Editor’s Note: This story is part of an occasional series about a disordered food and food culture.
Accepting your body as it is and stopping all dieting may sound great, but would it harm your health?
Advertisements, pop culture and even doctors can talk about health and weight as if they were one and the same: smaller bodies are healthier and bigger bodies should be unhealthy.
But health and the body aren’t that simple and uniform, and health can vary from person to person, said Jeanette Thompson-Wessen, a nutritionist in the United Kingdom whose approach isn’t focused on weight loss.
A higher body mass index (BMI) is associated with conditions such as diabetes and heart disease, said Philipp Scherer, professor of internal medicine and director of the Touchstone Diabetes Center at the University of Texas Southwestern Medical Center. However, BMI is a controversial way of measuring health, and it’s just one of many factors associated with changes in a person’s well-being, said Dr. Asher Larmie, a UK-based GP and activist.
Medical care, the environment, social conditions and biology make up the majority of the factors that determine our health, according to the Office of Disease Prevention and Health Promotion’s Healthy People 2020.
Still, we often place great importance on a person’s appearance when assessing their health, said Shana Minei Spence, a registered dietitian in New York. And even as we learn to shed the burden of societal beauty standards, it can be hard to feel confident in your body if you view your size as unhealthy.
Experts say it may be time to disentangle health and weight and focus more on behaviors that promote our health than the number on the scale.
It’s important to understand that the studies pointing to terrible health outcomes for people with higher body fat can only point to correlation, not causation, Larmie said.
While studies can say that people with higher weight tend to have more cases of heart disease, they can’t say that weight caused the heart problems, Larmie added.
But the importance of those studies should not be discounted, Scherer said. The correlations are strong, and “from a physiological perspective, we work with correlations in the clinic,” he said.
However, other factors may still play a role, such as access to medical care, Scherer said.
And for people with larger bodies, good medical care can be hard to come by, said Bri Campos, a body image coach based in Paramus, New Jersey.
Not only her clients are afraid to go to the doctor. Although she educates people about their body image and mental health, Campos is often afraid to go to the doctor for fear that she will feel embarrassed about her weight, she said.
“I can get strep throat, I can get a rash,” Campos said.
“Due to my body size, it’s very unlikely I’ll be able to go to the doctor and get a real diagnosis that isn’t ‘you should probably lose weight.'”
Spence likes to remind her customers: Bodies are not business cards.
We can’t look at a person’s body once and get a sense of their health, their habits or their biology, she said.
“Do we have access to someone’s medical records? Shall we talk to their doctor?” she said. “And often, frankly, sometimes health is out of our control. There are so many chronic diseases that people just develop.”
While we can see correlations between body size and health status widely, it’s not as clear-cut when researchers look at individuals, Scherer said.
“The field in general is really embracing that not everyone with that very high BMI is type 2 diabetes,” he said.
People in smaller bodies can develop heart disease or diabetes, and there are plenty of people in larger bodies that are considered completely metabolically healthy, Scherer said.
“It’s just a reflection of our genetic heterogeneity and how we deal with excess calories,” he added.
What does it actually mean to be healthy? And can diets help you with that?
That depends on which areas of health you prioritize.
Health consists of many factors. Avoiding illness is one, but so is maintaining mental health, keeping social networks active, getting enough sleep and reducing stress, Spence said.
Limiting your calories or omitting certain foods in general may not be healthy if it negatively impacts your mental health or prevents you from enjoying time with friends and family, she added. And sometimes those restrictions can cause you to lose weight without properly nourishing your body.
“Weight loss doesn’t equal happiness, and it doesn’t mean you will necessarily get healthy, because how you handle weight loss can also be detrimental to your health,” Spence said.
For most people, restrictive dieting with the intent to lose weight doesn’t work. More than 80% of people who lost weight gained it back within five years, according to a 2018 study.
If our phones didn’t work as often as they were intended, most people wouldn’t be using them anymore, Campos said.
“But the diet culture has cheated us very well that you can get everything you ever wanted. You get health, you get fitness, you get praise,” she added.
What do we focus on if we want to get healthy if it’s not losing weight? Focus on health-promoting behaviors such as quitting smoking, exercising more, sleeping better, stressing less and eating the foods your body tells you you need, Larmie said.
You can lose weight because of that, but that’s not the goal, she added.
“By not focusing on weight, it means we can really focus on really healthy behaviors that are much more sustainable,” Thompson-Wessen said.