Reflections from a Medical Trauma Therapist: New Health At Every Size® (HAES) Principles and Framework of Care

Apr 8

A fat black woman laughing, looking to her right sitting with other people. She's wearing a purple shirt, has glasses and a nose ring. There's a person next to her and a plant behind her. — Image from Unsplash

The Association for Size Diversity and Health released revised principles and a new framework of care for providers on March 27th, 2024. A primary way many of my clients are traumatized by the medical system is through anti-fat bias. With the release of the new HAES® principles and care framework, I thought it would be a good opportunity to reflect on how such principles impact my work and guide my trauma informed perspective. If you are unfamiliar with the Association for Size Diversity and Health, this can be an introduction.

What Is ASDAH?

According to the Association for Size Diversity and Health, “ASDAH partners with service providers, educators, and advocates to dismantle weight-centered health policies and practices, with a focus on people who live with multiple forms of oppression.” They offer education, advocacy and connection within the community. I am part of a list of professionals that align with their HAES® values. It’s a helpful tool when looking for providers. It’s been a great community for me to find good referral sources for my client who I know will contribute to their healing journey.

Why Do These Updates Matter?

These revised principles and the framework of care matter because they provide a compass to providers continuing the work of making healthcare more inclusive and less oppressive to marginalized communities. Due to these updates, I thought I’d share my reflections and how each of these principles and guides impact my work as a HAES® therapist who works with people healing from medical trauma.

Updated HAES® Principles

1. Healthcare is a human right for people of all sizes, including those at the highest end of the size spectrum.

There are many barriers to adequate healthcare without providers causing more harm. As a HAES® practitioner, I believe people deserve quality, compassionate care regardless of their health status, size, or BMI. “Health” (however defined) does not make anyone morally superior. Many clients experience trauma related to how they are treated due to their size.

2. Wellbeing, care, and healing are resources that are both collective and deeply personal.

Individuals cannot fully strive for wellbeing, care, and healing in unsafe, oppressive environments. In viewing wellbeing, care, and healing in a holistic way, we must keep in mind promoting safe environments including but not limited to caring for our earth, access to food, shelter, and positive relationships. In this way, wellbeing is collective while also unique in each of our experiences. In order to heal trauma, you have to be in a safe space and time in your life, which happens communally and personally.

3. Care is fully provided only when free from anti-fat bias and offered with people of all sizes in mind.

As a therapist, part of our code of ethics is ‘do no harm.’ I acknowledge the harm anti-fat bias creates for the community, especially for fat folks. People of all sizes deserve to have quality, compassionate care that meets their needs and society deserves to be free of these harmful constructs. If for some reason I cannot provide this to a client, I will refer them out.

4. Health is a sociopolitical construct that reflects the values of society.

I agree that the current definitions of health are rooted in racist and ableist practices such as white supremacy, anti-black racism, and healthism. I believe each person has a right to define what ‘health’ means to them. We have ongoing opportunities to challenge current definitions and work towards collective liberation.

Two white fat women in a pool. One woman is in a red swim suit, hugging the other in a black swimsuit. The woman in the red is looking at the camera. — Image from Unsplash

New HAES® Framework of Care

1. Grounding in liberatory frameworks:

Health at Every Size® is not a standalone social justice movement but draws from and relies upon the ongoing liberation of all people, specifically drawn from black liberation, fat liberation, crip/disability liberation, womanism, intersectional feminism and more. Working from a trauma informed perspective, I draw on these movements to inform my work with clients and challenge myself to continue to dismantle oppression internally and externally.

2. Patient Bodily Autonomy:

Clients are fully in control of choices about their bodies. As I work in mental healthcare this isn’t as explicit of a topic in my work, but it’s important my clients know I respect and defend their bodily autonomy, especially while interacting within the healthcare system. One way to build safety is through choice and action.

3. Informed Consent:

Informed consent is a pillar of therapy and most medical settings. However, I acknowledge even informed consent is impacted by bias. I continue to work on challenging bias within myself and continue to promote client autonomy and informed consent. Clients have the right to comment on treatment, stop treatment or ask for referrals. I also have the right to terminate services with proper referrals.

4. Compassionate Care:

Compassion entails empathy, not pity. I don’t believe in toxic positivity. I acknowledge our experiences are different from one another and work to cultivate a safe therapeutic relationship where you are seen, heard, and respected.

5. Critical analysis, application, and execution of research & medical recommendations related to weight:

Anti-fat bias and weight stigma has significantly impacted research, education, and clinical recommendations. It’s important we question research design, implementation, and outcomes, especially in the ways bias has shaped them and not only take data at face value. Research and outcomes cannot be separated from the culture in which they are explored.

6. Skills and equipment to provide compassionate and comprehensive care for fat people’s bodies:

I currently provide all my services through telehealth, but when I do have an office, I make sure that my furniture and office layout can accommodate large bodies and people who use mobility aids. I want to make sure it’s physically a safe space for my clients.

7. Provider Roles and Responsibilities:

As a HAES® provider, it’s my responsibility to apply ethical and liberatory frameworks to my role. For me, this means not only providing high quality, ethical work one on one with clients, but moving through the world in a way that works on dismantling anti-fat bias, anti-black bias, ableism, anti-trans bias and misogyny outside of the therapy room. Ideally, we can work on tackling trauma before it happens and creating a safe place for all bodies and abilities.

8. Tools that support wellbeing and healing without contributing to oppression:

I work hard to help clients rebuild relationships with aspects of ‘health’ that have been co-opted by the weight loss industry such as food and movement. I want your relationship with these things to be based in your values. I work to build professional relationships with local providers who are also rooted in this framework to promote healing. Healing from trauma can be encouraged through a team approach.

9. Addressing Your Anti-Fat Bias:

I am consistently addressing how anti-fat bias impacts how I relate to myself and how I interact and treat others. To say I’m not impacted by bias would be lying and instead I work to dismantle and challenge such biases. I acknowledge the ways my body size, skin color, gender identity and other factors impact peoples’ experiences with me.

10. Addressing Systemic Anti-Fat Bias:

For me this includes being part of organizations such as the Association for Size Diversity and Health, contributing my time and finances to important causes that do this work, having hard discussions with people, and calling out shit behavior.

Check out the ASDAH website: https://asdah.org

Full written principles and framework of care: https://asdah.org/haes/

If you are looking for a therapist who is rooted in these values and principles, please reach out and we can discuss ways I may be able to help you on your journey. Schedule a free consultation today and start working with someone who respects you.

Check out my specialty pages here: grief, pregnancy loss, infertility, medical trauma, health issues, anxiety, and menopause.

Learn more about Chelsea here.

Chelsea Kramer