Advertisements, pop culture, and even doctors can talk about health and weight as if they were the same thing: smaller bodies are healthier and larger bodies should be unhealthy.
Still, we often place a lot of importance on a person’s appearance when evaluating their health, said Shana Miney Spence, a registered dietitian in New York City. And even if we learn to let go of the weight of society’s beauty standards, it can be hard to feel confident in your body if you think your size is unhealthy.
Experts say it may be time to untangle health and weight and focus more on the behaviors that promote our health rather than the number on the scale.
Correlation vs. causation
It’s important to understand that studies that point to dire health outcomes for people with higher body fat may only point to correlation, not causation, Larmey said.
Although studies can say that people who weigh more often have more cases of heart disease, they can’t say that weight caused the heart problems, Larmey added.
But the importance of these studies shouldn’t be dismissed, Scherer said. The correlations are strong, and “from a physiology perspective, in the clinic we work with correlations,” he said.
However, other factors may still play a role, such as access to medical care, Scherer said.
And for larger-bodied people, good medical care can be hard to come by, said Bree Campos, a body image coach based in Paramus, New Jersey.
It’s not just her clients who fear going to the doctor. Although she educates people about their body image and mental health, Campos is often afraid to go to the doctor for fear of being ashamed of 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’s highly unlikely that I’ll be able to go to a doctor and get an actual diagnosis that isn’t ‘you probably need to lose weight.'”
Bodies are not business cards
Spence likes to remind her clients: bodies are not business cards.
We can’t take one look at a person’s body and get an idea of their health, habits or biology, she said.
“Do we have access to anyone’s medical records? Do we talk to his doctor?” she said. “And often health is honestly sometimes out of our control. There are so many chronic diseases that people just develop.”
While we can see correlations between body size and health conditions on a large scale, once researchers look at individuals, it’s not so clear, Scherer said.
“The field as a whole really accepts that not everyone who has a BMI that high is type 2 diabetic,” he said.
People with smaller bodies can develop heart disease or diabetes, and there are many people with larger bodies who are considered perfectly metabolically healthy, Scherer said.
“This is simply a reflection of our genetic heterogeneity and how we deal with excess calories,” he added.
Does diet make us healthier?
What does it mean to be healthy anyway? And can diet help you get there?
It depends on which parts of health you prioritize.
Health consists of many factors. Avoiding illness is one thing, but so is maintaining mental health, maintaining 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 affects your mental health or prevents you from enjoying time with friends and family, she added. And sometimes these restrictions can cause you to lose weight without properly nourishing your body.
“Weight loss doesn’t equal happiness, and it doesn’t necessarily mean you’ll get healthy, because the way you lose weight can also be detrimental to your health,” Spence said.
If our phones don’t work as often as they’re designed to, most people won’t use them anymore, Campos said.
“But diet culture has done a very good job of fooling us into thinking you can have anything you’ve ever wanted. You will get health, you will get fitness, you will get praise,” she added.
What should we focus on if we want to be healthy if we are not losing weight? Focus on health-promoting behaviors like quitting smoking, moving more, sleeping better, stressing less and eating the foods your body tells you you need, Larmey said.
You may lose weight as a result, but that’s not the goal, they added.
“By not focusing on weight, it means we can really focus on some really healthy behaviors that are much more sustainable,” Thompson-Wessen said.