Is weight loss an important health goal?

Editor’s note: This story is part of a topical series covering disordered eating and diet culture.


It may feel good to accept your body as it is and stop all dieting, but will doing so harm your health?

Advertisements, pop culture, and even doctors can talk about health and weight as if they were the same: small bodies are healthy, and large bodies must be unhealthy.

But neither health nor the body is simple and uniform, and health can vary from person to person, said Janet Thompson-Wessen, a nutritionist in the United Kingdom whose approach does not focus on weight loss.

A high body mass index (BMI) is associated with conditions such as diabetes and heart disease, said Philip Scherer, professor of internal medicine and director of the Touchstone Diabetes Center at Texas Southwestern Medical Center. However, BMI is a controversial way to measure health, and it is only one of many factors associated with changes in a person’s well-being, said Dr. Asher Larmy said.

Health care, environment, social circumstances and biology make up most of the factors that determine our health, according to the Office of Disease Prevention and Health Promotion’s Healthy People 2020.

Still, we often place too much importance on a person’s appearance when evaluating their health, says Shana Minei Spence, a registered dietitian in New York. And even if we learn to let go of the burden of societal beauty standards, it can be difficult to feel confident in your body if you view your shape as unhealthy.

Experts say it may be time to ignore health and weight and focus more on the behaviors that promote our health than the number on the scale.

It’s important to understand that studies indicating dangerous health outcomes for people with high body fat may indicate correlation, not just causation, Larmey said.

The studies may show that overweight people have more heart attacks, but they don’t say that weight causes heart problems, Larmy added.

But the importance of those studies shouldn’t be discounted, Scherer said. The correlations are strong, and “from a physiology standpoint, 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, says Brie Campos, a body image coach in Paramus, New Jersey.

His clients aren’t the only ones who fear going to the doctor. Although she teaches people about their body image and mental health, Campos is often afraid to go to the doctor for fear of being embarrassed about her weight, she said.

“I can go in for strep throat, I can go in for a rash,” Campos said.

“Because of my body shape, it’s very unlikely that I can go to a doctor and get a real diagnosis that isn’t ‘you probably need to lose weight’.”

Spence likes to remind her clients: Bodies are not business cards.

We can’t look at a person’s body and get a sense of their health, their habits or their biology, she said.

“Do we have access to somebody’s medical records? Are we talking to their doctor?” she said. “And often health is honestly sometimes out of our control. There are a lot of chronic diseases that people just develop.”

Although we can see large-scale correlations between body size and health conditions, once researchers look at individuals, it’s not as clear, Scherer said.

“The field as a whole really accepts that not everyone with a very high BMI will have type 2 diabetes,” he said.

People with smaller bodies may have 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.

What does it mean to be healthy anyway? And can diet help you get there?

It depends on which aspects of health you prioritize.

Health is made up of many factors. Avoiding disease is one thing, but so is maintaining mental health, keeping an active social network, 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 spending time with friends and family, she added. And sometimes those restrictions can lead to weight loss without properly nourishing your body.

“Weight loss doesn’t equal happiness, and it doesn’t mean you’ll be healthy because how you go about losing weight can also be detrimental to your health,” Spence said.

For many people, restrictive diets aimed at losing weight do not work. According to a 2018 study, more than 80% of people who lose weight regain it within five years.

If our phones didn’t work the way they usually do, most people wouldn’t use them, Campos said.

“But diet culture has done a very good job of tricking us into believing that you can have everything you want. You will get health, you will get fitness, you will get appreciation,’ she added.

If we don’t lose weight, what should we focus on to stay healthy? Focus on health-promoting behaviors like quitting smoking, walking more, getting better sleep, less stress and eating foods that your body is telling you it needs, Larmy said.

You may lose weight as a result, but that’s not the goal, they add.

“By not focusing on weight, it means we can really focus on some healthy behaviors that are more sustainable,” Thompson-Wesson said.

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