Advertising, pop culture, and even doctors can talk about health and weight as if they were one and the same: smaller bodies are healthier and larger bodies should be unhealthy.
However, we often place too much importance on a person’s appearance when evaluating their health, said Shana Minei Spence, a registered dietitian in New York. And even if we learn to shed the burden of societal beauty standards, it can be hard to feel confident in your body if you view your size as unhealthy.
Experts say it may be time to sort out health and weight and focus more on health-promoting behaviors rather than the number on the scale.
Correlation versus causation
It’s important to understand that studies showing dire health outcomes for people with higher body fat may only point to correlation, not causation, Larmie said.
While 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, Larmie added.
But the importance of these studies should not be discounted, Scherer said. The correlations are strong, and “from a physiology perspective, in the clinic we work with correlations,” he said.
Other factors may still be at play, however, such as access to medical care, Scherer said.
And for people with larger bodies, good medical care can be hard to come by, said Bri 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 shamed about her weight, she said.
“I could go for strep throat, I could go for a rash,” Campos said.
“Because of my body size, it’s very unlikely that I can go to the doctor and get a real 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 a look at a person’s body and understand their health, habits or biology, she said.
“Do we have access to someone’s medical records? Are we talking to their doctor?” she said. “And often health is honestly sometimes out of our control. There are so many chronic diseases that people just develop.”
Although 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 in general really embraces that not everyone who has a very high BMI is type 2 diabetic,” he said.
People with smaller bodies can develop heart disease or diabetes, and there are many people in larger bodies who are considered completely metabolically healthy, Scherer said.
“It’s just 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 what part of health you prioritize.
Health consists of many factors. Avoiding disease is one, but so is maintaining mental health, keeping active on social media, getting enough sleep and reducing stress, Spence said.
Restricting 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 mean you’ll necessarily be healthy, because the way you continue to lose weight can also be detrimental to your health,” Spence said.
If our phones didn’t work the way they were often intended, most people wouldn’t use them anymore, Campos said.
“But diet culture has done a really good job of tricking us into thinking you can have everything you’ve ever wanted. You’ll get health, you’ll get fit, you’ll get praise,” she added.
What do we focus on if we want to get healthy if it’s 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, Larmie 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.