PCOS and HAES: Why I Use a HAES-Aligned Approach to PCOS Management

Have you ever heard of the phrase “Health at Every Size” and thought, “but you can’t be healthy at every size!”

Let’s chat about it!

PCOS and the Focus on Weight

Some of the old school / outdated “advice” for managing Polycystic Ovary Syndrome (PCOS), is focusing on weight loss and cutting out food groups like sugar, gluten, or dairy. While some lifestyle habits can be very helpful to manage your PCOS, taking a restrictive approach tends to backfire.

Have you ever felt hopeless trying to manage PCOS?

Binged after restricting food?

Or just given up on your health because it felt too hard? This is what I’m talking about!

I’ve worked with hundreds of folks with PCOS, and I’ve found that this type of approach is not effective. It usually causes more harm than good. So instead, I use a Health at Every Size® (HAES®) – aligned approach to help my clients thrive with PCOS!

First off….what is Health at Every Size®?

The Health at Every Size® framework means that all bodies – no matter what size – have the right to equitable healthcare. 

All bodies also have the right to pursue health, which may mean something different to different people. We often think of health as the absence of disease, but the reality is that hardly anyone is immune to disease and this is a really crappy definition of health. Health is very individualized and means different things to different people.

HAES® also acknowledges that health is not a matter of morality. In other words, you are not a good or bad person based on whether you have a medical condition!

There are five HAES® principles, which are 

1. Weight inclusivity
2. Health enhancement
3. Eating for well-being
4. Respectful care
5. Life-enhancing movement

The Association for Size Diversity and Health has more in depth information about these principles on their website. 

I’ve also heard that they are updating their principles and overall definition of HAES – I’m excited to hear how this shifts in the future!

Here are 3 reasons why support PCOS and HAES with my client work:

Because every BODY deserves quality and fair health care – regardless of their size or health status

This is the most important reason!! Even if someone in a larger body has health conditions like PCOS and insulin resistance, they still deserve proper treatment from their healthcare providers. Full stop. 

This proper treatment means that the provider will not blame all of the patient’s health issues on weight, and will provide any necessary tests or treatments. 

Let’s talk about joint pain as an example:

I noticed my clients in smaller bodies who have joint pain are more often offered imaging, diagnostic tests, treatment and physical therapy. My clients in larger bodies are usually told that their joint pain would improve if they lost weight. This is an example of lazy medicine.

Joint pain can be caused by many issues: physical injury, lack of movement, muscle weakness, etc. These can all occur independent of size. If a larger patient comes in with joint pain, they should be treated equitably to someone in a smaller body.

This is just one example of why HAES and PCOS just make sense. If people in larger bodies are not treated the same or offered the same interventions then how can we possibly blame health outcomes solely on weight? 

Pcos and haes

I have treated clients with PCOS of different shapes and sizes, and will treat them with compassion and respect – which is what I want them to experience with all healthcare providers. 

With the PCOS and a Health at Every Size approach, I am able to dig deeper into what health means to each individual, and work from there.

Some clients may want to prioritize improving insulin resistance, and others may want to decrease binging. Both are valid goals in PCOS management that I can help with. With this approach, we can spend our time focusing on attainable health outcomes – not shrinking bodies.

Because weight alone is a poor indicator of health

Disclaimer: I typically don’t use the words “obese” or “overweight” with clients because they are stigmatizing. However, we will use those words  in this section to explain how current weight standards, such as the Body Mass Index, are not very reliable.

There is some data that may seem surprising when it comes to weight – especially if you’re not familiar with Health at Every Size®! Here’s a glimpse at that research: 

• The lowest mortality rates are found in the “overweight” category
• Being in the “obese” category is associated with better survival time during a serious sickness or injury
• About ⅓ of people in the “normal” weight category were unhealthy based on their blood pressure, lipids, blood sugar, etc.
• About ⅓ of people in the “obese” category were healthy based on their blood pressure, lipids, blood sugar, etc.
• In those who are physically fit, mortality rates are similar in larger bodies & smaller bodies

Since weight is not a good reflection of one’s health or how someone is managing their overall health with PCOS, I don’t focus on weight with clients with PCOS.

Most of my clients have been pressured to lose weight by their doctor or family. This has led them to weight cycle, which is when someone loses weight but then gains the weight back… sometimes even more than what was lost. This cycle tends to happen over and over again and can actually make insulin resistance and inflammation worse.

Instead of this diet cycle, we focus on each persons’ individual health goals. This often involves behaviors around nutrition, movement, sleep, stress management, and/or mental health. This pretty much sums up PCOS and HAES.

Because health improvements happen regardless of weight loss

There are plenty of studies that also show how other health markers can improve with different health conditions, even if you don’t lose weight. 

• Gestational Diabetes: In those with Gestational Diabetes, the risk for developing Type 2 Diabetes after pregnancy lowered with regular exercise – regardless of weight
• Insulin Resistance and Triglycerides: Regular exercise improves Insulin Resistance and Triglycerides in those with PCOS 
• Fatty Liver: Resistance exercises like shoulder press and bicep curl helped lower the amount of fat on the liver – you guessed it, even when they did not lose a significant amount of weight!

Gestational diabetes, insulin resistance, high triglycerides, and fatty liver are all common in PCOS, so it is great that we have data showing how lifestyle factors like movement can improve those conditions. 

While I wish there was a lot more weight-inclusive research out there, I use my client’s lived experiences as my foundation of practice.

If someone tells me their PCOS got better by dieting but dieting wasn’t maintainable or was detrimental to their mental health and overall well-being, I believe them. If someone tells me they’ve tried everything they can to lose weight but can’t, I believe them. And support them in shifting their focus to something else.

In summary…

The fact that everyone deserves equitable healthcare is enough of a reason for me to use a Health at Every Size® approach with PCOS. The research about weight as a bad indicator of health, and how health can improve without weight loss are even more reasons to use this approach with PCOS.

If you are ready to learn more about managing your PCOS by focusing on health and wellness but NOT weight loss, check out my group coaching services! I would love to help. 

Sources

1. The health at every size® (HAES®) principles. ASDAH. (2022, April 22). Retrieved February 10, 2023, from https://asdah.org/health-at-every-size-haes-approach/
2. Childers, D. K., & Allison, D. B. (2010). The ‘obesity paradox’: A parsimonious explanation for relations among obesity, mortality rate and aging? International Journal of Obesity, 34(8), 1231–1238. https://doi.org/10.1038/ijo.2010.71 
3. Tomiyama, A., Hunger, J., Nguyen-Cuu, J. et al. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. Int J Obes 40, 883–886 (2016). https://doi.org/10.1038/ijo.2016.17
4. Bao W, Tobias DK, Bowers K, et al. Physical Activity and Sedentary Behaviors Associated With Risk of Progression From Gestational Diabetes Mellitus to Type 2 Diabetes Mellitus: A Prospective Cohort Study. JAMA Intern Med. 2014;174(7):1047–1055. doi:10.1001/jamainternmed.2014.1795
5. Samantha K. Hutchison, Nigel K. Stepto, Cheryce L. Harrison, Lisa J. Moran, Boyd J. Strauss, Helena J. Teede, Effects of Exercise on Insulin Resistance and Body Composition in Overweight and Obese Women with and without Polycystic Ovary Syndrome, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 1, 1 January 2011, Pages E48–E56, https://doi.org/10.1210/jc.2010-0828
6. Hallsworth, K., Fattakhova, G., Hollingsworth, K. G., Thoma, C., Moore, S., Taylor, R., Day, C. P., & Trenell, M. I. (2011). Resistance exercise reduces liver fat and its mediators in non-alcoholic fatty liver disease independent of weight loss. Gut, 60(9), 1278–1283. https://doi.org/10.1136/gut.2011.242073