Advertisements, pop culture and even doctors can talk about health and weight as if they are one and the same: smaller bodies are healthier, and larger bodies must be unhealthy.
A higher body mass index (BMI) is associated with conditions like diabetes and heart disease, said Philipp Scherer, professor of internal medicine and director of the Touchstone Diabetes Center at University of Texas Southwestern Medical Center. However, BMI is a controversial way to measure 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 general practitioner and activist.
Still, we often place a lot of importance on a person’s appearance when assessing their health, said Shana Minei Spence, a registered dietitian in New York. And even if we learn to shed the burden of societal beauty standards, it can be difficult to feel confident in your body if you view your size as unhealthy.
Experts say that it may be time to untangle health and weight and focus more on behaviors that promote our health than the number on the scale.
Correlation versus causation
It’s important to understand that the studies that point 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 at a higher weight often have more instances of heart disease, they can’t say that the weight caused the heart problems, Larmie added.
But the importance of those studies shouldn’t be discounted, Scherer said. The correlations are strong, and “from a physiology perspective, in the clinic we work with correlations,” he said.
Other factors could still be at play, however, like access to medical care, Scherer said.
And for people in larger bodies, good medical care can be hard to come by, said Bri Campos, a body image coach based in Paramus, New Jersey.
It’s not just her clients who fear going to the doctor. Even though she educates people about their body image and mental health, Campos is often afraid to go to the doctor for fear that she will be shamed about her weight, she said.
“I can go in for strep throat, I can go in for a rash,” Campos said.
“Because of my body size, it is very unlikely that I can go to the doctor and get an actual diagnosis that’s not ‘you should probably lose weight.'”
Bodies aren’t business cards
Spence likes to remind her clients: Bodies aren’t business cards.
We can’t take one look at a person’s body and get a sense of their health, their habits or their biology, she said.
“Do we have access to somebody’s medical records? Are we talking to their doctor?” she said. “And often health is honestly sometimes out of our control. There are so many chronic illnesses that people just develop.”
Although we can see correlations between body size and health conditions on the large scale, once researchers look at individuals, it’s not that clear, Scherer said.
“The field at large really embraces that not everybody who has that very high BMI is a type 2 diabetic,” he said.
People in smaller bodies can develop heart disease or diabetes, and there are plenty of people in larger bodies who are considered completely metabolically healthy, Scherer said.
“It’s just a reflection of our genetic heterogeneity and how we cope with excess calories,” he added.
Does dieting make us more healthy?
What does it mean to be healthy anyway? And can dieting help you get there?
That depends on what parts of health you prioritize.
Health is comprised of many factors. Avoiding disease is one, but so is maintaining mental health, keeping active social networks, getting enough sleep and reducing stress, Spence said.
Restricting your calories or cutting out certain foods may not be healthy overall if it negatively impacts your mental health or keeps your from enjoying time with friends and family, she added. And sometimes those restrictions can make you lose weight without properly nourishing your body.
“Weight loss doesn’t equal happiness, and it doesn’t mean that you’ll necessarily get healthy because how you go about losing weight can also be detrimental to your health,” Spence said.
For most people, restrictive dieting with the intention to lose weight doesn’t work. More than 80% of people who lost weight regained it within five years, according to a 2018 study.
If our phones didn’t work the way they were intended that often, most people wouldn’t use them anymore, Campos said.
“But diet culture has done a very good job of deceiving us that you can get everything you’ve ever wanted. You’ll get health, you’ll get fitness, you’ll 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 like quitting smoking, moving more, sleeping better, stressing less and eating the foods your body is telling you that you need, Larmie said.
You may lose weight as a result, but that isn’t the goal, they added.
“In not focusing on the weight, that means we can really focus on some really healthy behaviors which is much more sustainable,” Thompson-Wessen said.