Why Trans Care Must Take a “Health at Every Size” (HAES) Approach
When we speak about transness, we are also inherently speaking about bodies. Trans people deserve access to care that not only acknowledges that, but works to legitimize and destigmatize bodies that don’t fit in with the norm. The HAES model makes room for marginalized bodies, and while HAES focuses on weight and body size, there is a distinct overlap in conversations about fatphobia and transphobia, especially for individuals that are fat and trans.
Narratives about Bodies
Bodies are the vessels that enable us to move through the world, and each one is distinct from one another. Still, we are spammed with messaging that insists some types of bodies–small, white, non-disabled bodies that conform to society's gender roles–are better, more desirable, and more worthy than others.The perpetuation of these narratives leaves people outside of those identities to reckon with their own self worth and place in the world, often on their own.
Rather than disrupting and rejecting this flawed outlook, LGBTQ+ communities often reproduce it, leaving trans folks at risk, feeling undesirable and unworthy not only in the world at large but within their own communities. No trans person should be punished because they refuse to or are unable to conform to socially acceptable notions of the ideal body.
Health at Every Size
Health at Every Size (HAES) is a healthcare model that embraces a holistic, continuum-based definition of health for individuals of all body shapes and sizes. While all individuals should have the ability to call up a doctor or therapist and receive competent, non-judgmental care, this is not our current reality. Health is a loaded term, and it has been gatekept from many marginalized individuals throughout history. HAES acknowledges this reality but posits that all individuals should be able to access well being in ways that are useful and meaningful to them.
One major tenet of HAES that must be widely adopted is weight inclusivity, which aims to detach moral value judgments from body weight. Evidence supports that all bodies are good bodies because they hold us, regardless of size. HAES practitioners also recognize (while health is not indicative of worth) that weight cannot be used as an accurate signifer of health. HAES attempts to integrate this knowledge into the healthcare sphere. Care workers have a responsibility to internalize HAES and integrate the model into practice because no person should feel left behind due to the body they live in.
5 Dos and Don’ts to Help You Incorporate a HAES-Informed Lens in Your Practice!
Do direct your clients to incredible fat queer & trans content creators.
If you’re providing resources, ensure that you are not only sharing the perspectives of thin people. Individuals like Caleb Luna and Stephanie Yeboah are putting out incredible content nearly every day--from IG posts to books--for people of all sizes!
Don’t assume that your fat client wants to lose weight.
Being fat is a perfectly okay way to be and does not in and of itself present a problem. Instead, acknowledge that the real problem is the toxic ideology of fatphobia and the resulting stigma that fat folks are left to bear.
Do notice how moral-based judgment around fatness shows up for you, and unlearn it.
No one is immune from holding problematic beliefs, but we all must take responsibility in dropping them. Begin the introspective work of noticing what yours are, how they infiltrate your work, and unlearning them one by one. Your clients deserve a version of you that is constantly unlearning and relearning!
Don’t tell self-identified fat clients how to describe their bodies or that they’re “not fat.”
We must respect and celebrate individuals’ ability to identify as fat and drop the idea that fat is a bad word. This reclaiming can be powerful, and we should always embrace the language that feels most affirming for clients in all aspects of their identities.
Do break down barriers when you’re able.
Even simple things like the chairs in your office or waiting room can be inaccessible to fat people! Make sure your physical space is able to welcome clients of all sizes by making swaps and accommodations as necessary.
The Intersection of Transness & Fatness and Where HAES Comes In
Both fat bodies and trans bodies are bodies that do not fit in and are often treated as less than. Fatphobia--like transphobia--has never been about health and has always been rooted in moral judgments about fat people, and both systems of oppression are violent. So what does this mean for fat trans bodies? Fat trans people are ungendered and hyper-gendered simultaneously by peers and care workers. Fat trans people are regularly turned away for gender-related surgeries due to outdated and incorrect concepts such as BMI. Fat trans people may face job, housing, and healthcare discrimination from multiple angles. These experiences solidify that the HAES perspective, one that honors the validity of diverse bodies, is doubly important when working with trans and gender non conforming individuals.
Even within trans communities, our role models are often thin and cis-passing, but so many trans folks do not fit that description. Don’t we fat trans folks also deserve access to health, well being, representation, and joy? No lens is a quick fix for all of the unlearning that has yet to be done, but by employing a HAES perspective to work with trans people, we begin the process of embracing community members with all bodies—fat, trans, Black, disabled, non cis passing, and beyond.
In short, we must internalize that we cannot disconnect conversations about transness from conversations about bodies. Thus, it would be antithetical to provide so-called trans competent services without acknowledging the inherent validity and strength of each body, regardless of how it fits in with others. We all deserve this and more.
BLOG AUTHORS ALL HOLD POSITIONS AT THE GENDER & SEXUALITY THERAPY CENTER (G&STC). THIS SPECIFIC BLOG WAS WRITTEN BY G&STC THERAPIST IN TRAINING HOPE GLASSMAN. FOR MORE INFORMATION ABOUT OUR THERAPISTS AND SERVICES PLEASE CONTACT US.