See Part 1
Welcome to part 2 of this 2-part series on toxic fitness and diet culture, the Health at Every Size® (HAES®) paradigm and trauma-informed practice within the Pilates industry. Part 1 introduced this series and focused on the issues of toxic fitness and diet culture. Part 2 on the other hand is more solution-focused by covering HAES® and trauma-informed practice.
Health at Every Size® (HAES®)
The HAES® principles prioritise ensuring safe and fair healthcare access for individuals irrespective of their size, health condition, or health intentions (ASDAH n.d). HAES® is against weight-centric care and advocates for an approach that promotes improved wellbeing for individuals in all bodies (River Oak Health n.d).
It is untrue that HAES® claims every person in every body is “healthy”. What it does do is advocate for equitable access to healthcare for all that is not focused on weight as an outcome (ASDAH n.d).
As discussed by River Oak Health (n.d), focusing on weight may make people disappointed if they don’t see “results”. Thus, they are likely to disengage in “healthy” behaviours. Nicholson (2018) suggests this connects well with the idea that your BMI, weight and weight loss are not actual behaviours you can engage in, and for those who wish to improve health we should instead focus on tangible behaviours.
‘One study compared risk of death by a number of healthy habits and by BMI. They found people who engaged in 2, 3, or 4 of the healthy habits had no significant difference in risk of death regardless of BMI status. So, engaging in healthy habits has a greater effect on health than BMI.’
(ASDAH n.d)
‘Another argument for a weight neutral approach is that assessment of health using BMI does not account for other lifestyle factors such as dietary quality, physical activity and smoking and alcohol intake, which are actually stronger determinants of death and disease than BMI.’
(River Oak Health n.d)
One can also argue that one of the reasons larger individuals can face poorer health outcomes is due to the many ways they experience discrimination and commonly associated healthcare avoidance.
‘… Areas of discrimination not only impact health through greater social isolation and creating additional barriers to healthcare through lack of insurance and less pay, they add to the overall stress of being oppressed (allostatic load) and contribute to poorer health and worse health outcomes.’
(ASDAH n.d)
The HAES® Principles are:
‘Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum.
Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind.
Wellbeing, care, and healing are resources that are both collective and deeply personal.
Health is a sociopolitical construct that reflects the values of society.’
(ASDAH n.d)
Next, it is time to look at the final piece of our puzzle; trauma-informed practice.
Trauma-Informed Practice
As discussed by the Center for Health Care Strategies (n.d), Trauma-informed practice is a paradigm that dictates the way services should be delivered. They posit that the framework acknowledges the widespread impact of trauma and asks providers to consider all the ways in which trauma may impact people’s lives. This knowledge should then be used to influence the way services are shaped: avoiding re-traumatisation and “do no harm” are at the forefront of this approach (Center for Health Care Strategies n.d).
So, what is trauma?
‘Trauma can arise from single or repeated adverse events that threaten to overwhelm a person’s ability to cope.’
Kezelman C (4 February 2021)
A child’s increased experience of stressful and possibly traumatic events correlates with a heightened risk of chronic health issues and participation in health-risk behaviours. Trauma can negatively impact health across all life stages.
Center for Health Care Strategies (n.d).
Trauma-informed care revolves around safety, trustworthiness and transparency, collaboration and mutuality, peer support, empowerment and choice, and respect for diversity (Kezelman 2021; youth.gov n.d; Center for Health Care Strategies n.d). Providers should adopt an optimistic sentiment, stressing that recovery is attainable (Kezelman 2021). Within an organisation it can be seen helpful to work with the following approach:
‘Building awareness and generating buy-in for a trauma-informed approach; supporting a culture of staff wellness; hiring a workforce that embodies the values of trauma-informed care; and creating a safe physical, social, and emotional environment.’
(Center for Health Care Strategies n.d)
Examples inspired by the Center for Healthcare Strategies (n.d) of how this might be applied to a Pilates studio can be read below:
- Referring clients on to trauma-informed services as necessary.
- Ensuring areas are well-lit (including outdoor spaces like carparks).
- Allowing clients to share any information they feel is relevant to their Pilates experience (e.g. past fitness trauma) in a safe, private and confidential manner.
- Never suggesting that clients should remove clothing.
- Seeing the client instructor relationship as two equals walking alongside each other.
- Establishing permission to give tactile cues – make it specific to body areas – do so without pressure – express that they can retract their permission at any time.
- Have a warm and welcoming space and attitude.
- Ensure you welcome diversity through your marketing, such as including those living in bigger bodies.
- Give clients options through your cueing – promote movement exploration rather than dictation.
- Layering exercises – making it abundantly clear it is a safe space to pick a layer that feels good and to not continue adding on.
- Promoting clients to rest as needed.
- Not calling people out in front of a class.
- Intuitive movement – as discussed in Part 1.
- Never assume someone’s gender identity and pronouns.
- Collaborative exercise programming and goal setting – it’s a relationship of collaboration with clients.
- Actively seeking feedback.
Center for Healthcare Strategies (n.d)
Conclusion
As someone in recovery from his eating disorder and mental health conditions, and as someone who works in the Pilates industry, I often feel defeated by the constant barrage of toxic fitness and diet culture. I find it particularly difficult to find movement spaces that I feel uphold a HAES® and trauma-informed approach. I recognise that there has been a recent shift in the industry against certain ideals, but further progress is still necessary.
So, what does all this mean? Well, it means that toxic fitness and diet culture are rife in society and that it is time to challenge harmful beliefs around wellness – especially those that praise weight loss and thinness as morally and physically virtuous. It is time to stand up to rhetoric such as “no pain no gain” and begin to view fitness in a nuanced and inclusive way.
This article was written on Palawa land.
The views expressed in this article are solely my own.
About the author: Henry was born and raised in Nipaluna (Hobart), and was diagnosed with Anorexia Nervosa along with other mental health challenges as a young adult. Henry began Pilates to support his dancing and before the age of 19 had completed a Diploma of Professional Pilates Instruction, a Certificate IV in Contemporary Pilates and Teaching Methodology and a range of other qualifications and professional development. Henry has continued to work in almost every aspect of the fitness and Pilates industry around the country and is currently an associate educator for Pilates International Training Centre (PITC). Henry is an advocate for continued learning, Health at Every Size® (HAES®), trauma-informed practice and ditching toxic diet and fitness culture.
References:
- ASDAH (Association for Size Diversity and Health) (n.d) Health at Every Size® Principles, ASDAH, accessed 13 May 2024. https://asdah.org/haes/
- River Oak Health (n.d) ‘Why Health at Every Size ®’, River Oak Health, accessed 20 May 2024. https://www.riveroakhealth.com.au/blog/blog-post-title-four-6mehs-nbx5w-d666z-k6aee-h8x5s-kkeks-3bmjl-k9jjg-wdz72-ls3lc-tdm7t-4l5kn
- Nicholson Z (29 May 2018) ‘Understanding the ‘health at every size®’ paradigm’, The Royal Australian College of General Practitioners, accessed 14 May 2024. https://www1.racgp.org.au/newsgp/clinical/understanding-the-%E2%80%98health-at-every-size%E2%80%99-paradigmn
- Center for Healthcare Strategies (n.d) ‘What is Trauma-Informed Care?’, Center for Healthcare Strategies, accessed 16 May 2024. https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/
- Kezelman C (4 February 2021) ‘Trauma informed practice’, Mental Health Australia, accessed 16 May 2024. https://mhaustralia.org/general/trauma-informed-practice
- Center for Healthcare Strategies (n.d) ‘What is Trauma?’, Center for Healthcare Strategies, accessed 16 May 2024. https://www.traumainformedcare.chcs.org/what-is-trauma/
- gov (n.d) ‘SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach’, youth.gov, accessed 16 May 2024. https://youth.gov/feature-article/samhsas-concept-trauma-and-guidance-trauma-informed-approach
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