I have mixed feelings after reading Health at Every Size. I have struggled for over 3 decades with eating disorders and even when my weight has been well-within "normal" ranges (i.e., a "healthy BMI") I have still felt pressure to diet, to get thinner, to generally not feel happy with who I am or how I look. Over the years I've read a variety of books on health, fitness, diet, weight and disease - including different diets such as Paleo, keto, vegetarian, vegan, Whole-30, Mediterranean, etc. and I kept seeing Health at Every Size referenced, so I thought I'd read it.
First, my key takeaway might not be what the author intended. My take is that restrictive dieting in which we listen to outside sources for guidance is the problem. When we listen to societal and cultural norms telling us what is beautiful and what is not, that's a problem. When we listen to the government telling us what is healthy or not, that's a problem. When we listen to Weight Watchers, or Jenny Craig, or Atkins, telling us what to eat, when to eat and how much to eat, that's a problem. When we listen to that doofus guy who calls you a "fat heifer" when you're 5'6, 130 lbs and a size 6, that's a problem. When you listen to the nightly news screaming about the "obesity epidemic" and blaming every condition under the sun on being overweight, that's a problem.
I'm not saying, nor do I think Linda Bacon is saying, that we should reject science and "go with only our feelings and instincts" - however - too often the news gets it wrong. As Bacon references, correlation does not equal causation. Studies may find a correlation between obesity and cancer. Does that mean obesity causes cancer? Maybe...but until we study every single variable and its effect on getting cancer, we cannot (and should not) take "obesity causes cancer" as truth. Could it be that obese people get less exercise and are less active? That they don't get proper sleep? That they do not have good, positive social networks? That they are less likely to go to a doctor when ill? That they are on more medications? Are they more likely to smoke? More likely to drink alcohol? Eat processed foods? Eat fewer vegetables and fruits? So a link exists between certain conditions and obesity, but could it be something else causing the cancer?
Equally as important, Bacon points out that when correlations are found, it's typically for individuals who are very obese (I think she wrote that it was at a BMI of 41+). So this panic that someone who is 30 lbs overweight is going to get cancer, heart disease and diabetes because of being overweight is simply wrong. Taking it further, the idea that the very institutions created to "help" us with these issues may very well be propagating this misinformation is pretty likely. Drug companies, weight loss organizations, the government, certain medical professions and the food industry have a huge stake in diet culture. How can we truly trust what they tell us?
Now, I had some issues with Health at Every Size. For a book that claims not to be a diet book, she spends an inordinate amount of time talking about what foods to eat, how much activity to get, etc. More than once, I was annoyed when I felt she fell into "dieting tips" propaganda. As someone who has spent her entire adult life on and off restrictive diets, I am sick to death of reading I should eat more fiber to feel more full, that I should park further away and walk or that I should eat more vegetables. I skimmed over pretty much all of that (and there was quite a bit).
Second, she is a big proponent of "intuitive eating" in which a person must reject diet culture and learn to listen to her own body when it comes to food. In other words, our bodies will tell us when it is hungry and if we truly listen, we will know exactly when, what and how much to eat. Perhaps she can live that way, but for someone struggling with eating disorders, it's an issue for me. Why? My intuition sucks. I've spent so many years not buying/eating certain foods that giving myself free rein is disastrous. This book and others on the topic of intuitive eating will tell you that most people gain weight when first trying to learn this way of eating and unlearn old styles. Again, speaking as someone with an eating disorder I can say - this is not good for my mental health. I gained 30 lbs over a few months and I descended into a brutal and scary depression.
And not only that - my orthopedic issues went absolutely bonkers. I was diagnosed with widespread osteoarthritis in my 20s (from my jaw and neck down to my toes) and gaining weight directly caused my feet, ankles, knees, hips and back to hurt. A lot. In fact I had to cancel a hiking holiday over Thanksgiving because my back was so acute, and I had a miserable vacation in Dubrovnik because my ankles and knees were so inflamed (no one told me Dubrovnik had 10 gabillion stairs). I simply cannot live happily gaining weight while waiting for my "intuition" to override decades of diet culture.
Even with the parts I felt were flawed, I think this is a critically important book. Many will say it's all about fat acceptance and dismiss it outright; however, I think it's more about acceptance in general and learning that the science of weight (gain and loss) is inherently flawed. Lumping all people who are outside of "healthy BMI range" (which is kind of a load of poo anyway) as fat, overweight, obese, etc. and then building a multi-billion dollar industry to all at once tear them down and try to rebuild them is a tragedy. Even worse is when we apply flawed, or fake, science to bolster these ideas. I think Bacon did a good job exposing the half-truths and outright lies, even though sometimes it felt like she went too far to the other side, but I'd still recommend the book.