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Health at Every Size: Common Questions Answered

Updated: Jan 8, 2023

Written by: Natalie Faella, MS, RDN, LDN | January 25, 2022

I know. It’s a hard pill to swallow that we don’t have to try to “control” our weight in order to be healthy. Even harder pill to swallow — we really don’t have any “control” over our weight at all. It makes sense if this doesn’t sit well and if you’re still skeptical after reading my last post.

I’m hoping to help by answering some common questions I get when people first learn about Health at Every Size (HAES):

“What do you mean weight loss doesn't improve health? My [family member, friend, coworker] said their [cholesterol, blood pressure, diabetes] improved after they lost 15 pounds.”

Yes, weight loss can result when we adopt new health behaviors. For example, if a person typically does not incorporate lean proteins, fruits, vegetables, whole grains/fiber, etc., into their diet, and then does replace some of their typical foods with these, weight loss may result. Similarly to how if a person is not usually physically active, but then starts going for walks, or moving more in ways they enjoy, weight loss may result. Or if a person starts sleeping better or adopts new coping skills for stress management that displace behaviors like emotional eating or binge drinking, weight loss may result.

But weight loss is not what improved that person's cholesterol, blood pressure, or even diabetes. The health behaviors that displaced some of their usual behaviors: eating more fiber, fruits, vegetables, less saturated fat (from switching to lean proteins), moving more, managing stress, getting quality sleep, etc., did.

A great description of this comes from Lindo Bacon, author of Health at Every Size, Body Respect and other great books and articles. She makes the point that weight is to health as yellow teeth are to lung cancer. Having yellow teeth doesn't cause lung cancer, but can be a result of smoking cigarettes, which are known to cause lung cancer. Similarly to how our weight can be a result of our eating habits, genetics, stress, socioeconomic status, etc., but not the cause of our health issues. Our health issues are a result of our genetics, stress, socioeconomic status, and (even less so than the preceding) our diet and exercise habits.

This is why liposuction (i.e., fat/weight reduction without lifestyle changes) alone won’t improve biomarkers of our health (cholesterol levels, blood pressure, etc.), because we aren’t getting to the contributing factors like managing stress, eating more fiber and antioxidants, moving more, etc. Similarly to how whitening your teeth won’t reduce your risk of lung cancer if you keep smoking cigarettes, but learning how to quit smoking can.

This is also why you know people who are relatively thin or have a BMI within the “normal” range who have high cholesterol, high blood pressure, diabetes, etc. Once again, our size does not dictate our health.

"But I thought we could control our weight? What is a set point? Can we change it?"

We all have a unique set point, or weight range, that our body likes best. It is the weight range we're in when we are honoring our appetite and not fixating on our weight or food rules (i.e., not trying to control our weight through restrictive diets or over-exercising to burn extra calories). A person's set point can be within any BMI range — not just a "normal" BMI and it's estimated to range from about 10-20 pounds for the average person. Our set point range is largely determined by genetics, and our environment and lifestyle will impact where we are in that range.

We cannot change our set point and by trying to through dieting, we can ultimately raise it to a higher range. (That's right. People eventually can diet themselves to higher weights). Our set point is tightly regulated by the brain, specifically, the hypothalamus where other things are regulated like body temperature. There is a certain amount of body fat our brains prefer and will try to maintain. In order to maintain homeostasis within our set point range, compensatory processes will be initiated by the hypothalamus if we get out of range. For example, if our fat storage drops below preferred levels, increased appetite, conservation of energy (for example, slowed heart rate), and an increased preference for body fat storage will result in attempt to get levels back where they belong. Just like how the body will shiver as a way to warm up when body temperature drops, or sweat as a way to cool down when overheating.

Additionally, our set point is more tightly regulated at the low end of our range than at the upper end, which is why it can increase as a result of dieting. This makes sense when you think about in terms of evolution — in order to stay alive during times of famine, our body needed these regulatory mechanisms, like energy conservation, to keep us alive. Mechanisms to keep us in range when we're at the high end, however, are more flexible. For example, we can easily override the feeling of fullness, but cannot tell our body to stop conserving energy when we're at the low end of our set point range. This highlights a very important physiological reason why diets don't work. Especially yo-yo dieting (dieting on and off), which tells the body "famines" will be recurring and need to be prepared for.

Think about it. Do you know someone whose weight has stayed relatively consistent over the years and they haven't ever really dieted? How about someone who does go through restrictive eating and/or overexercising phases? Chances are the person who doesn't diet has had a more stable weight.

"But why are there more "obese" people now? Why weren’t there as many when my mom or grandma was a kid?"

Evolution can help answer part of this question, too. We have inherited a genetic tendency to store fat as a means of survival. We just no longer need it because for most of us, food is readily accessible at all times. We are no longer experiencing shortages or famines (unless self-inflicted through dieting), and we are also more sedentary with desk jobs versus hunting and gathering.

In addition to genetics, the environment plays a role in our weight and in which genes we actually express, too. There are many factors that impact the expression of weight-related genes, like stress, nutrition, sleeping habits, physical activity level, and maternal nutrition to name a few. Nutrients from our diet can actually turn certain genes on or off, and physical activity and stress can impact our hormones, which can in turn affect the genes we express, too. This is in part why we can have the gene for something but never express it.

So if you combine the fat-storing survival genes with environmental factors that have changed over the years like accessibility to and types of food in our diets, sedentary lifestyles, stressors (like decreased work-life balance and the pressure to be thin), with yo-yo dieting (which is raising people's set points), it makes sense that weights have increased over the years.

"If weight does not impact our health status, what does?"

A bunch of things:

  • Genetics. You can be the healthiest, happiest, least stressed person on the planet, but still have high cholesterol, blood pressure, or increased risk for X, Y, and Z due to your genetics.

  • Socioeconomic factors. How much money you make impacts a variety of factors that influence health like the types of food you can buy, where you live (proximity to healthy food options, safe vs. unsafe environments), and your health insurance coverage. And as previously mentioned, our environments and lifestyle factors can influence our genetic expressions.

  • Stress. Daily stressors add up, especially if we don’t have the time or skills to cope with them. There are also many stressors outside of our control that even the best stress management techniques can’t touch (for example, feeling unsafe in your home).

  • Weight cycling. A result of yo-yo dieting where weight is lost, regained, lost, even more gained, etc. This has been linked to increased blood pressure, insulin resistance (a symptom of type 2 diabetes), inflammation, cortisol (stress hormone) levels, and risk for heart disease.

  • Diet. Some specific things that come to mind include: high saturated or trans fat intake, which can raise our "bad" cholesterol and increase our risk for type 2 diabetes. Low fiber intake can increase our risk for heart disease and GI issues. Low fruit and vegetable intake and high sodium intake can increase our blood pressure. Fasting or dieting can cause unstable blood sugars and increased cortisol levels and fat storage.

  • Lack of exercise. Regular movement is not only good for our hearts, lungs, joints, and muscles, but for stress relief and our mental health as well.

It's OK if you're still feeling skeptical after reading this and last week's HAES blog. You should always question things, especially nutrition and health-related advice you haven't heard before or are unsure about (take it with a grain of salt, right?). It is good to question things so that we'll be motivated to increase our knowledge in those areas and not just default to accepting the popular beliefs or messages we often receive. There is a good chance you aren't receiving HAES-related messaging too often, and are receiving a lot of the opposite. Take your time to digest this information and of course, reach out to me with any questions along the way!

Stay tuned for more on an anti-diet approach to nutrition, health & wellness by subscribing here. And reach out with any questions here!


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