My relationship with food and my body has always been a difficult one. I spent my teens binge-eating, and my student years borderline underweight and terrified of gaining. Then I was prescribed an antidepressant that happened to cause rapid weight gain (a rare side effect), and to my utter amazement, I developed boobs. I had been convinced that I would be flat-chested at any weight and therefore needed to stay as skinny as possible, but in fact putting on a stone or so gave me enough cleavage that I was less worried about the size of my waist. For a while, I was relatively relaxed about my weight. More pounds crept on, but my BMI was still in the healthy range and I was now a DD cup. I wasn’t entirely happy about my apple shape, but if I chose my clothes carefully, I thought I looked all right. Eventually, though, I reached the point where I was classed as overweight and it may not be coincidence that around the same time, I started to think I looked fat in any outfit. It was time to lose weight.
My first diet was a success, or so I thought at the time. I got details of the WeightWatchers points system from my partner and once I’d learned which foods would fill me up and which treats I could ‘afford’, I lost the weight fairly painlessly, stopping half a stone or so below the maximum ‘healthy’ weight for my height. I kept the weight off for a good while too, following WeightWatchers’ plan for maintaining weight. But then, a year after I’d started the diet, several traumatic events and life stresses had me turning to junk food for comfort again. Slowly but surely, I started to regain weight until I was back where I’d started.
I tried to diet again, and this is where it all went horribly wrong. I was now a vegetarian, limiting my options, and I was on a higher dose of antidepressants which are known to cause increased appetite. The situation with my mental health had also gone from ‘in remission from depression for several years’ to ‘frequently relapsing’. Whether because of all this, or for some other reason, sticking to a calorie-controlled diet in any kind of sensible way seemed almost impossible. Every time I tried, I either gave up because I was so hungry all the time, or a switch seemed to flick in my head and I would start starving myself. I have spent the past couple of years yo-yoing from overweight to my target weight and back again. I most recently dieted in May-June last year and by December I had gained two stone. I now have a BMI of 27, which is the highest it’s ever been, and I’ve been feeling deeply unhappy about my size.
When fatigue stopped being my biggest problem, I knew I wanted to do something about my weight and body image, but what? I didn’t want to start another diet, get sucked into an eating-disordered mentality and end up larger than ever, so I eschewed the usual weight loss resources and tried to find something aimed at people like me. People who might not have a full-blown ED, but do struggle with eating-disordered behaviours. This led me to a book called Getting Better Bit(e) by Bit(e), which has a chapter specifically for people with a history of binge eating or bulimia who are overweight.
What I read shocked me. I had assumed that, as my BMI is ‘unhealthy’, I needed to lose weight and should just find a more sustainable way of doing so. Instead, the authors – both psychiatrists who specialise in eating disorders – told me that the health risks of being overweight have been greatly exaggerated, especially for people who are in the ‘overweight’ rather than ‘obese’ category. That it’s far more important to be physically fit, and above all that repeatedly losing and gaining weight does a lot more damage than simply being overweight.
Not long after this, purplepersuasion published an excellent blog post about her own cycle of dieting/restricting and bingeing/regaining, and one of the commenters recommended the Health at Every Size concept and Linda Bacon’s book. I bought a copy and devoured it. What Bacon says (I’m loving the potential for food-related puns ) makes so much sense to me and has already made a huge difference to the way I feel about my body and food.
In a nutshell, HAES is about being healthy irrespective of how much you weigh or what your BMI is. It’s an approach focused on intuitive eating, physical activity and self-acceptance rather than dieting or weight loss. The book provides a lot of scientific evidence that backs up what I’d learned from Getting Better Bit(e) by Bit(e), and shows that:
- Diets don’t work in the long term. Over 99% of people who diet regain the weight.
- People with a BMI over 25 are more likely to develop certain health conditions such as high blood pressure, cardiovascular disease and diabetes, but there’s no proof that being overweight or obese causes these things. It’s more likely that the causes are other factors which often go hand in hand with being overweight, such as a poor diet, not getting enough exercise and a pattern of losing and gaining weight. (The exception is osteoarthritis, which is directly caused by obesity.)
- There is some evidence that people who are overweight, as opposed to obese, are healthier and live longer than people towards the lower end of a ‘healthy’ weight range.
Why don’t diets work? Bacon argues that everyone’s body has a ‘setpoint’, a weight range of about ten pounds which is natural and appropriate to them and which their body will try to maintain. If you go below your setpoint, your body will do everything in its power (increased appetite, cravings for calorie-rich food, lowered metabolism) to regain the weight. If you go above your setpoint, your body will also try to lose the weight but it’s not as efficient at doing this, because our bodies aren’t really designed for a modern environment where we don’t have to go out and hunt our own woolly mammoths – or whatever it was that cavemen ate. When you diet, your body assumes that food is scarce and it may even increase your setpoint to better protect you against the next ‘famine’. As I understand it, the stuff in this paragraph hasn’t been proven beyond all doubt yet, but there is a lot of evidence to support it.
Instead of dieting, Bacon recommends:
- Eating as much as you need to satisfy your hunger, stopping when you’re full.
- Choosing ‘real’ foods over processed foods where possible, and eating a wide variety of different foods (this is a good way to make sure your diet is nutritious without becoming a slave to nutritional facts and figures).
- Allowing yourself the foods you crave, but eating them mindfully and stopping when your body’s had enough.
- Regular (but not excessive) physical exercise.
(There’s a lot more detail on how exactly to do all this in the book.)
I’ve been following the HAES approach for a couple of weeks now and I think it’s brilliant. I haven’t totally got the hang of mindful and intuitive eating yet, but what’s incredible is that all my urges to binge and overeat have vanished. I really didn’t expect that to happen. I didn’t think I was prey to the “I’ve blown my diet anyway, I might as well stuff my face” type of thinking – I’ve done CBT, I know that’s neither rational nor helpful – but I hadn’t realised just how much the shame I felt about my weight and my eating was triggering me to turn to food. The idea that there’s nothing wrong with being fat (Bacon deliberately uses the term ‘fat’) and that I can be healthy at this size is very liberating. HAES is supposed to help your body return to its setpoint and I have to admit I am hoping my setpoint will turn out to be lower than my current weight – I’m also encouraged that I’ve had to tighten my belt by one hole since I started HAES. But the focus on self-acceptance and on health is more important and is what’s really helping me.