The History of Health at Every Size®: Chapter 6: The Late 1990s

Hands holding a bar of chocolate with strawberries on a tabletop - Source: Louis Hansel on Unsplash

by Barbara Altman Bruno, Ph.D., DCSW. Previously posted on the Health At Every Size® Blog and reposted here with author permission.

The late 1990s found increasing pressure from pro-weight-loss groups against the fledgling anti-diet, pro-health forces. The American Obesity Association (AOA) formed in 1995, thanks mostly to generous funding from the drug industry, which then used Everett Koop’s false and misrepresented figure of 300,000 deaths per year from obesity in order to get FDA approval for Redux (a weight-loss drug which had already been found in Europe to be dangerous-to-lethal). Other vested interests were those wanting health insurance mandated to pay doctors who worked with weight loss and weight loss surgery, and various diet programs and producers, many of which had already been discredited by the US Congress and the Federal Trade Commission.

Although the AOA claimed to be an advocacy group for fat people, they had only one member. By calling obesity a disease rather than a body size, daily, lifelong medication could be advocated. NutriSystem and Jenny Craig started employing physicians to prescribe fen-phen.

Meanwhile, several real advocacy groups for fat people and/or against the diet industry came together in October 1996 when the AOA held a so-called “consensus conference” with Shape Up America!, the purpose of which was to establish guidelines for treating the “disease of obesity” and get mandated health insurance coverage. AHELP members, including Debbi Kauffmann and Barbara Altman Bruno, were joined by several NAAFA members including Lynn Meletiche, and speakers AHELP founder Joe McVoy, Lynn McAfee of the Council on Size & Weight Discrimination, Glenn Gaesser, and NAAFA executive director Sally Smith, in denouncing the sham.

Several books appeared which supported the ideas of both physical and mental health at larger sizes. Exercise physiologist Glenn Gaesser’s Big Fat Lies (1996; 2002) dispelled many of the weight equals-health notions that had been fostered. He described “metabolic fitness,” which in particular addresses how the body is able to produce and respond to insulin. He advocated that people of any size keep active for about 20 minutes per day, and commented that without losing any weight, most people could ameliorate Type 2 diabetes solely through eating and movement.

Ironically,  although he strongly opposed dieting, his publisher required him to include some sort of eating plan in order to get the book published, Gaesser’s work on fitness was supported by that of Steven Blair of the Cooper Institute for Aerobics Research (fitness, rather than body size, determined longevity, and weight loss was correlated with higher mortality from heart disease) and Ralph Paffenbarger and I-Min Lee, of the Harvard Alumni Study (active men whose weight cycled seemed to have a much greater risk of death than people whose weight stayed stable). Another exercise physiologist, Wayne Miller, would go on to become co-editor with Jon Robison of the Journal of Health at Every Size, which succeeded the Healthy Weight Journal.

Therapist and educator Cheri Erdman’s two books, Nothing to Lose: A Guide to Sane Living in a Larger Body and Live Large! Ideas, affirmations & actions for sane living in a larger body were published in 1995 and 1997, respectively. Erdman describes the “spiral of acceptance,” the process of coming to accept one’s body as it is. She co-created a support program, Abundia, offering an annual weekend retreat for larger women.

Another author, mental health researcher and therapist Carol Johnson, created her esteem-building program, Largely Positive, several years before her book, Self-Esteem Comes in all Sizes: How to Be Happy and Healthy at Your Natural Weight, was published in 1995.

Barbara Altman Bruno, a clinical social worker and educator, published Worth Your Weight: What You Can Do About a Weight Problem, in 1996. Like Erdman and Johnson, she supported people in building their health, mental health, and self-esteem, and she provided “eating lessons” (now known as intuitive eating), starting in the mid-1980s. Bruno, who was also NAAFA’s Mental Health Advisor, wrote “Guidelines for Therapists Who Treat Fat Client” (co-written subsequently with David Garner and twice again with Deb Burgard). In 1999 she and psychologist-educator Michael Loewy published “Weight Problems and Solutions” in Current Thinking and Research in Brief Therapy, vol.3.

In 1995, the Society for Nutrition Education recognized the Weight Realities Division, a group of nutrition professionals supporting health at every size. Members of the division included Joanne Ikeda, Ellen Parham, Michelle Grodner, Adrienne White, and Francie Berg.

In 2002, joined by Jennifer Buechner, Anne McPherson, and others, this group published a HAES®-oriented resource list at http://www.sne.org/weightrealitiesdivision.htm . They also published guidelines for childhood obesity programs. In 1998, Ikeda wrote If My Child Is Overweight, What

Should I Do about It? In 1999, nutritionists Karin Kratina, Dayle Hayes, and Nancy King published Moving Away from Diets: New Ways to Heal Eating Problems & Exercise Resistance.

Also in 1995, W. Charisse Goodman’s book, The Invisible Woman: Confronting Weight Prejudice in America, pointed out that “Weight prejudice supports a greed which cloaks itself in a hypocritical concern for health, much as the racist philosophy of the ‘natural order of things’ once supported the American slave trade.” (p. 32) She also likened weight prejudice to sexism and anti-Semitism.

AHELP stopped meeting after 1996.

Pat Lyons continued to teach Great Shape fitness classes for Kaiser Permanente. She and Laura Keranin of Kaiser also began a series of support/sharing sessions—think tanks—for people in many disciplines working with this new, health-centered paradigm. The Think Tank subsequently left Kaiser and has been meeting in northern California since the mid-1990s, attended by many ASDAH members including Deb Burgard, Ellyn Herb, Lynn Ellen Marcus, Carol Squires, Sandy Andresen, and Frances White of NAAFA.

Elizabeth Scott, a social worker, and Connie Sobczak, a survivor of eating disorders whose sister died from an eating disorder, formed The Body Positive in 1996 “to give people tools to reconnect to their innate body wisdom so they can have more balanced, joyful self-care, and a relationship with their whole selves that is guided by love, forgiveness, and humor.” (from the website).

Cinder Ernst, a plus-size fitness instructor living in the San Francisco Bay area, started training larger women to become aerobics instructors after meeting Lyons in 1989. She also started fitness classes for large women and continued for 20 years, while becoming a personal trainer. One of her clients was Marilyn Wann. Two other larger women who became fitness instructors were Lisa Tealer and Dana Schuster, who in 1997 opened the Women of Substance Health Spa in California. The spa was specifically designed to be weight-neutral (not favoring a particular body size or shape). During its existence, it hosted the Think Tank meetings.

In New York City, dancer and former bulimic Rochelle Rice, concerned about societal antifat messages that also equated fitness with slimness, opened her exercise studio for larger women, In Fitness & In Health. In Pennsylvania, psychotherapist, former bulimic, and fitness teacher Kelly Bliss had been working with larger women. Rice’s book, Real Fitness for Real Women, was published in 2001, and Bliss’s book, Don’t Weight: Eat Healthy and Get Moving Now! in 2002. Bliss also created a library of videos for plus-sized fitness. On the west coast, Mara Nesbitt-Aldrich, who had been giving massages since the early 1970s, shifted her focus to larger women after being moved by their stories of being verbally abused and neglected by their massage therapists. She created Yoga for Chair and Bed videos for larger people.

In their 1998 New Year’s Day editorial, “Losing Weight—An Ill-fated New Year’s Resolution,” Marcia Angell, MD, and Jerome P. Kassirer, MD, editors of the New England Journal of Medicine, warned, “Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition.”

By lowering “normal weight” to below a BMI of 25 in 1998, a panel of “obesity specialists” convened by the National Heart, Lung and Blood Institute instantly nearly doubled the number of Americans defined as overweight or obese. Since most of the studies did not support this move, the panel cited the Nurses Health Study for their rationale.1

“The ongoing Nurses Health Study presented a number of publishing biases. Being neither randomized nor controlled, it surveyed mostly-white female nurses in 11 states. Weight was self-reported by mailed-in questionnaires. Even more unfortunate, the data in its 1995 report applied to only a small subgroup of the nurses studied. Deaths in this subgroup, which was used to rationalize the NHLBI guidelines, totaled only 11 percent of total deaths and only 4 percent of the sample in follow-up.

Even so, the adjusted relative risk of 1.2 for mortality for BMIs of 25 to 26 was not statistically significant. Racial and gender comparisons could not be fairly made since 98 percent of the nurses were white and nearly all were women.”

However, unlike most other studies, which found lowest risk at a BMI of around 24 to 30, the Nurses Study reported higher risks at a BMI as low as 23. This was apparently the desired result. (Healthy Weight Network; http://healthyweight.net/cntrovsy.htm)

NAAFA and other size acceptance allies in 1998 held the Million Pound March in Los Angeles. One of the speakers at the march was singer Carnie Wilson, who subsequently received and became a shill for weight-loss surgery. Another speaker was actress Camryn Manheim, who subsequently and triumphantly dedicated her Emmy award to “all the fat girls.”

Also in 1998, Marilyn Wann’s book, Fat!So?, appeared, following her ‘zine of the same name. Other HAES-related books of note include Richard Klein’s Eat Fat, and Laura Fraser’s Losing It: False Hopes and Fat Profits in the Diet Industry.

The name of the movement that was burgeoning was discussed in many arenas, Frances Berg and Joanne Ikeda, members of the Think Tank, and list-members on the ShowMeTheData listserv all debated between “health at every size” and “health at any size,” with practitioners using either phrase.

One of the most quoted sources for the war on obesity was an article, “Annual Deaths Attributable to Obesity in the United States” by David Allison, JoAnn Manson, Kevin Fontaine, June Stevens, and Theodore VanItallie, (JAMA. 1999 Oct 27; 282 (16): 1530-8.), in which they estimated the annual number of deaths attributable to obesity to be between 280,000-325000. (See An Epidemic of obesity myths: http://www.obesitymyths.com/myth2.2.htm) 

8 Johanes, L., and Stechlow, S. (September 2, 1998). “Dire warnings about obesity rely on slippery statistic.” The Wall Street Journal.

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Pic is of Barbara Altman Bruno, a woman with short light brown hair and glasses

Barbara Altman Bruno, Ph.D., LCSW, is a clinical social worker, size acceptance activist, and HAES pioneer. She has presented at clinical conferences, appeared in television, radio, magazines, newspapers, and demonstrations, and has written many articles, including well-being columns for larger people, guidelines for therapists who treat fat clients, a brief history of HAES, and a book, Worth Your Weight (what you CAN do about a weight problem). She is former co-chair of education for the Association for Size Diversity and Health (ASDAH) and is on NAAFA’s Advisory Board.

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