The Size Dilemma – Why Health Care Providers Have Different Opinions on Weight, Size, and Health
When it comes to body size, it seems like everyone has an opinion. Our public health sector in the United States is firmly in the anti-adiposity camp, that is to say they have a narrow view of what a healthy body size is and they dedicate large sums of time, energy, and money to promoting healthy weights, or a BMI between 18-25 for adults. Other healthcare practitioners, usually those not associated with governmental organizations, are often more accepting of different body sizes, especially larger body sizes, and tend to focus more on other health factors besides overweight and obesity.
Even outside the healthcare community, there is still a line in the sand and there are people standing firmly on one side or the other of it in groups we shall call: Body Positivity and Thin Living. Instagrammers, bloggers, public speakers, authors, and more crowd closely together on either side of the line and shout their message as loudly as possible at those standing opposite them. The din is almost deafening. And here’s the really sad part, for many of the people who are most profoundly affected by body size, especially larger body size, their voices are often not heard as they are shoved to the back of crowd. Or perhaps they don’t feel they have an opinion or a voice because nobody has ever asked them what they think or want.
Today, with the help of our very own Registered Dietitian, we are going to explore the tenets of each group, Body Positivity and Thin Living, and try to help you decide what you want your priorities to be, or to help you understand and support the priorities of your loved ones. We’ll discuss why healthcare providers are so divided on this issue, explain the science, and let you choose what you think you should do in and for your own body.
Laying the Groundwork
Let’s start with some statistics on larger body sizes. According to the Centers for Disease Control (CDC), over 42% of US adults age 20 and up have clinical obesity and over 31% are have overweight, which means over two thirds of US adults are clinically in need of weight loss to improve their health according to our current medical criteria.1 The CDC also cites the following conditions as common health effects of overweight and obesity: Higher mortality rates from all causes, high blood pressure (hypertension), dyslipidemia (high amounts of unhealthy fats in the blood), Type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and breathing problems, cancers (many types), “low quality of life,” mental illnesses, body pain, and physical difficulties.2
With such dire statistics and health problems, it’s no wonder there is a huge effort from the public health sector, and Thin Living group in general, to improve these statistics and reduce the amount of obesity-related disease in the U.S.
Change is really hard though, and those in the Body Positivity group point out that while these statistics may (or in some peoples’ opinion may not) be true, there is evidence to suggest that losing weight is an exercise in futility for most people. Statistically, somewhere between 80-95% of people who successfully lose weight will gain it all back, and many gain additional weight on top of it.3 This is because weight loss sets off a chain of metabolic events that increase hunger levels, lower metabolism, and increase the efficiency with which the body stores calories.4 The more times you diet, the lower your metabolism can get. With such a low probability of sustainably positive weight loss results, many argue that it is unethical to automatically push people towards weight loss. Besides the toll repetitive attempts at weight loss can have on a person’s body, there is also the risk of pushing someone into an eating disorder. Overweight people are at a higher risk of disordered eating than those who live in smaller bodies, and most health professionals do not even screen for history of eating disorders before recommending weight loss.5
Choosing a Side
Let’s be clear, we truly believe that most people are in Thin Living and Body Positivity groups because they genuinely believe they are taking part in a healthcare movement that will benefit themselves and those they love. However, since these two groups are inherently polar, they can accidently bring feelings of shame, failure, inadequacy, and wrongdoing to others. For example, Body Positivity language can make those who are pursuing weight loss feel that their efforts are in vain and that they are somehow wronging other people who are living in larger bodies by bringing shame to them. On the other hand, Thin Living rhetoric can bring a sense of failure to those who are unable to fit into the narrow mold that their definition of health upholds.
Both groups are trying to help people live their best lives, but here’s the problem. At Wholesome Story, we believe people should be allowed to decide for themselves what their “best life” is, and healthcare providers should help patients and clients to pursue that. Choosing a side isn’t helpful, but listening to our bodies and making practical, thoughtful decisions about what to do in and with our bodies is always a good idea.
With that said, you may still be thinking, “But I still don’t know what to do about my body; it’s not healthy and I want to change that.” Our dietitian here at Wholesome Story is of the opinion that the course an individual takes to pursue better health should be shaped by their overall story, circumstances, abilities, desires, and medical history.
You see, lots of factors play into the size our bodies settle into at different stages in life: developmental determinants, gender, age, hormones, diet, exercise, metabolism, genetics, mental health, physical ability, and past experiences, both physical and emotional, all play a role. So, it’s important to take these factors into account when deciding the best course for pursuing better health.
Factors to Consider
If you’re trying to decide between pursing weight loss or just improving your health within your current size, ask yourself the following questions:
• Where do I store my fat? If you store your fat around your organs, as visceral fat, then weight loss is likely much more important because visceral adiposity (excess fat around the vital organs) is associated with much higher rates of heart disease and diabetes, whereas fat stored in other areas of the body is not as highly tied to disease.6
• Am I apparently healthy aside from my weight? If you’re concerned your excess weight may be causing silent health problems that could affect you later on, but you don’t know for sure, consider asking your doctor for a blood panel that includes data on conditions commonly associated with excess weight such as blood lipid levels, blood glucose levels, an A1C score, liver markers, and vitamin levels. If those tests come back all good and you’re living a healthy, happy life, then maybe you shouldn’t let your size get you down.
• Do I have a headstrong personality and life circumstance that enable me to pursue a difficult health goal every day? Maintaining weight loss is very difficult and requires a lot of discipline and effort, especially if you’re planning to lose a large amount of weight. Knowing you need stamina to succeed is important. If you don’t know if you can do it but want to try, just remember not to beat yourself up about it if you find you can’t do it. One survey on weight loss found that 22% of respondents would be willing to give up sex if it meant losing just 10 pounds and another 17% said they’d give up their favorite T.V. shows and streaming services for the same amount of weight loss.7 It’s obviously not a matter of desire or willingness to try hard, so be kind to yourself and take time to consider whether you’re ready to take on that burden.
•Is my excess weight getting in the way of personal goals and needs? Perhaps you’re trying to conceive, but your hormonal issues are getting in the way, or you really want to take that vacation to Hawaii, but you can’t fit into the airplane seats. In cases like these, weight loss could be the only answer to your dilemma. Two things are very true about fat, it is hormonally active, and it takes up space.8 So, losing even a small percent of your total body weight might be the key you need to unlock the door to your dreams. Go for it if that’s what’s important to you!
•Does pursing weight loss drive me to engage in unhealthy behaviors? For many individuals, weight loss can lead to skipping meals, exercising excessively, obsessing about weight and size, and increasingly tying self-worth to their visual presentation. These are all unhealthy behaviors and ought to be considered carefully when pursuing weight loss. One study found that nearly 27% of respondents who were pursuing weight loss experienced high amounts of stress, depression, and dissatisfaction with the results of their efforts.4 Don’t harm yourself trying to fit into a mold you can’t step into in a healthy way.
•Would focusing on other aspects of my health allow me to pursue health in a more sustainable way? Maybe you just need to work on increasing your physical stamina and flexibility or reducing your LDL cholesterol. Perhaps you’d benefit most from gaining better control of your blood glucose levels or from pursing mental health care. These are important aspects of health that are often discussed alongside obesity, and pursing those things isn’t tied to negative self-image in the same way. However, improving those parameters may also come with the added benefit of a smaller trouser size. For some individuals, weight loss is best viewed as a possible benefit of pursuing health goals, not the ultimate goal in itself.
You Do You
Regardless of what size you are, or what pursuing health looks like for you, please remember not to judge others or yourself. Life is a difficult journey for everyone and some of us wear our stress, health problems, addictions, trauma, childhood scars, and other experiences and conditions, as extra weight. For some of us, this will not change and shouldn’t have to, and for others, it can and should be considered. The only person who can make those kinds of decisions though, is the person in question.
Please join us at Wholesome Story in a new group of people where all are welcome, the group of Autonomy and Affirmation, where each person’s journey and abilities are their own and are not judged according to the experiences and expectations of others.
In parting, remember that eating healthy, whole foods, and lots of plants foods, is one of the simplest, safest, and most effective things we can do to promote good health in our bodies. As with every preventative/restorative measure though, sometimes these changes alone are not enough to help our bodies function the way we want or need them to. If you are struggling with health problems, please contact your doctor or other healthcare provider such a Naturopathic Doctor, Dietitian, or Mental Health Professional to see if they can offer appropriate guidance and care. We at Wholesome Story believe that healthy communities require community effort, so we advise you to keep your healthcare community aware and involved in your journey as you pursue better health.
- CDC. FastStats - overweight prevalence. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Published September 10, 2021. Accessed April 1, 2022.
- CDC. Adult obesity causes & consequences. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/adult/causes.html. Published March 22, 2021. Accessed April 1, 2022.
- Pogored HE. Why people diet, lose weight and gain it all back. Cleveland Clinic. https://health.clevelandclinic.org/why-people-diet-lose-weight-and-gain-it-all-back/. Published October 2, 2020. Accessed April 1, 2022.
- Bombak A. Obesity, health at every size, and public health policy. American journal of public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/. Published February 2014. Accessed April 1, 2022.
- NEDC. Eating Disorders and People with Higher Weight. Eating disorders and people with higher weight. https://nedc.com.au/eating-disorders/eating-disorders-explained/eating-disorders-and-people-with-higher-weight/. Published 2017. Accessed April 1, 2022.
- Institute of Medicine (US) Subcommittee on Military Weight Management. Factors that influence body weight. Weight Management: State of the Science and Opportunities for Military Programs. https://www.ncbi.nlm.nih.gov/books/NBK221834/#:~:text=The%20individual%20has%20no%20control,some%20environmental%20and%20social%20factors. Published January 1, 1970. Accessed April 1, 2022.
- Shortlister. 81 Weight Loss Statistics & Health Benefits in 2022 │ Shortlister. Shortlister.https://www.myshortlister.com/insights/weight-loss-statistics. Published January 27, 2022. Accessed April 1, 2022.
- Rush Stories. Overweight but healthy? Why Good Health Goes Beyond Weight. Rush System. https://www.rush.edu/news/overweight-healthy. Published 2022. Accessed April 1, 2022.