What is Health at Every Size®? A Guide for North Carolina Patients

What is Health at Every Size®? A Guide for North Carolina Patients

If you live in a larger body, making a doctor’s appointment in North Carolina often requires a mental pep talk.

You know the drill. You go in for a sinus infection, a sprained ankle, or a mental health check-up. But before you can speak about your symptoms, you are shepherded onto a scale in the hallway. You are handed a pamphlet about BMI. And regardless of why you came in, the treatment plan somehow ends up being the same: “Have you considered losing weight?

This isn’t just annoying; it is a barrier to care. It causes medical avoidance—where patients delay seeing a doctor until an issue becomes an emergency because they cannot face the shame of the exam room.

But across North Carolina, from the mountain clinics of Asheville to the medical hubs of Durham and Charlotte, a shift is happening. A growing network of providers is adopting a framework called Health at Every Size® (HAES®).

This guide will explain exactly what HAES is (and what it isn’t), why it is scientifically valid, and how you can find a healthcare team in NC that treats you, not just your number on a scale.

1. Defining Health at Every Size® (HAES®)

First, let’s clear the air. In the media, HAES is often misrepresented as “giving up on health” or “claiming everyone is healthy.” Neither is true.

Health at Every Size® is a public health framework and an ongoing social justice movement. It rejects the weight-centric model of care (which assumes thinness = health) and replaces it with a weight-inclusive model.

According to the Association for Size Diversity and Health (ASDAH), the principles are:

1. Weight Inclusivity: We accept and respect the inherent diversity of body shapes and sizes. We reject the pathologizing of fatness.
2. Health Enhancement: We support health policies that improve access to information and services for everyone, acknowledging that health is multidimensional (physical, social, spiritual, occupational, emotional).
3. Respectful Care: We acknowledge our biases and work to end weight discrimination and stigma.
4. Eating for Well-being: We promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure—rather than external diet rules.
5. Life-Enhancing Movement: We support physical activities that allow people of all sizes, abilities, and interests to engage in movement to the degree they choose.

The “Health” in HAES

HAES providers believe that health is a resource, not a moral obligation. You do not owe anyone “health” to be treated with dignity. However, if you do want to pursue health, HAES suggests that focusing on behaviors (movement, sleep, nutrition, stress) is more effective and sustainable than focusing on weight manipulation.

2. Why the “Weight-Centric” Model is Failing NC

In North Carolina, our major hospital systems—Atrium, Novant, Duke, UNC—are world-class in many respects. Yet, they are largely built on a “Weight-Centric” model. This model operates on the assumption that higher weight causes disease and that weight loss is the cure.

The Scientific Flaw

The problem is that intentional weight loss fails for about 95% of people in the long term. Most people regain the weight within 2-5 years, often gaining back more than they lost.

This creates a cycle called Weight Cycling (or yo-yo dieting). Research shows that weight cycling is independently linked to:

• Increased inflammation.
• Higher risk of hypertension.
• Greater insulin resistance.

The Irony: When a doctor prescribes a diet to “improve your heart health,” they may actually be prescribing a cycle of weight fluctuation that damages your heart health.

The Diagnostic Blind Spot

When doctors focus on weight, they miss what is actually happening.

• Case Study: A patient in Raleigh goes to the doctor for knee pain. The doctor says, “Lose 50 pounds.” The patient diets, doesn’t lose the weight, and the pain persists. Two years later, a weight-neutral doctor finally orders an MRI and finds a torn meniscus that needed surgery, not a diet.
• The HAES Difference: A HAES doctor treats the knee. They might recommend Physical Therapy (PT) or surgery now, rather than making care conditional on a body size change that may never happen.

3. What Does a HAES® Appointment Look Like?

If you have only ever experienced weight-normative care, walking into a HAES-aligned practice like Radical Healing in Durham or Resilient Mind Counseling in Asheville can feel disorienting—in a good way.

Here is what you can expect:

The Lobby & Intake

• The Furniture: You won’t find those flimsy chairs with arms that dig into your hips. You’ll find armless chairs, loveseats, or bariatric-rated seating.
• The Paperwork: The forms might ask, “What are your preferred pronouns?” and “Do you have a history of disordered eating we should be aware of?” They rarely ask for your goal weight.

The “Blind Weigh-In” (or No Weigh-In)

This is the biggest shock for new patients.

• Consent: You are not automatically weighed. A nurse might ask, “Is it okay if we skip the weight today?” or “We only need a weight if anesthesia is required. Otherwise, we can skip it.”
• Blind Weight: If a weight is medically necessary (e.g., for chemotherapy dosing), you can stand on the scale backward. The number is recorded silently, and the provider agrees not to discuss it unless it indicates a sudden, acute health crisis (like rapid fluid retention).

The Exam

• Equipment that Fits: The provider has large and extra-large blood pressure cuffs readily available. (Using a “standard” cuff on a large arm creates a falsely high reading, leading to misdiagnosis of hypertension).
• Gowns that Close: You are given a gown that actually covers your body, preserving your dignity.

The Conversation

• Focus on Symptoms: If you have high blood pressure, the doctor discusses medication, stress reduction, and gentle movement. They do not say, “Come back when you’ve lost 20 pounds.”
• Neutral Language: They use terms like “person in a larger body” or “higher weight,” or they might mirror the language you use (including the word “fat” if you have reclaimed it). They avoid stigmatizing terms like “obese” or “overweight” whenever possible.

4. Navigating the NC Landscape: Who is Actually HAES?

North Carolina is a mixed bag. We have radical pockets of care and vast deserts of traditionalism. Here is how to navigate the specific regions.

The Triangle (Raleigh-Durham-Chapel Hill)

The Triangle is the epicenter of HAES-aligned integrated care in the Southeast.

• Radical Healing (Durham): This is the gold standard. It is an integrated wellness campus offering Primary Care, Therapy, and Physical Therapy. They are explicitly social-justice oriented, prioritizing BIPOC and Queer folks. They accept insurance (BCBS, Aetna) and even some Medicaid plans.
• Flora Physical Therapy (Durham): Brook Orvis and her team offer “Weight-inclusive care” for pelvic floor and orthopedic issues. This is vital, as many PTs shame patients for their weight during rehab.
• Dietitians: Practices like Stepping Stones Nutrition and Lutz, Alexander & Associates (with offices in Raleigh, Durham, and Cary) are strictly weight-neutral. They work with your doctor to advocate for you.

Western NC (Asheville)

Asheville’s vibe is more “holistic” and “somatic.”

• Resilient Mind Counseling: While primarily mental health, they maintain a rigorous referral network of HAES-friendly doctors in Buncombe County.
• Nutritious Thoughts: A large group of HAES dietitians who bridge the gap between medical nutrition therapy and intuitive eating.

Charlotte & The Corporate Hubs

Charlotte can be trickier due to a high concentration of cosmetic and “wellness” clinics that co-opt body positive language to sell weight loss.

• Vetting Tip: In Charlotte, look for providers affiliated with The Emily Program (formerly Veritas Collaborative) or independent practices like Pearl Counseling. These providers are trained in eating disorder protocols, which are inherently weight-neutral.
• Primary Care: It is harder to find a dedicated “HAES Clinic” in Charlotte. Patients often have success with Direct Primary Care (DPC) doctors like Promina Health (Wilmington/region) or independent DOs (Doctors of Osteopathy) who tend to take a more holistic view than MDs in large systems.

The “Weight Management” Trap

Warning: Both UNC Health and Duke Health have “Weight Management Programs.” These are not HAES programs. They are medical weight loss clinics. While they may be “polite,” their goal is to shrink your body. If you are looking for weight neutrality, steer clear of departments labeled “Lifestyle Medicine” or “Obesity Medicine” unless you have vetted the specific provider.

5. Deconstructing the “Southern Diet” Myth

Living in North Carolina means navigating a specific cultural stigma: the demonization of Southern food.

We are told that biscuits, sweet tea, grits, and barbecue are “why we are fat” and “why we are sick.” This is a classist and racist narrative that pathologizes the foodways of the South.

A HAES provider in NC approaches this differently:

1. Cultural Respect: They understand that food is connection. Telling a Southern grandmother to stop cooking collards with ham hock is telling her to disconnect from her history.
2. Nutritional Reality: Collard greens are a superfood. Grits are a source of energy. A HAES dietitian helps you add nutrition (e.g., “Let’s make sure you get enough protein with those grits”) rather than subtracting culture.
3. The “Sweet Tea” Conversation: Instead of banning sweet tea, a HAES provider might ask, “How does your body feel when you drink it all day vs. when you drink water?” The goal is internal body awareness, not external restriction.

6. Access: Insurance and Affordability

A common misconception is that HAES is “boutique medicine” for wealthy people who can afford private-pay doctors. While that sector exists, HAES is increasingly accessible in NC.

• Insurance: Most licensed HAES therapists and dietitians in NC (like those at Three Oaks Behavioral Health or Redefined Nutrition) are in-network with Blue Cross Blue Shield of NC (BCBS), Aetna, and sometimes United.
• Medicaid: This is the frontier. Radical Healing in Durham accepts Medicaid, which is a massive victory for health equity.
• Preventative Care Codes: A weight-neutral annual physical is billed exactly the same as a weight-centric one. The code for “Annual Wellness Exam” does not require you to be weighed. You are paying for the service, not the lecture.

Using Out-of-Network Benefits

If you find a HAES specialist (like a specific therapist) who doesn’t take your insurance, ask for a Superbill.

• Many NC corporate insurance plans (Bank of America, Wells Fargo, Duke Energy) have out-of-network benefits.
• You pay the provider upfront, submit the Superbill to your insurance, and they mail you a check for a percentage (often 50-70%) of the cost.

7. How to Advocate for Yourself (Scripts)

You cannot always find a perfect HAES doctor, especially in rural NC counties. Sometimes, you just need to see the only doctor in town. Here is how to “HAES-ify” a standard appointment.

Scenario A: The Nurse asks you to step on the scale.

• You: “I prefer not to be weighed today.”
• Nurse: “It’s policy.”
• You: “I understand. Please note in my chart that I declined the weight. I am happy to have my vitals taken otherwise.”
• (Note: They almost always say okay. It is not illegal to refuse a weight.)

Scenario B: The Doctor suggests weight loss for a specific complaint (e.g., back pain).

• You: “I understand that weight loss is your recommendation. However, I have a history of yo-yo dieting and I am not interested in pursuing intentional weight loss at this time. What treatment would you prescribe a thin person with this same back pain?”
• (This forces them to pivot to evidence-based interventions like physical therapy or anti-inflammatories).

Scenario C: They refuse a test until you lose weight.

• You: “Please document in my medical chart that you are refusing to run an MRI for my back pain until I lose weight.”
• (Doctors rarely want to document a refusal of care due to liability. This often gets the test ordered.)

Conclusion: You Deserve Safe Care Now

You do not have to wait until you are “thin” to deserve healthcare. You do not have to apologize for the space you take up in the exam room.

North Carolina is changing. The existence of practices like Valid Love, Resilient Mind, and Radical Healing proves that a new model of care is taking root—one that treats you as a whole human being, not a “before” picture.

Your Next Steps

1. Check the Directories: Use the(https://asdah.org/listing/) or the(https://crcfored.com/) to find vetted providers near you.
2. Interview Your Doctor: Call the front desk before you book. Ask: “Is your practice weight-inclusive? Will the doctor respect my request not to be weighed?”
3. Build Your Team: If you can’t find a HAES doctor, find a HAES therapist or dietitian first. They often have a list of “safe” doctors they refer clients to.

Disclaimer: This content is for educational purposes and does not constitute medical advice. If you are experiencing a medical emergency, please call 911.