Written By: Natalie Faella, MS, RDN, LDN | September 29, 2021
What if I told you that weight loss wasn’t the answer? That weight loss does not lead to better body image or health? You’d probably think I’m nuts because dieting and weight loss are prescribed for almost everything. Beyond that, weight loss is praised and celebrated when it’s (briefly) achieved, and it’s the cause of our sorrow, frustration, and plummeting self-esteem when it’s not. So how could our weight not be so important?
The truth is, our body weight actually has very little to do with our health. Our body weight is determined by a number of things; these include the ones we usually thinking about, like diet and exercise, in addition to our genetics, stress levels, and socioeconomic factors, which play major roles. These are also the determinants of our health status, with stress and socioeconomics playing the largest roles. That’s right — even larger than diet and exercise. Higher stress levels and lower socioeconomic status are two huge risk factors for many chronic diseases like heart disease, diabetes, high blood pressure, etc. For example, there is increasing evidence that marginalization and poverty are more strongly associated with type 2 diabetes than diet, exercise, or weight.
But for so long we’ve been led to believe that high body weight alone was the cause of these chronic diseases, and that losing weight was the only way to prevent or improve them. This may be because studies that make connections between weight and disease rarely assess for other factors like physical activity level, diet, weight cycling, or socioeconomic status. When studies do control for these factors, the association with weight and disease greatly decreases or disappears.
Let's look at weight-cycling (side effect of yo-yo dieting) for example. Weigh-cycling has been shown to increase inflammation, blood pressure, cholesterol, and insulin resistance (a symptom of type 2 diabetes). The Framingham Heart Study (an ongoing study of over 32 years) has also shown there is a significant correlation between weight-cycling and mortality rates (both associated with heart disease and all-cause mortality).
When studies do control for these factors, the association with weight and disease greatly decreases or disappears.
To quote Lindo Bacon author of Health at Every Size and Body Respect: “Blaming fatness for heart disease is similar to blaming yellow teeth for lung cancer, rather than considering that smoking might play a role in both.” Body weight can be a side effect of these health determinants (stress, socioeconomic factors, diet, weight-cycling, and physical activity), but not the cause of disease, like how yellow teeth can be a side effect of cigarettes but is not the cause of lung cancer.
What about BMI?
Body Mass Index, or BMI has been used as a determinant of health and risk for disease for many years. But the truth is, it’s pretty bogus. BMI is a measure of our weight compared to height by using the equation: body weight in kg divided by height in meters squared. It’s simply a math equation like y=mc+b. I’m still not entirely sure what that equation is used for like how I’m not sure why BMI even matters.
Why this random equation? BMI was created by a mathematician in the late 1800s who essentially wanted to demonstrate how individuals' body weight varied by height. Yup, a mathematician created this measurement that now holds so much weight (no pun intended) in the way people are treated both inside and outside of the doctor’s office.
In the 1990s, BMI categories were assigned (rather arbitrarily) as underweight, normal weight, overweight, obese, and so on. For some reason, “overweight” was set as a BMI of 25-29 and “obese” set as 30-35, even though health risks don’t seem to correlate with BMI until it is greater than 40, and those in the overweight range (25-29) tend to live longer than those in the normal weight category. Could this have anything to do with the fact that those who helped create these categories happened to have financial ties to the weight loss industry at the time?
Health risks don't seem to correlate with BMI until it is greater than 40, and those in the "overweight" range tend to live longer than those in the "normal" weight category.
So the categories don’t mean much, and the numbers themselves are just numbers. They don’t take into account fat mass, bone mass, or muscle mass. (Remember, a mathematician created this). And still, many healthcare providers recommend weight loss when they see anyone with a BMI of 25 and up. (And just for reference, Tom Brady’s BMI is 27).
These BMI categories contributed to (or maybe even laid the groundwork for) weight stigma. When you think about it — what does “overweight” even mean? When a person is tall, we don’t call them “over height.” When a person is average height that’s what we say — not that they’re of “normal height.” So who is to say there is a “normal,” or as it implies correct weight?
This focus on weight and BMI can prevent individuals with higher BMIs from receiving medical treatment. They may avoid their annual doctors appointment because they don't want to be scolded or shamed for their weight. It can also backfire on those in the “normal” weight categories, who may go undiagnosed with issues like high cholesterol, blood pressure, etc. because it was overlooked as being a problem since the person is a “healthy” weight.
Focusing on weight prevents those in the medical community from seeing and treating the whole person. In society, it fuels weight stigma and the belief that we won’t be healthy, desirable, successful, or happy until we weigh a certain amount. These beliefs are detrimental to a person’s self-esteem and can lead to adverse health effects like weight-cycling and eating disorders. Not to mention, this weight focus has also proven to be ineffective at actually helping people achieve thinner, healthier bodies.
So how do we shift our focus?
How can we stop obsessing about our own weight? And stop perpetuating the weight stigma? Here is where the help of health professionals who take a Health At Every Size (HAES) approach can come in. Like myself! :) HAES is a non-weight-focused approach to health that promotes things like healthful, intuitive eating and joyful movement with the focus on health enhancement, not alteration of body weight or shape.
I realize this can be a tough concept to wrap our heads around, as all we’ve ever heard is that our weight and BMI matter, and lower is better. I encourage you to read more about this, reach out with questions, and get more informed about HAES and why the specific number on the scale (or BMI calculator) does not matter as much as you have been led to believe it does.
Learn Health At Every Size (HAES) approach to wellness here and stay tuned for more from me by subscribing here!
And check out my two blogs on HAES: Taking Weight Out of Wellness and HAES: Common Questions Answered
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