Advertisements, pop culture, and even doctors can talk about health and weight as if they were one: smaller bodies are healthier, and larger bodies must be unhealthy.
Still, when assessing a person’s health, we often place a lot of emphasis on a person’s appearance, says Shana Minei Spence, a registered dietitian in New York. Even if we learn to shed the burden of societal beauty standards, it’s hard to feel confident in your body if you don’t think you’re in good shape.
Experts say it may be time to sort out the relationship between health and weight and focus more on the behaviors that promote our health rather than the numbers on the scale.
correlation and causation
It’s important to understand that studies that point to poor health outcomes in people with higher body fat can only point to correlation, not causation, Larmie said.
Larmie added that while studies can say that people with higher weight generally have more heart disease, they can’t say that weight causes heart problems.
But the importance of these studies should not be underestimated, Scherer said. The correlations are strong, “from a physiological point of view, in the clinic we use correlations,” he said.
However, other factors may still play a role, such as access to health care, Scherer said.
It can be difficult for larger people to get good medical care, says Brie Campos, a body image coach in Paramus, N.J.
It’s not just her clients who are afraid to go to the doctor. She said that although she educates people about their body image and mental health, Campos is often afraid to go to the doctor for fear that she will be ashamed of her weight.
“I can treat strep throat, I can treat rash,” Campos said.
“Because of my size, I’m unlikely to go to the doctor and get an actual diagnosis that isn’t ‘you should probably lose weight.'”
The body is not a business card
Spence likes to remind her clients that the body is not a calling card.
We can’t just look at a person’s body and learn about their health, habits or biology, she said.
“Can we access someone’s medical records? Are we talking to their doctor?” she said. “Honestly, health is sometimes out of our control. There are a lot of chronic diseases that people just develop.”
While we can see correlations between body size and fitness on a large scale, once researchers look at individuals, the picture is less clear, Scherer said.
“The whole field really thinks that not everyone with a very high BMI has type 2 diabetes,” he said.
Smaller people can develop heart disease or diabetes, Scherer said, while many of the larger people are thought to be completely metabolically healthy.
“It’s just a reflection of our genetic heterogeneity and how we deal with excess calories,” he added.
Will dieting make us healthier?
What does it mean to be healthy anyway? Can dieting help you get there?
It depends on which parts of your health you prioritize.
Health is made up of many factors. Avoiding illness is one of them, but so are maintaining mental health, maintaining an active social network, getting enough sleep, and reducing stress, Spence says.
She added that restricting your calories or cutting out certain foods can negatively impact your mental health or keep you from enjoying time with friends and family, which may be unhealthy overall. Sometimes these limitations allow you to lose weight without properly nourishing your body.
“Losing weight doesn’t equal happiness, and it doesn’t mean you’re bound to be healthy, because the way you lose weight can also be detrimental to your health,” Spencer said.
Campos said that if our phones didn’t work the way they were intended, most people wouldn’t use them anymore.
“But food culture does a great job of fooling us that you can get everything you want. You get fit, you get fitness, you get compliments,” she added.
If we want to get fit without losing weight, what should we focus on? Focus on health-promoting behaviors like quitting smoking, exercising more, sleeping better, having less stress, and eating the foods your body tells you to need, Lamy says.
You might lose weight as a result, but that’s not the goal, they add.
“Not focusing on weight means we can really focus on some really healthy behaviors that are more sustainable,” Thompson-Wesson said.