Take the weight off weight: what the HAES approach reveals in the short and long term

For decades, the conversation around obesity has had a single protagonist: body weight. The classic formula “eat less and move more” may generate initial changes, but the problem arises when the script demands sustainable endings. Evidence shows that many individuals regain weight in the years that follow if lifestyle changes are not maintained, fueling a cycle of frustration, stigma and disengagement from healthcare. In response to this scenario the Health at Every Size (HAES) approach proposes a paradigm shift: focusing on health and well being behaviors without positioning weight loss as the primary goal.

From “Losing Pounds” to “Gaining Health”: What HAES Actually Evaluates

The article published in Frontiers in Nutrition (October 2024) reviewed the available evidence on HAES-based interventions in adults with overweight or obesity. PRISMA 2020 guidelines were followed, and studies were identified through searches in PubMed, Scopus, Embase, Web of Science, and SciELO. After screening 324 records, 20 articles were included mainly randomized controlled trials and quasi-experimental studies published between 2013 and 2023. These interventions aimed to improve eating behaviors, body image psychological well being physical activity, and selected cardiometabolic markers.

In practice, many of these interventions share common components: nutrition education without rigid prescriptions work on body image, stigma reduction, promotion of intuitive eating (responding to internal hunger and satiety cues) and in several cases, physical activity framed as “enjoyable movement” rather than punishment. The message is not “weight does not matter” but something more uncomfortable for diet culture: weight is not the only indicator of progress and pursuing it as the sole objective may carry psychological and behavioral costs.

Encouraging Results… and the Weak Point That Raises Concern

Overall findings are clear: in the short term, HAES is often associated with meaningful improvements. Several studies reported enhancements in quality of life and psychological wellbeing others showed positive changes in eating behaviors (such as reductions in emotional or uncontrolled eating), greater body acceptance, and improvements in the relationship with food. In the cardiometabolic domain, some studies observed associations between weight changes and improvements in waist circumference, glucose levels, or lipid profiles, although consistent differences between groups or across time were not always observed.

Now comes the critical point: the challenge is not improvement it is maintenance. When examining follow ups ranging from 12 to 24 months the review suggests that part of the benefits may fade once the intervention ends or when maintenance strategies are lacking. Some changes in dietary intake, diet quality, or between-group differences lose statistical significance over time. However, certain psychological components such as autonomy, well being related functioning or reductions in depressive symptoms in some studies appear to show greater persistence. A key issue highlighted by the article is the presence of “non responders”  individuals with poorer psychological status, higher levels of depression or lower adaptability to behavioral change, who may require more personalized approaches.

In summary, HAES emerges as a feasible and potentially valuable strategy for promoting health and well being “beyond the number on the scale.” At the same time, the review is candid: more diverse studies (including a greater representation of men), longer follow-up periods, larger samples, and better characterization of dietary intake are still needed to understand which specific nutritional changes drive sustained improvements. The underlying idea is powerful and forward looking if we aim for lasting health outcomes perhaps the focus should not be on “controlling bodies” but on building sustainable behaviors in diverse bodies.