Weight and health

I’m very interested in the relationship between weight and health, although I hold some unconventional views. I think that weight alone should not be used as an indicator of health and that focusing on weight loss as a goal in health interventions can have some unintended negative outcomes.

First, I will preface this by saying that I am not denying that the US population, on average, eats worse and is less active than it was in previous generations, and that this has led to poorer health outcomes. As a person interested in public health, I think there should be efforts (on multiple levels, not just individual) to improve our nation’s health. I also realize that we have, on average, gained weight.

While I recognize this relationship between our increasingly unhealthy environments/lifestyles and our increasing size, I don’t think that it’s as clear-cut as many in our society make it out to be. I believe that someone can have a technically unhealthy BMI (over 25) but still be healthy while someone who has a normal BMI can be unhealthy. Now, clearly there are countless credible studies that have found that people with higher BMIs tend to be at risk for an assortment of health problems that are less common among people with lower BMIs, but there are also a number of studies that complicate this apparently obvious relationship (for example: here, here, and here). And while perhaps on average someone with a BMI of 30 is more likely to have certain health issues than someone with a BMI of 20, this does not mean that all people with a BMI of 30 are unhealthy and that all people with a BMI of 20 are healthy.

I believe that our focus on weight as the primary sign of health and our obsession with weight loss as the way to gain health has lead to some unintended negative consequences: 

1. There are many very unhealthy ways to lose weight. If weight loss is the focus instead of adopting healthy behaviors regardless of weight loss, people may try to lose weight at any cost, even if it means actually being less healthy. 

2. People who have a normal BMI may think they’re healthy even if they aren’t eating well or getting enough physical activity, while people with higher BMIs who adopt healthy behaviors may become discouraged and think they aren’t healthier if they don’t lose weight. 

3. By conflating weight with health, people who do not have a normal BMI are automatically judged as being unhealthy, even if they actually are healthy/do have a healthy diet and exercise regularly.

As a society, we are very focused on losing weight as the key to being healthy, but I think there may be a different way to approach it. What about being healthy simply for the sake of health, not weight loss? This is what I like about Health at Every Size (HAES). I find this approach to health very interesting and others have argued that we should have a paradigm shift away from focusing on weight loss to HAES. Here, here and here are some published articles on the benefits of HAES.

Of course, it should go without saying that even someone who does have a high BMI and actually is very unhealthy (for whatever reasons) should still be treated as a human being and not discriminated against. Here’s an example of weight discrimination: this study found that the higher your BMI, the less your doctor respects you.

It should also be noted that the degree of agency people have in controlling their weight (and health in general) is greatly debated. Our society tends to put the blame largely on individual-level factors (usually focused on behaviors, but sometimes genetics are mentioned too). Public health professionals and some other experts have done an excellent job of pointing out other factors, including environmental and social.

I am not the first person to say these things, and many other people have written much more eloquently than me on these issues. I know many people feel passionately about this topic and may disagree with me. I love to discuss this issue, so feel free to voice your opinion!