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Can you have health at every size?

April 2, 2022 by

Let’s start this by acknowledging some very important truths.

People who are overweight face bias and discrimination.

This discrimination extends into health care which can often increase the likelihood of poor health outcomes.

Obesity is more prevalent in low-income demographics and in minorities, so a bias against people who are overweight disproportionately impacts people who face bias in other areas of their life.

BMI does not take into account body composition.

BMI is based on Caucasian body types and my not be appropriate for all ethnicities.

Notwithstanding that, BMI does tend to be an appropriate measure of obesity for MOST people.

None of that changes the answer to this question, however. The answer is no, you cannot be healthy at every size. Please don’t come at me with pitchforks just yet.

The Health at Every Size movement is rooted in acceptance and appreciation of our bodies, even if we are overweight. Instead of focusing on weight loss, this approach has us focus on our habits and more and more nutrition coaches are getting on board with this movement. While the intentions are very good, I believe the details frequently get lost in translation and to promote anything other than HAES makes you a fat shammer in the eyes of the HAES disciples. The worst thing HAES coaches can do is give someone the illusion that they do not need to be concerned about their health if they are obese. If that was the case, obesity wouldn’t be a medical condition.

Even with normal blood pressure, insulin levels, and cholesterol, simply being overweight increases a person’s risk of heart disease by almost 30%. There is no such thing as being healthy and obese.

Does that mean that thin people are inherently healthy? Absolutely not. Aside from the fact that “skinny fat” is a real condition with real risk factors, health has many facets. Someone who is metabolically and physically healthy can suffer from a myriad of mental health disorders that derive from an obsession with their bodies or with food. The obvious ones are anorexia and bulimia, but orthorexia is starting to become more and more prominent in our society as well. Orthorexia can manifest as an obsession with food quality, food tracking, and very restricted diets and is not always associated with controlling body weight. There are people who have an unhealthy obsession with exercise. There are fit people who are mentally very unfit.

It is important that we look at health on a spectrum and assess how we define it. Just because a person has one facet of health does not mean that have all facets of health.

Despite all of our knowledge on health, obesity, and weight loss, the rates of obesity in the western world continue to climb. The reason for this hasn’t exactly been nailed down, but I suspect it is due in large part to the flawed approach most people use when trying to lose weight and the frustration and apparent certainty of failure leading to a cessation of effort to achieve a healthy body weight.

I have coined this phenomenon the “F*ck it Why Even Try?” mentality, and it is pervasive. This attitude oozes into many facets of our lives and makes behavior change very difficult. Someone who is 100lbs overweight might recognize how dire their situation is and feel hopeless to change it. As a lost cause, what is the point of doing anything at all to reverse their health? Nutrition and exercise seem like tools for thin people only.

This is where HAES gets it right. Changing the belief that exercise and salads and activity are for healthy people only, it encourages people to build these same habits even if they are overweight. They highlight the many tools that exist to measure progress beyond the scale, tools that are especially useful for people who can’t seem to get the scale to budge. Being as healthy as we can at our current bodyweight builds a bridge of sorts. It gives us the tools we need to be healthier at a healthier weight down the road.

HAES also advocates eliminating the discrimination that overweight people face on a daily basis.

Side bar: The irony of the fattest society in history being intensely biased against people who are overweight is not lost on me. And it shouldn’t be lost on you either. If anything, it should bring into question what biases truly exist and dominate society. Is it obesity or is it something else?

It is important to take a step back for perspective. It is not that body weight doesn’t matter; it definitely does. But it is not the only thing that is important, and it certainly does not define our value as human beings.

If you are overweight, losing weight will probably decrease your risk of a long list of diseases. The key is going about your weight loss in a sustainable way and focusing on making good choices instead of focusing on not making bad ones. Start where you are, make small changes you can stick with, and see where this path towards health takes you.

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