Low-fat, low-carb, Paleo, keto, South Beach, intermittent fasting—the list goes on. Given that our culture idealizes thinness and shuns larger bodies, it’s not surprising that nearly one in five midlife women has dieted in the past few years, according to the Centers for Disease Control and Prevention. And many have regained the weight and see themselves as having failed. Less than 1% of very large people got to a “normal” weight at all in a study that included almost 100,000 women, and most who did regained the pounds they had lost within five years.
Some medical experts are now saying what many of us have been desperate to hear: It’s extremely tough to drop weight long-term, for reasons that have nothing to do with willpower—and it may not even be necessary.
“The dominant message people get from government, health organizations, and the media is that weight and health are connected. But really, there is no strong evidence to suggest that higher weight automatically leads to poorer health,” says Jeffrey Hunger, Ph.D., an assistant professor of psychology at Miami University of Ohio and a longtime weight-stigma researcher (and yes, that’s his real name!).
If you’re extremely large-bodied, dropping some pounds can protect your joints from arthritis and make it easier to exercise. But for most women over the “ideal” weight, focusing on other health measures may be much more important than what the scale says.
So why isn’t that a message you’re likely to hear from your health care provider? “The evidence has been piling up for years, but experts are so stuck in their beliefs, they don’t accept anything to the contrary,” Hunger says. Add to this all the people and companies with financial interests in pumping out anti-fat messages, from diet purveyors to drug companies to book authors. Plus, the message that body fat is bad and needs to be diminished as much as possible is such gospel in our society that it’s hard to believe it may not be true.
Here are eight important facts that many are overlooking. These realities may be just what you need to feel better about your body, whatever your weight.
1. Weight is not an accurate measure of health.
Doctors worry that heavy women are “cardiometabolically unhealthy,” a shorthand term that encompasses blood pressure; levels of cholesterol, triglycerides, and blood glucose; and other measures of heart and arterial fitness.
But researchers at UCLA and the University of Minnesota evaluated nearly two dozen studies and concluded that there was “no clear relationship between weight loss and health outcomes.” In other words, shedding pounds didn’t meaningfully lower blood pressure, diabetes risk, or cholesterol.
Equating being heavier with having poor cardiometabolic health and being thin with the opposite is way off the mark, researchers at the University of California concluded. They pored over data from more than 40,000 participants in the government’s annual National Health and Nutrition Examination Survey and found that nearly half the people classified as “overweight” (and more than a quarter labeled “obese”) had perfectly healthy blood levels of lipids and glucose, meaning they were cardiometabolically fine. Meanwhile, a full 30% of the “normal-weight” participants had unhealthy levels of these markers.
The bottom line: Weight alone is not indicative of health, so nobody can tell whether or not a person is healthy based on their weight.
2. Healthy behaviors are more important than the number on the scale.
In a paper published in Social Issues and Policy Review, Hunger and colleagues reviewed many studies on weight and health and discovered that healthful behaviors, not fitting into our skinny jeans, are what make us healthy—and help us live longer. Heavy people who do healthy things are as likely to thrive as anyone else. On the list: being physically active, eating nutritious foods, and quitting smoking, of course—but also socializing enough to avoid isolation, minimizing stress, and managing depression.
“Your attention should be not on a target weight, but on how many days you intend to exercise this week and how much produce you’ll be eating,” says Mary S. Himmelstein, Ph.D., an assistant professor of psychological sciences at Kent State University in Ohio. Then dial a girlfriend, schedule some yoga, and find a good therapist if you need one.
3. You can be fat and also fit.
Our culture regularly equates carrying extra body fat with being out of shape, but plenty of large-bodied women can easily run laps around their thinner counterparts at the gym. That’s because in reality fitness and weight have little to do with each other, Himmelstein says.
A team of international researchers proved this when they followed 43,000 (mostly white) participants across the weight spectrum. At the outset, they measured blood pressure, cholesterol, glucose, and the like, then tested the participants’ fitness levels using a treadmill. Those who were metabolically sound and also fit had the same mortality rates during the next decade regardless of their weight. Those who were considered obese and unfit, however, were more likely to die.
4. Shedding pounds doesn’t always lead to health gains.
If low weight equaled good health, dropping pounds would automatically make people healthier—but that’s not what happens. Hunger points to a meta-analysis that found that even after dieters lost weight, their blood pressure, glucose, and other blood markers weren’t significantly better when they were reevaluated two years later. Heavy people may make health gains when they are put on a weight-reduction plan, as in the famous Diabetes Prevention Program in 2002, which cut people’s risk of developing the disease. But as the study’s UCLA and University of Minnesota scientists point out, participants in it, as in other weight-loss trials, were urged to exercise—which the scientists suggest was likely more of a health driver than the loss of pounds.
5. Weight is way more complex than calories in, calories out.
“So many things go into the weight you are,” Himmelstein says. Genes, ethnicity, medicines you take, where you live, what your income is, and how much you sleep all play a role, even if most doctors focus only on calories. Weight is so complex that even longtime researchers don’t yet understand all the variables involved. People might be heavier because these days food is so easily available. Or maybe it’s the crazily larger portions restaurants serve compared with 35 years ago.
Barbara Corkey, Ph.D., professor emeritus of medicine and biochemistry at Boston University School of Medicine and director of the Obesity Research Center, is intrigued by the notion that chemicals used in farming, additives in processed foods, and/or other toxins that make their way onto our plates may cause our bodies to erroneously release too much insulin, a hormone that makes us want to eat more. Corkey suggests that it may be not that obesity brings on problems like insulin resistance, as many doctors believe, but that unnaturally high insulin levels lead to obesity and insulin resistance.
6. You can in fact be too thin.
There may be no upper limit to how rich you’d like to be, but there’s definitely a floor for how thin you should be. Having a body mass index (BMI) below 23 (less than about 130 pounds for a 5’ 3” woman) is linked to greater mortality than being a few pounds heavier, a team of international researchers discovered when they examined hundreds of studies with over 30 million participants. This was true even when they excluded people who might have been thin because they were already sick.
Plus, sinking to a too-low BMI can make you feel awful. When Oprah Winfrey dropped to a low weight for her (remember the jiggling fat she wheelbarrowed onto her show?), she was constantly frazzled and exhausted, she told crowds at her wellness events in 2019. Only when she put some pounds back on and reached the right weight for her did she feel better. (It’s important to note that BMI itself has come under fire as a flawed measurement, because, among other issues, it doesn’t differentiate between fat and muscle, categorizing athletes and others with a lot of muscle as “overweight,” and it doesn’t consider ethnic differences in body type.)
7. Many health care providers are dangerously biased.
Most people with high body weight have a story about how their doctors judged or blamed them or didn’t listen, Himmelstein says. This is true with all types of providers—even ones who specialize in weight management! It can lead to a vicious cycle in which women avoid going to the doctor because they don’t want to be fat-shamed, then miss out on treatment or early detection, Himmelstein says. In other cases, health complaints that have nothing to do with weight are inaccurately blamed on a person’s size, so patients miss out on the correct treatment.
In this way, among others, doctors’ bias can make people sicker—which might then add to the perception that all who are large-bodied are unhealthy. When a study assessing the 2009 H1N1 flu pandemic confirmed that obese people suffered more complications and death from the disease, the authors pointed out that this might have been because those patients weren’t given critical antiviral medicines as early in their disease as others. (It’s unclear whether they didn’t seek out treatment as soon or it wasn’t offered to them by medical professionals.)
Problems like diabetes, cancer, and autoimmune conditions are especially important to identify early, when they are more easily treated, and health professionals’ putting too much emphasis on body weight seems to be keeping people from getting the best care.
8. Eating healthily will get you farther than a weight-loss diet.
Dieting can help you trim pounds, but keeping them off is another story. The low nutrition levels and excessive exercise of many weight-loss plans aren’t sustainable, Hunger says. Plus, when you cut back on calories, your metabolism slows to a crawl. “Our body’s biological architecture doesn’t understand what the thin ideal is—it’s doing all it can to protect us from what it perceives as famine,” he notes.
Because of these factors, a European analysis of large-bodied women calculated the chances of their reaching a “normal” BMI as less than 1 in 100! “Rather than make a drastic temporary change for a short-term goal like how you’ll look at a class reunion, focus on small, sustained changes, like eating more whole grains and plant-based foods and less red meat and processed fare so healthy eating becomes your new lifestyle to set you up for long-term health,” advises Ruwanthi Titano, M.D., an assistant professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City.
Even thin people benefit from ditching the focus on weight, Himmelstein says. A lot of brainpower goes into monitoring calories or carbs, she notes—time and energy we’d all be better off spending elsewhere. “Instead of trying to shrink your body, start to appreciate everything it does for you,” Hunger suggests. You’ll be healthy and feel good—the things that matter—no matter what your dress size.
This article originally appeared in the May 2021 issue of Prevention.
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