Have you ever stopped to wonder how an industry with so much money and power has failed to improve the lifelong health of its customers reliably?
The answer is simple: The product is designed to fail. If every dieter in America experienced long-term success, then the weight loss industry would crumble to the ground. Instead, millions of people hang their heads in shame when they regain their lost weight, or they maintain it at the expense of their mental health. Diet culture is insidious and inescapable, and we unwittingly believe the lies told by biased “experts” with vested interests because they are disguised as truth.
*Trigger warning: Throughout this post we will refer to the Body Mass Index (BMI) and its accompanying categorizations of the human body: underweight, normal weight, overweight, and obese. The BMI is federally recognized and used heavily in research on health promotion and disease prevention. While we believe these terms are stigmatizing and can be triggering for those with eating disorders, we use them here for brevity, coherence, and consistency with the research.
Lie #1: Studies show being overweight increases the risk of death and disease.
A quick Google search investigating the impact of obesity on one’s health will yield an overwhelming number of research studies seeming to suggest the same thing: Having a larger body increases your disease risk. What is not easily discoverable is the fact that many of these studies are biased because they are funded by corporations that monetize weight loss. There are panels of “experts” convened by major research agencies that are comprised of individuals representing special interest groups. Consequently, these individuals will present information most beneficial to them. Unless you have strong working knowledge regarding the execution and interpretation of research, the results are misleading. While obesity can be associated with increased risk for certain diseases, correlation does not equal causation. Causation is not well-documented in the scientific literature, but this fact is not communicated to the masses.
One study published in the Journal of the American Medical Association (JAMA) responsibly addresses this limitation:
We used the current federal definitions of overweight and obesity, which are based only on BMI, not on body composition. Our estimates give numbers of excess deaths associated with different levels of body weight, but the associations are not necessarily causal. Even if body weights were reduced to the reference level, risks might not return to the level of the reference category [emphasis added]. Other factors associated with body weight, such as physical activity, body composition, visceral adiposity, physical fitness, or dietary intake, might be responsible for some or all of the apparent associations of weight with mortality. Additional investigation of the effects of body composition and visceral adiposity on mortality would be of interest (Flegal, Graubard, Williamson, & Gail, 2005).
Epidemiological studies espousing a direct link between weight and health rarely address many contributing factors such as activity levels, genetics, nutrient intake, history of weight cycling, and low socioeconomic status. These factors do influence our morbidity and mortality risk, and it is concerning when they are not evaluated by studies claiming to identify such risk. When studies do control for these factors, the increased risk usually attributed to increased BMI either disappears or is significantly reduced. (This is less true at statistical extremes on either end of the BMI scale). As for the presence of illness in those at a higher BMI, it is likely certain behaviors increase the risk of weight gain at the same time they increase disease risk.
A 2012 study by the Department of Family Medicine, Medical University of South Carolina, Charleston examined the association between healthy habits and mortality across a wide range of body sizes. The results of this study strongly suggest health is achievable for people of all sizes, and we need to stop associating thin with healthy and fat with disease. The truth is, people engaging in healthy lifestyle behaviors may experience a significantly decreased mortality risk regardless of their baseline BMI.Another interesting pattern noted in the literature has been something referred to as the “obesity paradox.” In many diseases, having a higher BMI is associated with prolonged survival. When comparing people with type 2 diabetes, cardiovascular disease, chronic kidney disease, and hypertension, those with a higher BMI have demonstrated greater longevity than those with a lower BMI. Many epidemiological studies find that people identified as overweight and obese live at least as long as those in the normal weight category. Additionally, for people 55 and older, those with BMIs in the overweight and obese ranges had a significantly decreased risk of mortality.
The research is not as straightforward as the diet and wellness industry would like you to believe. It would be prudent for clinicians to pay close attention to all determinants of health when treating patients rather than merely prescribing weight loss.
Lie #2: BMI is a valuable, scientific measurement used to measure our health.
It is a commonly held belief in our society that BMI is rooted in science and is a valuable tool for individual health evaluation. Nothing could be further from the truth. BMI is a mathematical calculation devised in the 1800s by a man named Adolphe Jacques Quetelet. Quetelet was a Belgian astronomer, mathematician, statistician, and sociologist. Despite his ambitious list of academic endeavors, he was not a physician, nor did he study medicine. His impetus for the creation of the “Quetelet Index” was not borne out of medical necessity – it was to quantify the “ideal man,” believing the mathematical mean of a population represented its ideal. While creating his index, Quetelet used measurements gathered from the general population during that place and time, namely caucasians of Western European descent. The sampling was not a representative cohort of people for whom the BMI is used today.
Our society didn’t consider weight to be a significant predictor of health until the 1900s. Life insurance companies began using the self-reported height and weight of potential policyholders to determine what to charge them. At that time, insurance companies began to associate what they deemed “excessive weight” with decreased life expectancy. In 1972, researcher Ancel Keys popularized Quetelet’s index, renaming it “The Body Mass Index” and making claims about its superiority to the methods used by insurance companies. Keys and his colleagues tried to compare the BMI with measurements of fat using skin calipers and body density testing, but they used 7,400 predominantly white, healthy males as research subjects.The BMI has since become the accepted standard for measuring human beings to determine their disease risk, but it was never intended to be. BMI cannot differentiate between muscle, fat, bone, or water, nor can it determine the impact of one’s genetics or gender. This measurement is particularly inaccurate in certain populations, most notably athletes. The reason medical professionals and researchers like to use BMI is because it requires no expensive equipment and is relatively easy to calculate. By 1985, the National Institutes of Health (NIH) revised its definition of obesity to be dependent upon a person’s BMI.
The cut-off values for what is considered overweight and obese have become even more stringent over the years. In 1998, the NIH once again revised its definition of overweight and obese by decreasing the thresholds significantly. In an instant, millions of people were considered more medically at-risk than they had been moments before. Can we confidently assert to have a health “crisis” when the measurements used to define it are inherently flawed and continually shifting? The misuse of BMI is especially detrimental to women and people of color, whose bodies were never represented in its development. Despite its ongoing popularity, the BMI is not an effective way to measure a person’s health.
Lie #3: Dieting and intentional weight loss are imperative for optimal health.
The weight loss industry has done an excellent job convincing us that intentionally shrinking our bodies to fit into a specific size range is the way to achieve optimal health. However, this is categorically untrue. Positive health markers are found in a wide variety of body sizes. It appears to be the net effect of a person’s health-promoting behaviors, rather than weight, that determines our health status.Scientific literature has not demonstrated successful long-term weight loss maintenance from dieting. One may experience a period of short-term weight loss, but multiple biological mechanisms at play in response to weight loss make it very difficult to maintain. The few clinical trials with follow-up beyond six months fail to show lasting benefits. Not only do most people regain the weight they lost, but one-third to two-thirds of dieters regain more weight than they originally lost. This leads to feelings of guilt and shame for dieters as they chalk it up to personal incompetence. They make repeated attempts to shed the weight, and the cycle repeats itself. This pattern of weight loss and regain is referred to as “weight cycling” and is very damaging to one’s emotional and physical health. There is also a positive correlation between weight cycling and binge eating. The well-documented failure of weight loss programs seems perplexing considering their popularity, but this failure is necessary for what they are hoping to achieve: lifelong repeat customers and a steady revenue flow.
Aside from the fact weight loss is usually unsustainable, it is linked to increased mortality risk in at least two large-scale research studies (Andres, Muller, & Sorkin, 1993; Pamuk, Williamson, Serdula, Madans, & Byers, 1993). If a person does manage to maintain the weight loss, there is an increased risk for developing a chaotic relationship with food and his or her body. Dieting is a major risk factor for the development of an eating disorder.
Lie #4: We should encourage others to get “healthy” and applaud weight loss efforts.
Our culture’s obsession with thinness and the pursuit of weight loss at all costs has led to an increase in stigmatization and discrimination of larger individuals. Fat-shaming occurs in all situations and environments due to the false belief that confronting people about their weight will somehow motivate them to change it. Research and anecdotal evidence indicate stigmatization demotivates people from making changes to their behavior. Even worse, fat-shaming and weight stigma increase the risk for psychological and behavioral issues such as depression, poor body image, and the development of eating disorders.
Those in larger bodies fear stigmatization and discrimination at the doctor’s office. This fear leads to people postponing or avoiding medical professionals altogether, causing delays in proper diagnosis and care. Furthermore, medical problems go undiagnosed because clinicians attribute symptoms to a person’s weight, rather than investigating further as they would in a smaller individual. Eating disorder behaviors are encouraged by clinicians who have internal weight bias. There are countless stories in the eating disorder community of people in larger bodies actively engaging in damaging behaviors, but their behaviors went unnoticed or applauded because they resulted in weight loss. Since the rise of national obesity campaigns, the incidence of weight stigma has increased, negatively impacting the very population they claim they are trying to help.
Those in smaller bodies are not immune to the harmful effects of weight stigma. At the height of my own eating disorder, I sought care from a clinician for several medical concerns (all related to my eating disorder). Because I was in a body deemed acceptable by the medical community, the clinician did not order proper diagnostic tests, and my illness was completely missed. Furthermore, my eating disorder was strengthened by comments inappropriately attributing my low-normal vital signs to athleticism rather than their actual causes: starvation, weakened heart muscle, and hormonal dysregulation.
Clinicians are encouraged to enlist a weight-inclusive approach to their patients rather than assuming poor health in larger bodies and prescribing weight loss as the panacea for death and disease. A weight-inclusive approach is multi-faceted and directs its efforts toward reducing weight stigma while improving a patient’s access to and awareness of health-promoting behaviors.
A Different Type of Takeaway
A healthy weight is one that can be maintained effortlessly with non-restrictive, adequate food patterns that allow for fun and flexibility. It is a weight one can sustain without self-punishment, excessive amounts of exercise, or preoccupation with his or her body.
You are not alone if you’ve been victimized by diet culture and are feeling tempted to pursue weight loss. Try something different this year; make a resolution not to diet. You have full permission to choose a full, abundant life rather than one spent shrinking yourself to appeal to the masses. No matter your size, you deserve to take up space in this world.