Advertisements, 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 must be unhealthy.
Still, 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 unburden ourselves of society’s beauty standards, it can be hard to feel confident about your body if you see your size as unhealthy.
Experts say it may be time to untangle health and weight and focus more on health-promoting behaviors than the number on the scale.
Correlation versus causation
It’s important to understand that studies pointing to dire health outcomes for people with higher body fat can only point to correlation, not causation, Larmie said.
While studies can say that people with higher weight often have more cases of heart disease, they can’t say that weight caused heart problems, Larmie added.
But the importance of these studies shouldn’t be dismissed, Scherer said. The correlations are strong, and “from a physiology perspective, in the clinic we work with correlations,” he said.
Other factors could still be at play, however, such as access to medical care, Scherer said.
And for people with larger bodies, it can be difficult to find good medical care, said Bri Campos, a body image coach based in Paramus, New Jersey.
It’s not just their customers who are afraid of going to the doctor. Although she educates people about her body image and mental health, Campos is often afraid to go to the doctor for fear of being ashamed of her weight, she said.
“I can go in for strep throat, I can go in 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 other than ‘you should probably lose weight.'”
Bodies are not business cards
Spence likes to remind her clients: Bodies aren’t business cards.
We can’t take a look at a person’s body and get an idea of their health, their habits or their biology, he said.
“Do we have access to someone’s medical records? Are we talking to their doctor?” she said “And health is often out of our control. There are so many chronic diseases that people just develop.”
While 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 as a whole really accepts that not everyone who has such a 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?
This depends on which parts of health you prioritize.
Health is made up of many factors. Avoiding illness is one, but so is maintaining mental health, keeping social media active, getting enough sleep and reducing stress, Spence said.
Restricting calories or cutting out certain foods may not be healthy in general if it negatively affects your mental health or prevents you from enjoying time with friends and family, she added. And sometimes these restrictions can make you lose weight without properly nourishing your body.
“Weight loss doesn’t equal happiness and it doesn’t necessarily mean you’re going to be healthy because the way you go about losing weight can also be detrimental to your health,” Spence said.
If our phones don’t work the way they were intended to often, most people wouldn’t use them anymore, Campos said.
“But the diet culture has done a really good job of tricking us into thinking you can get everything you’ve ever wanted. You’ll be healthy, you’ll be fit, you’ll get compliments,” she added.
What do we focus on if we want to be healthy if 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.
As a result, you may lose weight, but that’s not the goal, they added.
“By not focusing on weight, that means we can really focus on some really healthy behaviors that are much more sustainable,” Thompson-Wessen said.