Weight and health are not the same thing. They are conflated in our diet-culture. We're fed the line that "thinness equals health", but that simply isn’t the case. Being in a smaller body doesn't automatically mean that someone is healthy, and conversely, being in a larger body doesn't mean someone is unhealthy. Why is this and how can we shift our focus from weight to health?
How are weight and health different?
The assumption that health imrpoves when we lose weight is widely accepted as "fact". However, while the evidence undoubtedly shows that higher weight is correlated with higher disease risk, when lifestyle factors are controlled for in these studies, the risk associated with weight is dramatically decreased. It cannot be said that being a higher weight causes disease, rather, lifestyle factors associated with having a higher weight are also associated with an increased risk of developing certain diseases. Correlation is not the same as causation. If weight was solely what determined health outcomes it would logically follow that as weight decreased health would simultaneously increase. According to this premise, we could conclude that a person on a diet of only Tic Tacs would lose weight and thereby improve thier health. Not so much.
High quality, long term evidence shows that weight-loss on it's own does not improve health (7). In reality, our behaviours are more important than weight when it comes to health. Although our health is not 100% determined by our behaviours (genetics, socioeconomic status and environment all play a huge role) our behaviours are what have the ability to affect our health. Weight is not a behaviour. Engaging in health-promoting behaviours, the good ol' boring ones we all know - physical activity, more fruit, veg and fibre, better sleep, stopping smoking, not drinking to excess etc. - is what can improve disease risk. Doing these things may also result in weight-loss but even if weight remained the same one would undoubtedly be improving health.
In fact, just increasing physical activity has been shown to improve health markers in individuals regardless of whether they in the study lost weight, remained the same weight or even put on weight!(3)
A weight-centric approach to health isn't healthy
There is a danger when we use weight as a measure of health. Firstly, when we make healthy changes to our lifestyles but our weight doesn't change it can mean that we get discouraged and give up.
Secondly, a weight-centric approach to health means that people in larger bodies are likely to experience discrimination and stimatisation by medical professionals (and society as a whole) because of thier size. This size/weight based discrimination means that those individuals are more likely to shy away from visiting the doctor when they are ill, experience poorer medical care than people in thinner bodies and experience worse mental health (depression, anxiety and body dissatisfaction) (4, 5, 6).
Shifting our focus from weight onto health means we're more likely to tap into how we actually feel - our energy levels, mood, mobility, focus and concentration - rather than getting hung up on the number on the scale. How we feel and how our bodies are functioning are much better indicators of health than what we weigh. It's much healthier to focus on cultivating habits that support our well-being than for us to make weight our primary focus.
Some ideas of ways you could shoot for health could be:
Drinking more water; adding more vegetables and fruit to what you eat; cooking from scratch more often if you’re able to; eating regularly, adequately and to satisfaction; finding and engaging in movement you really enjoy doing; getting enough good quality sleep at night; tending to your mental health; being outside more often; spending quality time with family and friends etc.
Remember that health looks different on every-body! Healthy bodies can come in a variety of shapes and sizes.
1. Bacon, L. (2013). Getting over the obesity paradigm: Health solutions that don’t backfire. Obesity Research & Clinical Practice, 7. doi:10.1016/j.orcp.2013.12.606
2. Bacon, L., Stern, J. S., Loan, M. D., & Keim, N. L. (2005). Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters. Journal of the American Dietetic Association, 105(6), 929-936. doi:10.1016/j.jada.2005.03.011
3. Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1). doi:10.1186/1475-2891-10-9
4. Latner, J. D., Durso, L. E., & Mond, J. M. (2013). Health and health-related quality of life among treatment-seeking overweight and obese adults: Associations with internalized weight bias. Journal of Eating Disorders, 1(1). doi:10.1186/2050-2974-1-3
5. Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, 100(6), 1019-1028. doi:10.2105/ajph.2009.159491
6, Puhl, R. M., & Heuer, C. A. (2009). The Stigma of Obesity: A Review and Update. Obesity, 17(5), 941-964. doi:10.1038/oby.2008.636
7. Tomiyama, A. J., Ahlstrom, B., & Mann, T. (2013). Long-term Effects of Dieting: Is Weight Loss Related to Health? Social and Personality Psychology Compass, 7(12), 861-877. doi:10.1111/spc3.12076