“Overweight” does not equal unhealthy

Meet Emma, Emma’s weight puts her in the “overweight” range for BMI. Emma is active daily with a mix of walking, dancing and yoga, she gets adequate sleep, eats from a variety of food with a balanced nutrition intake and she rarely overeats. Her bloods are perfect with no metabolic risk factors for disease.

Emma is fit and healthy, she does not need to lose weight. However this is not the message Emma receives from our culture.

Meet Kate, Kate’s weight also puts her in the “overweight” range for BMI. Kate struggles to be active, often doesn’t get enough sleep and her eating pattern is chaotic, often missing meals, then overeating, and her food variety is fairly low. Her bloods showed elevated blood pressure and slightly high blood sugar.

Now, is it Kate’s weight that is putting her at increased risk for disease, or is it her lack of activity, poor sleep and troubled eating pattern? If we simply removed 10kg of body fat from Kate’s body, would her health improve? Highly unlikely. If Kate chooses to do something about her current health status, it’s her health behaviours and emotional health she needs to focus on, not her weight. 

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If we keep spouting the same old blanket statement; “being overweight increases risk for disease” then we are telling all the Emma’s of this world that they are not healthy at their current weight. For Emma to lose weight, if indeed her genetics will allow that, she would need to start restricting calories (aka dieting) and/or doing a considerable amount more activity. Given that we know diets don’t work for long-term weight loss, that they damage physical and psychological health and that they are even a risk factor for weight gain, then advice to lose weight for people like Emma is not going to reduce disease risk. If anything, it will increase this risk.

Perhaps encouraging Kate to lose weight will see an improvement in health, but this will be because she changed her health behaviours (along with addressing emotional health), not her weight. Any weight she loses, if she does, is simply a side effect of these behaviour and mental health changes.

Continuing with the “overweight increases disease risk” message also places the focus solely on the individual and fails to address more important determinants of health such as social and financial inequality, stress, lack of sleep or rest and psychological health to name a few. This message also adds to current high levels of weight stigma and body shame and is actually having the opposite of the intended effect as discussed in this article. 

Unfortunately for catchy headlines, media grabs and millions of people, human health is incredibly complex and cannot be impacted on, at a population level, by simply saying “overweight = unhealthy”.

To learn more about how we can take care of our health without focusing on weight and the research behind this fact, you might like to read more about the paradigm HAES® (Health At Every Size) paradigm.

I have used quotation marks with the word overweight, as many people classed as “overweight” as per the BMI, are not above a weight that allows them to be healthy.

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Health is not a green smoothie, a slim body or being super fit.

We cannot assess a person’s health based only on how they look or what they eat.

So what is health or being healthy?

Health is a continuum, not something you achieve and then have forever, it is not a destination you reach.

Your health encompasses your physiology, your psychology, your emotional state and your social connection to other humans. Each of these are influenced by access to basic human needs such as food, water, rest, shelter, clothing, safety and social connection. 

Health can, and does, look very different for different people. While some people experience a good amount of health throughout their life, there are others who endure a lifelong struggle with certain aspects of their health.

  • You can have a chronic disease such as diabetes and enjoy health
  • You can have a physical disability or a mental health issue and have health
  • You can be in a large body, medium size body or small body and have health
  • You can eat all food, including chips, chocolate and ice-cream and have health

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The “perfect” diet, losing weight or being super fit are not a guarantee against poor health, or a guarantee for achieving lifelong health. You can be doing all these and still suffer poor physical, mental, social or emotional health. 

Equally, you can have what looks on paper to be a less than nutritionally sound diet and experience really good physical, mental, social and emotional health.

I’m not saying green smoothies, a slim body or being super fit are not healthy – if you enjoy these things and they add to your quality of life, then go for it – I’m just wanting to make the point they are not necessary to experience health and in some people the pursuit of the “perfect” diet, weight loss or a high level of fitness can actually cause health problems. Clinically, I have seen many people suffer physical, mental and emotional problems through these pursuits. If you have ever felt worse about yourself or found your eating becoming more disordered after a period of dieting, intense exercise or weight loss (or gain), then you have an idea of what I mean.

We must stop oversimplifying health to be about the physical or appearance. We must stop doing this, because for many, the pursuit of physical health sold to us via social media and our culture at large, not only serves to erode many people’s health, but is actually unattainable for most people due to the many key non-physical health determinants. 

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Healthy eating encompasses listening to our appetite and eating food that satisfies us when we feel hungry and being able to recognise when we’ve eaten enough.

Healthy eating is the mindful enjoyment of any type of food without needing to worry about calories or body weight.

Healthy eating is also sharing food with others over a meal, celebration or just to keep someone company.

Healthy eating is sometimes eating fruit and sometimes eating sweets.

Healthy eating includes sometimes eating when not hungry and sometimes eating more than you need.

But most of all, healthy eating is having a positive attitude to food and eating where there is enough nutritional variety but also where food can be eaten purely for the joy of eating!

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No food on its own is unhealthy or bad for you

The reason no food on its own is bad for you and the damage that can ensue from such thinking…

Like with everything in life – context matters.

Extreme example to make a point:

If you were lost in the wilderness and all you had to eat for several weeks were cakes & pastries would they be bad for you?

A: No as this food contains the vital nutrients carbohydrate, protein and fat and believe it not, they even contain a range of vitamins and minerals. This food would also provide some water… It would help keep you alive.

Now I want you to imagine this same scenario but all you have to eat is broccoli, which would you be better off with, the cake or the broccoli?

If you said the cake, you’re right; while broccoli is an excellent source of many vitamins and minerals, it is a poor source of the vital nutrients carbohydrate, protein and fat. You might still be alive when you’re rescued after several weeks, but you would be in much worse shape.

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More realistic example:

It’s 3.30pm and you’re hungry, in your mission to be healthy you’ve brought a nutritious snack of chopped up veggies and hummus. It’s been a crazy busy day and you don’t have time to take a break, let alone time to sit down and munch on veggies and hummus (plus you’re really quite hungry and the veggies are not calling to you). You decide to ignore your hunger and skip your break. By the time you finish work at 5.30pm, you’re ravenous and on the way home you grab some food from a vending machine, this doesn’t really satisfy you and you continue to much your way through whatever is easy to eat once you arrive home. You then find you’re not that hungry for dinner but think you should eat anyway as at least it’s a nutritious meal. You end up stuffed full and feeling like you’ve blown your mission to be healthy. Neither your physical or mental health benefit in this type of situation.

Now I want you to imagine the same scenario, but instead of ignoring your hunger, you grab a muesli bar you’ve hidden in your bottom draw – you hid it when everyone told you sugar was evil and muesli bars were full of this “evil” (most aren’t). When you finish work at 5.30pm, you’re a little hungry and now you have time to enjoy your veggies and hummus. By the time dinner rolls around, you’re moderately hungry again and finish your meal feeling comfortably full and content. You’re pleased you made a choice that felt right for you in that particular moment – that’s choosing to eat the muesli bar – as it served you well and you ate a range of nutritious foods that satisfied you.

Note: I am not saying the veggies and hummus are better than the muesli bar, or that muesli bars aren’t a good choice, quite the contrary. In the scenario described here, the muesli bar was a good choice. I am also not saying food from a vending machine is bad and there are times where such food does the job. One of the complexities with nutrition, is that it is not black and white (unless of course you have a food allergy or Coeliac disease) and there is no right or wrong choice.

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Things to consider when giving dietary advice

Do you ever give dietary advice that you yourself, would not be able (or want) to follow?

It’s not infrequent that I hear from clients how they’ve been given professional advice, often from a physician, that they just stop eating X in order to manage their weight, like it’s something you can just push a button and do.

X is often sugar, bread or carbohydrate in general.

The point of this piece is not to debate whether or not the human body needs carbohydrates to be physiologically healthy, the point is we are not machines and we cannot have physiological health without mental and emotional health.

If you give dietary advice, please pause for a moment and consider what you are asking someone to do – quite possibly for the rest of their life.

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When you advise someone that they would be better off health wise if they just stopped eating carbohydrates, this is really what you are saying…

  • You are saying this person can never eat out again freely or normally.
  • They can never travel overseas, be that Europe, Asia or South America and enjoy the local cuisine.
  • They can never again partake in a traditional Christmas meal with family or friends.
  • They can’t celebrate birthdays with cake, Easter with chocolate or take part in the ritual of almost any other special occasion you can think of.
  • Not only are you asking that person to avoid fully partaking in life, you are asking them to significantly alter two basic human needs, the need for food and the need for human connection.

Human connection is vital to health and for 1000s of years, humans have connected socially around food. Interfere with this and you interfere with a person’s right to live a full and meaningful life.

I would like acknowledge those with true food allergies, Coeliac disease or any other condition that requires complete avoidance of a food, as this can also make travel and special occasions difficult. However, in these cases, complete avoidance is life dependant or can have serious health consequences. This is not the case with advice to avoid certain food for weight control.

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Food doesn’t put on weight, but diet culture does…

There is no one food that causes a person to gain weight. You don’t eat cake or chips and wake up the next day fat. Of course if you over eat energy dense food on a regular basis, you may see your weight go up – but dieting does this too.

What many people don’t realise, is that activity avoiding the very food labelled “fattening” by diet culture, can, and often does, lead to weight gain over time, and it is now well established that dieting itself, is a risk factor for weight gain.

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How?

When was the last time you overate salad, fruit or vegetables? Sure, we’ve all eaten a roast dinner with veg to the point of being overfull, but generally speaking we don’t over eat these foods. One reason for this is that we don’t restrict them. When you can have much of something as you want, the desire for it lessens. Combine this with the mandate that you “should” be eating the salad, and you may find yourself not wanting to eat any salad period. Conversely, when you’re told you shouldn’t have something (or do something), your desire to have or do that thing usually increases. It’s the forbidden fruit effect and it holds true for many aspects of life, not just food. Deprivation drives desire.

With regard to us being unlikely to overeat salad or veggies, I can guess some of you will be thinking that’s because fruit and veggies are much more filling or that they’re not as moorish as sweet or fatty foods, and while there may well be some truth to that, it doesn’t change the fact that it’s the “forbidden” foods that we are inclined to over eat.

Other factors that drive overeating are biological hunger (often greater when dieting) and emotional drivers which I won’t go into detail here, but to suffice to say, being hungry and restricting food both exacerbate drivers of emotional eating.

When diet culture tells us to avoid or limit certain food, this ends up being the very food that is over eaten and that leaves us feeling guilty or that we’ve “failed” at taking care of our health. This sense of guilt or failure is also a big part of what drives further over eating of the very foods we’ve been trying so hard to limit. As you can see, restricting food seen as “unhealthy”, for most people, just isn’t the solution to eating more healthfully.

So what might happen if we took the “fattening” or “unhealthy” label off these foods, if we allowed ourselves to eat them with full pleasure whenever we truly desired them? Gasp!

This is known as unconditional permission to eat and a key aspect of intuitive eating. The classic diet thinking, or diet mentality, is that if I allow myself to even one bite of the food, I’ll never stop. Paradoxically, what people discover when they allow all foods, and when they eat these foods with attunement to appetite, taste and satisfaction, is that in time, they no longer desire them as often. It must be noted that for most people, getting to point where food no longer has a hold over you, is not as simple as just allowing all foods and most people will need to address the many other factors that influence food choices. That said, the waning desire that accompanies unconditional permission to eat, is fundamental to eating in a way that is both nourishing and sustainable. 

If you would like to learn more about the intuitive eating process and where to get help, look for a dietitian who works within the HAES (Health At Every Size) paradigm. Please be aware that anyone talking about non-diet or intuitive eating as a weight loss method will not using this approach effectively.

You can find us here:

HAES dietitians Australia

HAES dietitians worldwide

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