Why We Don’t Need to Stress About Body Size and Health

so you want to know more about weight and health?

CW: mention of ob*sity and other stigmatizing language

Let’s start with a body check-in: is your curiosity sparked from a place of intrigue and curiosity for deeper learning? Or are you feeling activated and defensive? Either way, take a deep breath, friend. I’m so glad you’re here doing this work.

what is Health at Every Size?

Health at Every Size (HAES) is a “…continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes. It is also a movement working to promote size-acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness. The HAES approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.” It is not to be confused with “healthy” at every size.

Definition: Association for Size Diversity and Health (ASDAH)

let’s chat BMI:

Most people will agree that the BMI is not an accurate predictor of health status. Yet some will still say ob*sity is a disease, and that being at a higher body weight inherently equals poor health due to the correlations between weight and health. As any good statistician will tell you, correlation does not equal causation.

The BMI was not designed to and cannot measure health. It is also exceedingly arbitrary as it stands today, having been changed in 1998, causing millions of people to become “overweight” over night. What prompted this change? Medical professionals wanted to use whole numbers to make it easier, so they decided to simply round up. For no scientific reason.

body diversity is on purpose

The BMI is harmful in many ways, but one thing it did aim to do was assess whether or not people’s heights and weights could be distributed normally across a population. Basically, what that means, is just as there are people out there with larger or smaller shoe sizes than “average,” there are also people with larger and smaller body sizes than the “average.” Of course, weight can and does fluctuate to a certain degree, but the body will do what it can to stay within its genetically determined set point range.

another check in:

Where do your values about health come from? How does it feel to potentially have those thoughts challenged when presented with information such as “the ob*sity epidemic does not exist?”

Can you sit with the fact that maybe everything you’ve learned and heard about this topic could be wrong? Especially if it meant life-saving care for so many people?

correlation, not causation

Sure, being at a higher weight may be correlated with a number of health problems, but did you also know that the number of movies Nicholas Cage appears in is also correlated with the number of people who drown in a pool in any given year? Something’s up, right? Right.

Turns out, fat people are being prescribed weight loss protocols by medical professionals, which results in weight cycling, which increases health risks (and is also likely to cause weight gain). 95% of diets fail within 5 years, resulting in re-gaining the weight and maybe more. We also know that losing and gaining weight throughout one’s life causes (not just correlates to) poor health outcomes.

weight stigma kills

There’s a lot more to the picture besides weight cycling and dieting. WEight stigma is also a major player in why fat people are more susceptible to poor health. Imagine going to the doctor because you can’t breathe well, being told to lose weight, and being diagnosed with stage 4 lung cancer a year later? I wish that scenario was hyperbolic, but it’s not.

People in larger bodies fear going to the doctor because of how they are likely to be treated. Weight stigma in the doctor’s office is rampant. It makes sense why one’s blood pressure would be up at the doctor, a place where fat people are so often shamed and blamed.

weight loss is not a health behavior

Refer back to the HAES definition: health comes from increasing health behaviors like eating fruits and veggies, moving the body joyfully, and of course all the super important social determinants of health. Losing weight in-and-of itself is not what causes health. Remember: correlation does not equal causation. We are also simply not always in control of our health status, nor is pursuing health a moral obligation.

so what do we do from here?

The answer is surprisingly simple: stop funding ob*sity research, and start providing weight-inclusive healthcare. That means treating the actual diseases of people in all body sizes, regardless of weight. A good question to ask yourself (or your doctor, if you live in a larger body) is “how would a doctor treat a thin patient with these symptoms?” and go from there.

It also means unpacking your personal anti-fat bias, which might take some time and deep healing. Confront what comes up for you around your ideas about fatness, and deconstruct what you’ve learned.

If this info is new to you, I know it can feel like a lot. You probably have lots of questions! I want to implore you to learn more from others, especially fat creators and educators. I will list a few of my favorites below.

@drrachelmillner
@fatdoctoruk
@fierce.fatty
@nic.mcdermid
@thefatsextherapist
@madeonagenerousplan
@sonyareneetaylor
@your_body_is_good
@therotund
@amapoundcake
@hannahtalksbodies

CW: Studies use and have stigmatizing language

Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10(1), 1-13.

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.

Hunger, J. M., Major, B., Blodorn, A., & Miller, C. T. (2015). Weighed down by stigma: How weight‐based social identity threat contributes to weight gain and poor health. Social and personality psychology compass, 9(6), 255-268.

Logel, C., Stinson, D. A., & Brochu, P. M. (2015). Weight loss is not the answer: A well‐being solution to the “obesity problem”. Social and Personality Psychology Compass, 9(12), 678-695.

Tomiyama, A. J., Hunger, J. M., Nguyen-Cuu, J., & Wells, C. (2016). Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. International journal of obesity, 40(5), 883-886.