Does Weight Equal Health?
Written by Isabel Vasquez, RD, LDN
Weight and health are one in the same in our society steeped in diet culture. Actively working to unlearn this is the foundation of Health At Every Size, which informs our approach here at Your Latina Nutrition.
You may have tons of questions and doubts. You may be super skeptical. That’s understandable. It’s a huge mindset shift from our cultural norms.
In this blog, we’ll bust the myth that weight equals health and offer tips for de-centering weight loss in your efforts to improve your health.
How is weight related to health?
While research has shown a correlation between higher weights and poorer health outcomes, it has not shown a causation. Correlation does not equal causation. (And by the way, studies have actually found that the “overweight” BMI category is associated with the lowest mortality rate)
Things like weight stigma and weight cycling are typically not controlled for in these studies, which means they are left out of the picture.
More recent research has shown that these factors actually play a pretty big role in the relationship between weight and health. Let’s dive into each one.
Weight Cycling
Weight cycling is when your body goes through big shifts up and down in weight. It often occurs from dieting, where you initially lose a bunch of weight, but then you end up regaining the weight lost and maybe even more.
There can also be unintentional reasons for these shifts in weight like illness or stress.
A 2019 meta-analysis and systematic review in Frontiers in Endocrinology examined 23 studies. The researchers found that body weight fluctuation was associated with increased risk of mortality for participants of all ages and cardiovascular disease for participants less than 60 years old.
To be clear, this study, like many studies equating weight with health, found a correlation and not a causation. Therefore, we can’t say for sure based on this study that weight cycling causes poor health outcomes, but it appears to be associated in some way.
We also don’t have a precise definition of what specific weight change qualifies as weight cycling. Some fluctuations are normal, but big shifts are typically what bring up concerns.
Weight cycling may also play a role in metabolic health. A 2021 study in the Journal of Diabetes Investigation found weight cycling to be “a strong independent predictor of new-onset diabetes.”
Additionally, a 2021 study in Cancer Causes & Control found that weight cycling is linked to higher rates of kidney cancer, independent of BMI.
Weight Stigma
Weight stigma alone has been shown to be an independent risk factor for various health issues including disordered eating, emotional distress, diabetes, and heart disease.
A 2018 systematic review in the Journal of Advanced Nursing found that weight stigma is associated with negative physiological and psychological health outcomes.
It is a form of discrimination that has real harms on health.
We see similar outcomes from racism. Too often we hear that being of a certain race is a risk factor for disease, rather than hearing the truth: racism is the risk factor.
If you are discriminated against, you feel like an outsider. You feel like you don’t belong. You may feel unsafe or at the very least, unsupported by those around you. Your cortisol–the stress hormone–levels will rise, and we all know that chronic stress is not great for the body.
This discrimination can come from those who are supposed to protect your health, like doctors or dietitians. In fact, healthcare providers are some of the worst perpetrators of weight bias.
A 2019 review in Primary Health Care Research & Development examined 21 studies on weight bias among healthcare providers and found really alarming themes. According to the researchers, these themes included:
contemptuous, patronizing, and disrespectful treatment
lack of training
ambivalence
attribution of all health issues to excess weight
assumptions about weight gain
barriers to health care utilization
expectation of differential health care treatment
low trust and poor communication
avoidance or delay of health services
and ‘doctor shopping’
With this in mind, it makes sense that people in larger bodies would avoid doctor’s visits and/or be hesitant to engage with healthcare providers.
If you’re not getting health care, your health might suffer. If you’re getting healthcare that is not getting to the root of your issue (e.g. attributing your issue to weight when there is a totally different reason you’re struggling), your health might suffer. Yet, the role of weight stigma is too often left out of the conversation.
Shifting Your Focus Towards Health-Promoting Behaviors
All that to say, certain behaviors are valuable on their own whether they result in weight loss or not.
So if you engage in health-promoting behaviors and do not lose weight, that does not mean the behaviors aren’t beneficial. It is better for your health to have a better body image and engage in behaviors without shame around your body shape or size being the motivator.
What do I mean when I say health-promoting behaviors? I’m talking things like:
Physical activity that you actually enjoy
Eating a variety of nourishing foods
Reducing stress
Getting sufficient sleep
Staying hydrated
Having a strong community
Being able to focus on these behaviors in a healthy way involves developing a healthy relationship to food and your body so you can focus on these things without it being for the sake of weight management.
Another very important point to remember is there isn’t any proven method of maintaining weight loss in the long-term, so even if weight loss was beneficial, we currently don’t have a way to help people lose weight sustainably.
Social Determinants of Health
When we speak about health-promoting behaviors, we can’t leave out the social determinants of health. Being able to prioritize these health-promoting behaviors requires a certain level of privilege.
The social determinants of health are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks”, per the U.S. Department of Health and Human Services.
If you experience food insecurity or homelessness or poverty, these health-promoting behaviors are not really possible.
That does not mean individuals facing these challenges are bad or don’t care about their health. It means the system is failing them and systemic changes must be made so everyone can have a fair shot at health.
Final Thoughts
Although weight is so frequently tied to health in our society, research around weight cycling and weight stigma challenges this assumption. Weight does not necessarily cause poor health outcomes. Rather, weight cycling and weight stigma may explain the poorer outcomes we see among larger-bodied individuals.
If you’re trying to improve your health, focusing on health promoting behaviors like eating a variety of food groups, finding joyful movement, reducing stress, sleeping well, and hydrating could be more beneficial and sustainable than trying to lose weight.
For more support, we offer a 3-part masterclass on intuitive eating to help you improve your relationship with food, your body, and movement.
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