You’ve been learning about – and are inspired by – the Health At Every Size ® movement, HAES for short…but it is so counter to the diet-obsessed culture you’ve been immersed in all your life. HAES can feel opposite to EVERYTHING you ever learned. From what you’re hearing from your healthcare providers to what your family said growing up, that little voice inside still wonders: how can it possibly be true that I am healthy in a bigger body?
How can you be “obese” and healthy??
(Oh, and, before I go on. Throughout this post, you’ll see the word “obese” in quotations to represent that this writer does not agree with the BMI classification system. Read on to learn why that is and how harmful stigmatizing medical terms like this can be on your health!)
By now, you know HOW to diet. You know you could always start another one…but after doing every plan under the sun since your teens (and feeling no better off), you wouldn’t be alone in feeling demotivated to try again! Many lifelong dieters I work with tell me they’re honestly no longer interested in a life of guilt and deprivation.
But then more questions pop up: what if you stop dieting and gain more weight? Is that healthy?
What if your doctor starts talking about BMI again at your next visit? How will you explain why you don’t want to go on a diet to them? Ugh – what is really true?
These are conversations I have with my clients all the time. It feels really confusing to make sense of new information about Intuitive Eating and HAES when you’re struggling with your own dieting history and even your own fears about what it means to be in a bigger body.
I believe you are capable of making the right choices for your body when you are informed about your options. And let me tell you: the freedom to make food choices based on your values and health goals instead of always making it about your size feels amazing after a lifetime of being just told the blanket “just lose weight”. As a Registered Dietitian I am here to help you understand how you can pursue health without focusing so hard on weight loss.
Here’s the current thinking on why it is possible to be “obese” and healthy.
BMI is bogus
BMI – short for Body Mass Index – is a ratio of your weight to your height. It was never, ever intended to be used to assess health. Created in the 1800s, the categories of BMI were created based on a small sample of European white dudes – no inclusion of ladies or anyone of any other ethnicity, because y’know – patriarchy and racism (1). The creator of the BMI made it clear that it was meant to study a population (though not a very diverse one), and not individuals, yet here we are using it to guide individual health care for diverse populations. Make it make sense!
BMI does not take into account fitness, body composition or genetic diversity of individuals. For example, muscular athletes are easily “overweight” and “obese” according to their BMI, despite having low percentages of body fat. This helps to illustrate that BMI isn’t all that useful to measure fat, even when it is accurately measured.
Even more frustrating? The BMI isn’t always based on accurate measurements. So when studies use this metric, the accuracy of the associations we make between size and being healthy only gets worse!
What do I mean? Many studies that use BMI are based on self-reported data. Let me ask you this: do you always tell your weight accurately to someone who asks about it? Or, has it been a while since you’ve weighed yourself? Or do you even know your accurate weight?
If you’re part of a research study and your weight is not reported accurately, you could actually be “miscategorized” according to your BMI. Maybe your reported weight would give you a BMI of “overweight” but in reality, your true BMI is “obese.”
Since much of the research about obesity is comparing one group to another, and data are often self report – how can we say that associations between weight and health are 100% accurate when we aren’t even able to properly categorize people into groups?
It is like asking if sixth graders or third graders are better at playing dodgeball, but in the study group, five third graders had snuck into the sixth-grade team. The data is bogus!
Unfortunately, self-report BMI categorizations are flimsy-at-best in health research; people aren’t in their actual categories ON TOP OF THE FACT the tool itself being built from data not representative of women and persons of color and ON TOP OF THE FACT BMI is meant as a tool to measure populations and not individual health. In science, this is called a validity problem.
Can I give you one more criticism of BMI while we’re here? Ideas that being fat was unhealthy existed before the widespread use of weight in individual medicine. When researchers design studies with the assumption that fat causes health problems, they introduce many types of bias in their work, including confirmation bias, in their studies (2).
Just as our society assumes that everyone in a larger body is unhealthy, and everyone in a smaller body is healthy – both can be 100% false (3).
Health is a lot of gray zones and that takes more finesse to do good research about.
bogus measurements create bogus data
When research studies are based on BMI, and we now know that these data are flawed in many ways, the conclusions are just as flawed.
Further – the “obese” category can includes diverse range of weights. We rarely study bigger bodies outside trying to get them to lose weight, so it’s hard to say that all bigger bodies pose the same risks. Plus, the higher your weight is, the more stigmatization you may face – which impacts your mental and social health, more on that later in the post.
With these miscategorizations and lack of control for nuanced variables, you make a weak association weaker. So, when studies say “people with a higher BMI get heart disease more often” – they can’t prove the cause, and how could they? There’s literally no disease that happens in fat people that doesn’t happen in thin people. I know, it’s mind-blowing considering all the media out there waging war on “obesity.”
Research is also done by human beings. Humans all have biases. While it may not be their intention, researchers are impacted by their own biases: as human beings, we tend to see what we’re looking for. Every time a researcher does a study, they have to make assumptions.
These days, there is still a ton of fat bias. You can test your own using this implicit bias test from Harvard. And when the researchers are doing studies looking to see that obesity is unhealthy – ta-da! – they somehow seem to always find that obesity is not healthy. Then, you look at the data and it doesn’t always support the conclusions made.
Part of this has to do with how they choose to massage the data. What assumptions are they making as they create their study group? Who are they excluding from the study? What variables may be missing? Are they making causation statements from associations they observe?
Every decision researchers make in the design and communication of their study has an impact. And many times, the media conflates messages in ways that are really harmful or misinformed, leading you to believe weight loss is more important than it may ACTUALLY be to your health.
“obesity” is not a behavior
Our research tends to treat obesity differently than most other things. For example, we can probably all agree that smoking is a behavior that increases health risks. So, comparing groups of people who are currently smoking daily to those who have never smoked might help us to understand the impact on that behavior.
People who are “obese” tend to get lumped together into one large group without allowing them to have different behaviors.
Some overweight people eat vegetables daily and engage in daily exercise and some don’t. Despite having different behaviors, they all have higher levels of fat tissue on their body.
So: why do we clump people in larger bodies together as one – vs. investigating the differences that their lifestyle and behaviors have on their health outcomes?
We actually have a study showing that healthy lifestyle habits – like eating fruits and vegetables, moving more, and drinking less alcohol – are associated with a significant decrease in mortality regardless of baseline body mass index (4).
And the flip side is just as problematic: in our fatphobic society, we assume that people in smaller bodies are healthier…even when that isn’t true either. When people in smaller bodies have health issues, we’re more willing to critically think about the data: what is going on in their lives? Do they have a family history of that disease or condition?
We don’t offer people in larger bodies the same critical thinking. Instead, we just assume that they’re lazy, unhealthy, and don’t want to change. This is a very hurtful stigma.
These assumptions and stigmas heavily influence our research, producing the results that researchers want to find instead of the truth.
weight stigma causes harm
In most of our research, we don’t account for the impact of weight stigma and weight cycling due to chronic dieting (5, 6). Both of these conditions can increase stress on the body as well as your heart.
Chronic dieting also does a number on eating disorder risk and mental health, which could also impact health and longevity. Weight stigma, in particular, can result in people avoiding doctor’s visits, or, in some cases, being dismissed because of their size (7).
And when they do go to a healthcare provider, symptoms and complaints tend to all be framed within the context of obesity…and dismissed. “Well, if you’d just lose weight…”
A client of mine once blamed some fatigue and pain she’d been having on recently gained weight and “being out of shape.” I encouraged her to look at that differently, and lo and behold she had an untreated UTI!
Very often people in bigger bodies are trained to blame fat as a cause of health concerns which is why I teach them skills to advocate so that not everything gets lumped into weight and size.
Check out my free Doctor’s Visit Guide to prepare for, and be ready to better advocate for yourself at your next doctor’s appointment. It helps you to advocate against being weighed if you don’t wish.
health is not measured by a number
Just think: what if your whole worth as a student at school was arbitrarily assessed by a single exam? That one stinking number would have nothing to do with how well you did in your other classes, your critical thinking skills, your ability to collaborate with your peers, or your ability to create music or art.
Trying to capture your whole health with one single number is just as messed up: we’re just more used to it, so it takes a fresh perspective to realize just how bogus it is.
Health is more than just body size. Genetics impacts our body size. Size diversity exists, but we still culturally worship a certain look.
A more accurate assessment of our health includes mental, social, and spiritual health.
So many clients say “at my thinnest, I was not healthiest.” They were taking diet pills, offering themselves no rest days, injuring themselves with workouts, skipping meals, felt wrought with guilt over what they ate, were constantly terrified to gain weight, and consumed with low self-worth.
How’s that for mental health?
Health is not just physical. Mental health matters. What I especially appreciate about Intuitive Eating is that it accounts for both mental and physical health by letting you explore the balance between both, instead of telling you “restrict your diet at all costs.”
Psst! If you’re new to Intuitive Eating, check out this post: six intuitive eating tips for beginners.
I want you to think about your last diet. Take a moment and reflect:
What were the rules?
Was it a certain number of calories?
Or perhaps, removal of certain food groups?
Every diet, even the most flexible one, has rules. These rules often reinforce rigid black-and-white thinking associated with disordered eating, anxiety, and depression.
When working with clients in my coaching programs, I offer clear skills to combat food guilt that emerges from “good” and “bad” thinking around food. This often leads to immediate improvements in mental, emotional, and social health.
Diets often do not work because forcing your body to become smaller often means giving up mental and emotional wellbeing.
My No-Guilt Framework goes beyond seeing mental health to be as important as physical health: I show you how to love and enjoy food without guilt or loss of control. Personally, I think satisfaction from food is an important part of culture and brings meaning to life. I believe all women – especially those with bigger bodies – who are told they can’t enjoy food, deserve to experience food joyfully.
To me, a diet does not “work” if it means giving up your ability to connect with others and feel free around food. By allowing an “all foods fit” approach, my clients learn to eat enough, until satisfied, without binges or guilt.
health is impacted by your behaviors
So now that we know that weight is far too simplistic to assess your health (or worth), how do you know if you’re healthy? And if we think about the social determinants of health – behaviors aren’t the ENTIRE
Still, if you have the access and desire to improve your health through behaviors, there are so many more meaningful ways to measure health. Here are a few of my favorites.
- Do you brush and floss your teeth?
- Do you experience movement that you enjoy regularly?
- Do you sleep 7-9 hours a night?
- How are your stress levels?
- What are your blood lipid levels like?
- And your blood sugar?
- Do you regularly choose whole grains?
- Can you enjoy sweets without guilt, shame, or binging?
- Do you have a balanced relationship with alcohol?
- When was the last time you laughed so hard your belly hurt?
- Are you engaging in meaningful relationships?
If dieting fear-mongers were truly interested in “health” and not fatphobic body shaming, their before and after photos would be things like lab values, taking medication regularly, and going to therapy. These behaviors matter more than size.
So what if you’re not actually healthy right now…now what?
you are worthy, right now
Even if you are not “healthy” by any measure, you are worthy of love, respect, and kindness right this very minute.
Look, it’s uncomfortable to say – but we’ll all get unhealthy *someday*.
It’s no one’s fault.
We all deserve dignity and respect, even when we’re unhealthy.
Chronic conditions like diabetes or heart disease don’t make you a bad person. Everyone experiences health differently (that’s part of life, and no fault of your own!) and has different goals.
Intuitive Eating helps you to go from where you are and enhance your health by connecting with your body and prioritizing what matters to you. Even a physical therapist will tell you: though weight is a factor in the experience, it’s not the cause of your pain. You still deserve treatment for your right-now body!
And remembering you are worthy even if you’re not healthy is a good start. This podcast episode about joint pain might be right up your alley: Does losing weight help with pain?
key takeaways: can you be “obese” and healthy?
You are a complex, dynamic, and wonderful person right this very minute. You deserve respect, joy, and abundance every darn day.
You are far too dynamic and amazing to be placed in a black and white category because of a number on a bathroom scale. Your true health is measured in your behaviors, not your weight.
“Obese” people can be healthy.
Thin people can be unhealthy.
We cannot know someone’s health status by looking at them or knowing their weight.
I’m determined to make this world kinder, less fatphobic, and to encourage better research about health and nutrition.
I support women in bigger bodies who want to find food freedom because I know for too long you have been prescribed and praised for dieting behaviors that harm you in the name of health.
Though I’m in a smaller body myself, I’m inspired by my mother’s story and have dedicated my career to supporting women like you find TRUE health. No more of this BS “lose weight” blanket advice that only makes things worse.
If this post resonated with you, please check out my 3 step guide to eat without guilt. You deserve to let that guilt go and find health in your here-and-now body. My clients do this, and you can too.