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Health At Every Size [Oct. 12th, 2012|12:57 pm]
There's a lot of debate going on regarding the Health At Every Size (HAES) movement. Most of it seems to focus on the idea that HAES is just a way of giving fat people permission to stay fat, or that it encourages people to get fat by not shaming them for not being perfect.

Setting aside the absurdity of thinking that HAES makes people get fat on purpose, let me explain *my* understanding of what it means. I'm not the expert, and other people may have differing views of it, but here's what I take from it.

First of all, the success of long-term weight loss is pretty miniscule: 90-95% of people who lose weight regain it within 5 years. Programs like Weight Watchers and Jenny Craig are *required* to put that "Results not typical" disclaimer on their ads because, hey, the success stories they are touting are NOT the usual outcome of the program.

Now, no one WANTS to regain the weight they fought to lose. Kirstie Alley had the additional incentive of a million-dollar salary, and she still couldn't keep the weight off. So assuming that Joe and Jane Average regain their weight only because they are lazy and gluttonous is pretty naive and arrogant. The shame and pain of being overweight would be enough to keep people thin, if it was the least be effective.

But research has shown that weight is not the predictive factor for health. Fitness is. Yes, obese and unfit people have a much higher mortality rate than normal weight, fit people. But for obese, fit people? That mortality rate drops down to almost the same as normal weight, fit people. And it's half the mortality rate of normal weight but unfit people. This graph really illustrates the differences:


So instead of trying to sell us on all being thin, a goal that eludes most the people who attempt it, HAES emphasized being FIT, a goal that is within the grasp of many more people, and that will actually improve their health.

Most of the time, overweight people are sold on exercise and fitness as part of the whole "get thin" package: "You should work out and eat healthy food AND THEN you'll get thin!" Fitness is treated as a means to reach the Holy Grail of a size 4 dress, instead of something that is an inherent good in and of itself. HAES is about unlinking fitness from thinness and emphasizing overall health, rather than an elusive goal weight.

Why is this important? Because most people won't succeed at getting thin, but CAN succeed at getting healthy. And if people only associate exercise and fitness with "the time that I'm on a diet" then they don't learn to think of it as something good on its own, only as something that they have to suffer through when they are in the dieting phase of their lives.

Furthermore, HAES is about saying that it's okay, and safe, and *fun* to work out even when you don't look like a magazine cover. It's about providing a supportive environment where people can work on their fitness without feeling embarrassed or pressured into conforming with someone else's ideal of beauty. It's about encouraging people to get moving and enjoy the body they have, without some hidden agenda that judges them if they don't lose weight.

Do people practicing HAES lose weight? Some of them do. Some of them don't. I have, over the last year, and I will probably lose more. But if the Weight Fairy came to me and said that I wasn't going to lose another ounce, I would keep on living like I'm living because this is about my health and how good I feel. It takes disconnecting fitness from the "...and then you'll lose weight!" message in order to make it something that discouraged, unfit people can learn to practice and enjoy.

And that, to me, is what HAES is all about.

[User Picture]From: halfmoon_mollie
2012-10-12 05:11 pm (UTC)
HAES is about unlinking fitness from thinness and emphasizing overall health, rather than an elusive goal weight.

This is a wonderful post and very informative. And very true. I'm using myself as an example. I will probably never be thin - unless I'll ill. There is not a thin woman in my family. But I do work out, I do move and I do try to eat healthier. I know how I feel. I know how my clothes fit. I know that my blood pressure is normal and so is my cholesterol.n (It pisses my doctors off and confuses the people at the Red Cross when I go to give blood.)

I'm thinking of the woman weight lifters I saw at the Olympics this past summer. They all were - very large. And probably fitter than anyone I've ever met, male or female.

Thank you for this.
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[User Picture]From: zoethe
2012-10-12 06:58 pm (UTC)
When I see really heavy people struggling, I so want to encourage them to stop thinking about their weight and start moving their bodies. It makes so much difference!
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[User Picture]From: audacian
2012-10-12 05:16 pm (UTC)
well said!
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[User Picture]From: cinema_babe
2012-10-12 05:30 pm (UTC)
HAES is about unlinking fitness from thinness and emphasizing overall health, rather than an elusive goal weight.

In my 20s I was involved with teh Fat Acceptance movement and this is one of the reasons
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[User Picture]From: mplsindygirl
2012-10-12 05:57 pm (UTC)
This is wonderful for me to read. I'm about 25% heavier than I was 25 years ago, and at a better fitness level now than I've been in years. I don't really lose weight much beyond a certain new "set point" for my body. My body image has improved more because of the things I am able to do, rather than the size of my clothes.

Fit at any size :) I like it.
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[User Picture]From: zoethe
2012-10-12 06:56 pm (UTC)
I weigh 50 more pounds than I weighed when Ferrett and I got married, but I can fit into the dress I wore that day. Fitness is HUGE!
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[User Picture]From: jeffpalmatier
2012-10-12 06:25 pm (UTC)
I started tracking my calories a couple of days ago. When I started adding them up, my reaction was, "Holy shit!" Unfortunately in my case, it looks like I'm overweight because I'm ingesting way too many calories over what I should be consuming. I'm going to have to make some changes in my diet, to put it lightly. I hope I can lose some weight and keep it off because I look horrible right now, especially compared to how I used to look years ago when I was thinner.
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[User Picture]From: zoethe
2012-10-12 06:51 pm (UTC)
Not mutually exclusive. I *was* eating way too many calories, and I have stopped doing that. What I was eating was absolute crap, and I've (mostly) stopped doing that. Part of getting healthier may well be a drop in weight, possibly substantial. It's making the drop in weight the only goal that is a problem for a lot of people.
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[User Picture]From: tylik
2012-10-12 06:28 pm (UTC)
I just wish as a society we could broaden the discussion to get past the shaming and blaming and talk more about a lot of the systematic changes in our environment. Because we are seeing some pretty major population shifts, and they aren't just about people eating bad and being lazy. (Artificial light are well documented as being linked to some of these, and I would rather suspect some of the hormone mimics might also play a role.)

I have lost a lot of weight and kept it off - not quite a third of my total body weight as measured from my highest point. There are some dietary shifts. There are exercise shifts, but not, I think, that much change in exercise level - because a bunch of that weight didn't come off until well after I was doing the crazy wushu stuff. I suspect the biggest pieces are about pain management, sleep, and possibly a food allergy. *shrug*

Which is not to say that fat is unhealthy of itself, or that losing weight is the goal. It wasn't particularly a goal of mine, and I've never dieted in my life. (And I have mixed feelings about my body in its current configuration. I mean, personally, I love it - but it means I get treated as a sex object a lot more in ways I don't like.) I do think weight gain is often a symptom of quite a number of underlying health problems. (Which makes all the doctors refusing to treat patients until the patients lose weight even more reprehensible, OMFG.) It's really well established in the literature at this point that diet by itself doesn't do a lot to reduce obesity in the long term, and even diet and exercise together aren't that great. Which you'd think might have people questioning their underlying assumptions more...
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[User Picture]From: zoethe
2012-10-12 06:53 pm (UTC)
It's much easier to just blame people for being "weak" than to address what is a very complex issue.
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[User Picture]From: caudelac
2012-10-12 06:33 pm (UTC)
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[User Picture]From: sammiantha
2012-10-12 06:44 pm (UTC)
Well said.
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[User Picture]From: roniliquidity
2012-10-12 07:43 pm (UTC)
Great post!
I've been struggling a lot with this in the past year. I started an aggressive exercise routine, because I felt like crap, I wanted to try and get my blood pressure under control, and if I lost some weight, that would be ok too. Nothing got better. My blood pressure didn't improve, my back ached, my knees hurt, and I was pretty bitter all that effort went no where. However, I'm hoping since we found the thyroid disorder and am figuring out the rest it allow me to improve my health rather than get by with "good enough."
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[User Picture]From: zoethe
2012-10-12 07:46 pm (UTC)
I hope the health problems getting resolved helps. Just remember to start slow--injuring yourself isn't going to help in the long run.
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[User Picture]From: lawchicky
2012-10-12 08:24 pm (UTC)
This is very true. I always want my weight to be at a point where I FEEL the healthiest. For me, there comes a level where the weight makes me feel less healthy, less mobile, more winded, etc. Luckily, my experience so far is that if I become more active at that point, and watch my calories, I can usually get back to where I feel more of an equilibrium.

Likewise, and this is something you NEVER read about, there's a certain weight for me that makes me feel ill because it's too low. Again, I start to have less energy, tend to get sick more easily, and become less mobile and just FEEL less healthy.

It would be naive to think that everyone's equilibrium is at the same weight. We all have different body types and conditions, but I think for everyone there probably is a weight that's too high to be healthy and one that's too low, with a great big area in between where we should be ok if we keep ourselves relatively active.
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[User Picture]From: zoethe
2012-10-12 10:01 pm (UTC)
Absolutely agreed. When I was a size 6 I looked like crap and felt miserable.
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[User Picture]From: anivair
2012-10-12 09:05 pm (UTC)
To be entirely fair to the concept, being overweight even if you're fit is a greater strain on the body and is less ideal .... that said, being overweight and in good shape is vastly superior to being thin and in garbage shape, of course.

Also, if you get fit (you eat less junk food and more real food, you walk, you lift some weights, you engage in some physical activity) you will almost assuredly drop weight if you are already obese. The odds are that you will not drop *all of the weight* and look like a fitness model, no. but you will shed some fat and you will be in better place. Any progress is better than no progress there.
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[User Picture]From: zoethe
2012-10-12 10:22 pm (UTC)
This is the assumption language that sounds judgmental and is based on outdated research. There are lots of fat athletes, and recent research shows obese people having better survival rates for some chronic diseases.

The quiet disapproval in this says, "if you don't have the results I expect, your efforts are useless." And that's not helpful.
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[User Picture]From: shandra
2012-10-12 09:08 pm (UTC)
I cannot believe how much better I feel when I am integrating both activity and working out into my life. Great post.
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[User Picture]From: walkertxkitty
2012-10-12 09:08 pm (UTC)
That's what I do.

I have no hope of ever being normal weight. Normal, as currently defined by medicine is no more than 169 pounds. I am 6 feet tall and there is no fat on my shoulders, which measure a grand 76 inches across. I have metabolic failure, which means that none of the organs which control weight loss work.

So I gave up and focused on things I like eating (which turned out to be an amazing array of vegetables and fruits seasoned with herbs and cooked in oils which are good for you) and movement which is safe and entertaining for me. I love hiking, swimming, and yoga, for instance, as well as weight training. Heck, even household chores count!

I will never have a healthy view of my body; the medical profession saw to that and I will always have to fight anorexia and other negative food oriented behaviors. I weigh 500 plus pound but...

If we switch to evidence based medicine, I am healthier than most normal weight people. Blood pressure, triglycerides, cholesterol, blood glucose are all on the low side of normal.

The point is, body size means nothing and should not ever be the first and only means of determining health. I will always be fat, but I don't need the added burden of conforming to a false science.
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[User Picture]From: zoethe
2012-10-12 10:24 pm (UTC)
Absolutely agree.
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[User Picture]From: ccr1138
2012-10-12 09:54 pm (UTC)
Preach it, sister! I think a lot of fat people exercise vigorously for many months and don't see very much progress in losing weight, so they quit. This is a shame. If they could look at it as something worthwhile on its own right, they might not get as discouraged. Although personally, I have to say I loathe exercise in most forms, because it's boring. Yes, Zumba and Jazzercise and Curves and whatever else you name ... BORING. The only exercise I truly enjoy is hiking in the woods. Not much of that available in suburbia, unfortunately.

I am 70 pounds overweight, and yeah, I need to lose that. But I've already lost 60 pounds, and people who've never tried to do that have no clue how hard it is. I told my doctor, "If it were easy, we'd all be skinny." And to those who seem to think all it takes is a modest cutting of calories and adding a daily walk ... I challenge them to go for three weeks eating ONLY a small amount of food (and nothing they actually like) and spending at least an hour a day forcing themselves to do an activity they find boring and difficult -- differential equations, perhaps. No doubt they'd be cheating within a week.

I'm not sure what the definition of "fit" is, though. Does it mean disease-free? Because I am diabetic. However, despite my weight, I can run up and down the stairs without breathing hard, touch my toes, hike 5 miles, etc. That's got to count for something.
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[User Picture]From: zoethe
2012-10-12 10:40 pm (UTC)
The level of hatred and aggression leveled at fat people is kind of amazing. Gee, if shame and hatred worked, everyone would be thin by now. There's an incredible amount of arrogance out there that is completely unhelpful. And ignores the research and facts.
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[User Picture]From: valarltd
2012-10-12 10:55 pm (UTC)
I would love a visit from the weight fairy. It would mean a few less carrots every day. (I like my carrots, but 20 baby carrots a day is pushing my limit)

I want to lose my weight because I hurt, My knees and ankles and feet hurt.
On the other hand, I can run for six minutes without feeling like I'm going to die, and my numbers are all good (except my good cholesterol: too low) I can touch my toes, given 3 weeks to stretch to it. I am still working on a sit-up.

It's the little goals
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[User Picture]From: zoethe
2012-10-12 11:54 pm (UTC)
20 baby carrots a day? Are you, like orange?

It was sex that got me started again. As in, I wasn't able to do some things I wanted to do. It's gone beyond that, but that's where it started.
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[User Picture]From: fallconsmate
2012-10-13 01:20 am (UTC)
one of the things my new (ok, so i've been seeing her a year now, that isnt *new*) endocrinilogist told me is "ALL of the drugs that treat diabetes CAUSE weight gain. ALL of them." none of the other 3 doctors who treated me told me anything other than "you're gaining weight! that's bad!"

none of them counseled me on nutrition. the nutritionist in her office DID. she's also treating my pain issues, which is helping me MOVE more.

move more. eat healthier. i can manage those things better than i could a year ago. its a start. :)

thank you for posting this, i appreciate it greatly!
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[User Picture]From: zoethe
2012-10-13 01:33 am (UTC)
That, IMHO, is malpractice of the most evil and insidious kind. To give you meds that make you gain, and then scold you for the known side effect, is the kind of behavior that calls for horse whipping.
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[User Picture]From: tithenai
2012-10-13 01:48 am (UTC)
Spot on. Another point in general is that thinness is constantly associated with health when a great many thin people are terribly unhealthy. I'm not talking about eating disorders; I'm talking about your average person by BMI standards who has high cholestoral, who smokes, who is sedentary, but looks thin, and therefore reaps a load of societal benefit while neatly sidestepping the shaming fat people get for being a "drain on the health care system."

I've significantly gained weight through fitness, and I fucking LOVE it. I've gained something like 20 lbs since January, and most of it's muscle. If I stay this weight when I'm 30 I'll be obese according to BMI charts, and I'm the healthiest I've been since highschool.
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[User Picture]From: zoethe
2012-10-13 02:16 am (UTC)
I am 50 pounds heavier than when Ferrett and I got married, but I can wear the dress I wore for the wedding. THAT'S how much difference fitness makes. Good for you, building up!
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[User Picture]From: wednes
2012-10-13 02:37 am (UTC)
Right on! I can say that my health has improved dramatically since adopting the HAES lifestyle. It's much more difficult to take care of a body you've been taught to hate, and exercising for years without any significant weight loss (and a few nasty injuries that might have been prevented with a competent trainer) was demoralizing. I can't even count how many times people (not doctors, just regular people) have told me I must be lying about exercising because everybody knows that people who exercise lose weight.

Medications for high blood pressure and bipolar disorder also cause weight gain in many cases. They can also raise blood sugar, which is hilarious when you think about how often they're prescribed for people who are already at risk for diabetes. I was told for years that losing weight would help with my "mild apnea" (which was actually quite severe but not properly diagnosed because don't you know losing weight fixes everything and if I'm not going to lose 100 pounds then I'm obviously not trying to be healthy). Come to find out, apnea causes severe weight gain if left untreated.
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[User Picture]From: zoethe
2012-10-14 04:41 pm (UTC)
It's so sad that people are shamed into hating their bodies. No one should feel that way.
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[User Picture]From: anderyn
2012-10-13 03:02 am (UTC)
I have been much more active than I used to be, and I feel so much better than I did before. I do think that being more fit is the answer, not feeling like a klutz and dork because you're fat. I am one of those people who will always be large, since it's genetic (my mother's family is famous for its large women), but I can be a healthy large. And that's what I want to be.
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[User Picture]From: mrs_kat_tyler
2012-10-13 04:17 am (UTC)

Sorry this is so long!

This post is making me feel a lot better on a day where I'm feeling really shamed about my weight. I'm on an online community for stay at home moms and one person asked about our opinions about ads like the ones in Minnesota where they are more shaming than anything else. I thought "hey! I'm obese but trying to make healthy choices and not embarrassed about my weight! I'll tell them why I don't think they'll work."

I explained how we live in a very small space with a tiny kitchen and no dishwasher and while it was just my husband and I it was already frustrating some days that I'd have to clean ALL the dishes as soon as I was done with them because I'd have no space and nothing to cook with later if I didn't but now that I have a baby it can be a real struggle. A baby doesn't understand that Mommy can't play because she's cooking and cleaning. Many nights getting take-out on the way home from picking my husband up from work at 8pm sounds a lot easier than being up cooking and cleaning till 10pm. I explained how most nights I'm not doing that because I am trying to learn a new way of cooking that is faster and easier so that we eat even healthier than before. I was taught to cook meals like pan searing a meat, making a sauce, roasting potatoes and sauteing green beans with herbs and wine, which is hard to do night after night with a baby. We already didn't eat typical junk food but once the baby arrived we've taken to eating a lot in restaurants but we've now made a commitment to change so he grows up eating at home mostly. I also said that I really understand though how when you are tired and overwhelmed and your house is a mess because you have two kids buying fresh groceries a couple times a week and cooking every day is the last thing you feel able to do and these ads address none of these issues.

I also spoke about how I've struggled to lose weight even on at 1500 calorie diet and I just can't keep up with weighing, counting and measuring every little thing that goes in my mouth with a fussy newborn. At the moment the best I can do is try to eat wholesome foods and exercise. I also spoke about how it is frustrating being the only person I know who has to restrict calories that much to lose any weight; my husband eats whatever he wants and is on the low BMI end. The rest of my family ate the same food as I did when I was growing up and I'm the only one that got fat. I already eat fairly healthily (certainly healthier than many of my thin friends) and have good blood pressure and cholesterol, I just keep being fat.

I was attacked as making excuses and "Making things more difficult than they are. How hard is it to just make an egg? You don't need space for that. Just put the baby in a carrier. There, solved your 'problems.'" "How is a 1500 calorie diet is hard to maintain?" "Some people put the effort in to eat healthy and clean. We all find it annoying, why are you complaining?" "What is wrong with you where it takes 1-2 hours to cook a meal, eat it, and clean things up? You are doing something wrong. You already said you only had a couple of pots and 2 burners so you are clearly making something up."

Interestingly, when I asked the women what they do to maintain their easy 1500 calorie diet or how they get their infants to stay calm while the cook and eat nobody had any suggestions. And I would assume that the reason so many women told me to stock up on take out menus and canned soups when I was pregnant was because a lot of women DO find it hard to manage everything, small kitchen or not!

I realize it is the internet and these women are ridiculously judgmental but it still hurts to be told that not only are your struggles not real, but your efforts to fix them aren't good enough. I also thought it was interesting that the women who said "I'm fat and it is totally because I like junk food and hate exercise" were applauded for their honesty. If that is what you are struggling with great, but I get the idea that I was flamed because I wasn't ashamed or giving the reasons for being fat they wanted to hear.
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[User Picture]From: zoethe
2012-10-13 04:35 am (UTC)

Re: Sorry this is so long!

Wow, I really am just is tears over the treatment you've been subjected to in the hands of a so-called support group. But I wish I could say I'm surprised. Mother groups are a staggeringly judgmental bunch, in my experience. If think there is a lot of defensiveness that translates into a weird competitive vibe.

My memory of the first six months of Erin's life is just trying to survive each day. Are there things I could have done better, or would have done differently? Sure! But that's with the knowledge and experience of hindsight. At the time, I was lucky to be intelligible day to day.

You will get better at all this, because baby will grow and you will learn. Don't let other people and their narrow worldview get you down.
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[User Picture]From: mariadkins
2012-10-13 04:23 am (UTC)
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[User Picture]From: libco
2012-10-14 08:52 pm (UTC)
Shared and loved.
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[User Picture]From: zoethe
2012-10-14 10:01 pm (UTC)
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[User Picture]From: fitfool
2012-11-27 01:05 pm (UTC)
Thanks for posting the link to that study! (though the link seems to be slightly wonky) I can't seem to find that chart showing relative mortality on that page though. Where did you get it? I'm not sure if I'm reading the tables of results properly or not, but I think the relative risk for Unfit (normal weight, overweight, and obses) might be even higher than that graph you posted shows. I really like the HAES message. Definitely reposting this article.
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[User Picture]From: zoethe
2012-11-27 11:02 pm (UTC)
I can't find the original link to the graphic, but it was on Ragen Chastain's site, Dances with Fat. I'm happy to have you repost it as I think it's a really important message!
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[User Picture]From: aitaissa
2017-09-18 03:37 pm (UTC)

yes some of them

Do people practicing HAES lose weight? Some of them do.
know more :
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