- Three PowerPoint® lectures with accompanying notes. Each PowerPoint is designed to take 50 minutes to teach and covers a different topic. They are meant to be presented in the following order:
- Overview of the Health At Every Size Paradigm
- Developing a Healthy Relationship with Food and Exercise
- Size Acceptance
- Pre-recorded lectures. The three PowerPoint lectures are available for streaming on-line. This format may be preferred for those using distance learning. If there is limited class time available to teach the HAES curriculum, instructors may also choose to require students to view pre-recorded webinars outside of class.
- Resource List. Extensive literature supports the efficacy of the HAES paradigm. This resource list provides only a snapshot of all of the available literature. The blogs, websites, magazine, newspaper and peer-reviewed journal articles provided on this resource list are some of the most well known articles in the field. Resources are organized by topic and by type of media. These resources can be incorporated into in-class and out of class activities as assigned readings.
- Assignment Ideas. A variety of assignment ideas are provided and categorized by the amount of time it will take students to complete the assignment (short, medium, long). Assignments vary in difficulty and address different learning styles and educational pedagogy.
- Exam Questions. A list of exam questions is provided for testing audience knowledge of the material. There are 30 exam questions (10 for each of the three lectures) available for use. Eighty percent of the questions are closed-ended (multiple choice or true false) and 20% are short answer or essay.
- Audience Feedback Survey. A survey is provided if you wish to obtain feedback from your audience at the conclusion of the curriculum. Use of this survey is optional and can be adapted to suit individual teaching needs.
Each of the three PowerPoint lectures was developed to take roughly 50 minutes of classroom time. Each lecture includes discussion questions and videos to engage audience members. If limited time is available to teach the curriculum, discussion questions and videos can be excluded. This curriculum can also be expanded by adding in-class activities from the Assignment Ideas list.
Preparation. Reading through the curriculum may not be sufficient to feel comfortable teaching HAES concepts to others. Therefore, instructors are strongly encouraged to read the following publications from the resource list prior to teaching the curriculum:
- Bacon L. (2010). Health At Every Size: The Surprising Truth about your Weight. BenBella Books.
- Bacon & Aphramor (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 10:9.
- Robison, J. (2006). Health At Every Size. Absolute Advantage Worksite Wellness Magazine
In addition, it may be helpful to view the pre-recorded lectures prior to teaching.
Terminology. There are many terms used to describe individuals of size. In the past the term ‘fat’ has been a derogatory term. HAES advocates are trying to reclaim the term fat as a descriptor rather than a derogatory term. Therefore, you are encouraged to use the term ‘fat’ and explain to your audience that this term is appropriate just as the term thin is used to describe a smaller framed individual. The terms ‘overweight’ and ‘obese’ are medical terms based on BMI standardizations. Given the limitations of BMI screenings for assessing health, these terms have limitations. If you intend to use the term ‘fat’ throughout the lectures, it’s best to explain the use of the term at the beginning of the presentation.
Managing Resistance. Discussions about body weight and body image often evoke immense emotion. The HAES message is counter to the messages audience members receive daily in the media. Therefore, initial exposure to the HAES paradigm results in a variety of responses. Some audience members immediately embrace the HAES paradigm while others will respond with discontent and even anger. One’s response to HAES concepts is likely related with his or her personal relationship with food, activity and body image.
Discussions about the HAES model and dieting can easily become heated. As the instructor it’s best to encourage audience members to be authentic and honest with their reactions. Encourage students to disagree with one another and provide a safe environment for civil conversations and exploration. As much as possible, present the research in a neutral fashion allowing audience members to draw their own conclusions. Before responding to audience questions and comments, invite classmates to respond to one another, encouraging discussion and disagreement. Instructors can provide personal reactions and experiences as well, but avoid pressuring, coaxing or manipulating audience members to adopting HAES principles. These tactics will likely result in increased resistance and discord.
Provide Resources and Referrals. Given the sensitive nature of topics surrounding weight and dieting, audience members may experience discomfort. Audience members with a history of disordered eating patterns and body dissatisfaction may especially find such discussions triggering. As the instructor, it’s important to make audience members aware of counseling resources available (e.g. student counseling centers, student health centers, or therapists within the community who specialize in weight and disordered eating).
Trademarking of Health At Every Size and HAES. The Health At Every Size and HAES terms have been trademarked by the Association for Size Diversity and Health to ensure that the use of the terms adhere to the HAES principles (listed above). Instructors and students are required to use the symbol ® the first time the Health At Every Size phrase or HAES acronym is used within a document or publication. The trademark is only to be used as an adjective (for example: Health At Every Size® approach, Health At Every Size® research, HAES® principles, etc.), never as a noun or verb, and never in the plural or possessive form. In addition to the symbol, ASDAH’s Trademark Notice must be prominently displayed on all publications utilizing the trademarked term/service: “Health At Every Size and HAES are registered trademarks of the Association for Size Diversity and Health and used with permission.”
Contact Information. Questions and comments regarding the Health At Every Size Curriculum can be sent to:
Dawn Clifford, PhD, RD
Northern Arizona University
(Dowload a PDF of this HAES® Curriculum Description here.)
Health At Every Size® Curriculum by ASDAH, NAAFA, & SNEB is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.