Weight does not always define good health
How do you define health? For many people, a ‘healthy’ weight comes top of mind. We live in a very weight-focused society driven by many factors, including society glamourizing the ‘ideal’ thin body, our own pressure to lose or fear of gaining, or healthcare hyper-focusing on weight and the obesity epidemic. Ironically, focusing on weight as a means to better health, increased self-esteem, and overall improved quality of life often backfires and can result in worse outcomes in all these areas. Attempts to meet this thin ideal further empowers and enforces society’s discriminative messages.
Does this mean those in larger bodies are doomed for an eternity of poor health? No. Despite strong and deeply ingrained influences, we need to start taking a weight-neutral approach and focus on behaviours that promote long-term health and well-being.
Most are familiar with body mass index. This value is calculated by dividing weight (kg) by height (m2). The BMI then classifies someone as underweight, ‘healthy’ weight, overweight or various levels of obese. The higher or lower the BMI falls from a ‘healthy’ weight, the higher the risk for health problems. This measure is often used in healthcare and research despite its many limitations. It doesn’t take into consideration muscle mass, naturally lean bodies, bone build, or where weight (stomach vs legs/hips) is carried. An individual who has high muscle mass may have a BMI classified as ‘obese’ despite low fat mass.
Waist circumference is another measurement used to assess health risk. This is based on evidence that excess abdominal fat (closer to organs) vs. around thighs and buttocks poses a higher health risk for disease.
Neither measurement should not be used as a sole measure for diagnosis or health status. It’s often more useful in studying populations than individual assessment.
Higher health risks?
Many studies related to weight have been short-term while we’re more interested in the long-term impact. Research has shown certain diseases, including diabetes, heart disease, arthritis, high blood pressure and certain cancers are higher with obesity. Improved management/prevention has also been observed with weight loss. Other studies have shown overweight and moderately-obese individuals are living just as long—in some cases, longer than ‘healthy’ weight individuals. Associations have been observed with weight and disease but cause for the association is not well understood. Regardless, of the potential health risks with excess weight, most can attest to years of trying various diets with disappointing results. Research shows that 90 per cent of people who lose weight on a diet will regain it back; up to 66 per cent of weight loss is regained within one year. Despite the shame and crushed self-esteem that results from weight lose attempts, it’s not the person who fails the diet but the diet that fails the person. It’s impossible to stick to an eating plan that cuts out food groups, restricts calories, consumes lives with preoccupation diets and weight, and requires fighting against our bodies’ biological famine response by increasing hunger, cravings and store calories as fat.
Let behaviour define health
It comes down to what you’re doing to promote health, not what you weigh. Someone in a larger body who exercises regularly and/or eats well is likely to be in better health than someone in a smaller body who does not. Research shows that consistent lifestyle behaviours improve health (blood sugars, hypertension, cholesterol, mobility) even when weight does not change. Taking on healthy behaviours comes with its own challenges, but research supports a lifestyle-focused approach as more sustainable, providing effective health outcomes, and promoting better physiological well-being than a weight loss-approach.
Health and wellbeing is defined by more than your physical health. Optimal health is affected by a number of factors including balanced nutrition, physical activity, managing stress and mental health, sleep, abstinence/minimal substance use, access to healthcare, and personal health values. It can also be affected by age and genetics. We can control some factors while others we cannot.
Health must be defined as your best health. Healthcare providers and medical guidelines may provide guidance, knowledge and support, but the individual decides the best plan of action. Best health is reached when you’re leading a lifestyle you can happily and realistically maintain. For some it may result in weight loss, while others may experience no change or weight gain. Making lifestyle changes to improve health is a choice; for some that may mean practicing many healthy habits, while other people may not embrace that same objective.
Reaching your best health
Slow and steady wins to health: It’s a lifelong process that has to be viewed as a journey. There is benefit in small, sustained changes. Unlike most diet plans, it’s not about perfection or an all-or-nothing approach. Focus on small, realistic and achievable goals with a long-term focus. You may start out with adding in more fruits and vegetables; once you feel confident, work on maintaining and/or adding another goal. The more consistent you are with behaviours, the more likely the benefit. At the same time, adaptation is key, requiring alterations and redefining your health as life circumstances, values, and health status changes.
Shift from self-control to self-care: Self-control implies self-discipline to restrict and resist and beating yourself up for not achieving a goal. Self-care shifts the focus to taking care of you and what’s in the best interest for better mental and physical health. This includes self-compassion when goals don’t go as planned.
Making lifestyle changes is often easier said than done; it’s important to identify your own barriers. If increasing activity is your goal but you’re struggling due to poor sleep, perhaps modify and work on your sleep pattern first. Financial constraints often lead to food insecurity. Work within your limitations, adding nutritious foods as circumstances allow.
Focus on the benefits. If you’ve been very weight-focused, this can be a challenging shift and may provide less immediate and measurable results than a number. Take notice of changes in energy, mood, hunger, improved fitness, decreased pain and improved digestion. When not hyper focused on controlling your weight, there’s time to put into life’s meaningful things.
Seek out support—from your friends, family, coworkers, community groups—that support a weight neutral approach. Find reliable resources to increase your knowledge including physicians, hospital-based programs, dietitians and physiotherapists. Check out Health at Every Size for more information and support. If you’re struggling with low body image, preoccupation/disordered relationship with food and weigh, find help from a trained counselor.
Shifting from a weight-focused approach to a weight-neutral approach may be a very challenging transition and one that not everyone will support. It’s unlikely that one article will stand up against other forces telling you otherwise. Even if you’re not ready to take weight off the table, consider lessening the focus or incorporate actions that support realistic change and acknowledge the experienced benefits. This will help in your pursuit of a healthier and happier you.
Changing the conversation
It can be intimidating speaking to a healthcare professional, especially one who is very weight-focused. Remember you are the key participant and decision maker in your care, while your health professional is there for guidance. Explain your concerns with focusing on weight and that such focus is not being supportive to your overall health.
If being weighed is triggering for you, politely decline. Shift the focus to the benefits of behaviours you have developed or that you plan to work on. Ask for their support or resources/referral to someone who can. If lifestyle changes are not presently a focus for you, acknowledge their suggestions and once again politely decline.