Why recommending weight loss, even when a person’s BMI is high, is often unhelpful and misguided

I was tagged in a post showing the image of a fat body and how being this size is damaging to their health (particularly organs and joints) and why weight loss through a change in diet and activity level is necessary.

I am going to attempt to break this down as simply as possible to explain why such attitudes are misguided and damaging to a person’s health. This is a very complex topic going well beyond health science and I hope those with a deeper understanding of social justice matters will forgive me for only mentioning them as a factor without going into depth.

Let’s say this person, I will call her Marie, does have issues with organs and joints, let’s say she has diabetes and knee pain. The mainstream assumption is losing weight will help. If Marie does intentionally lose weight, she will intentionally change something in order for this to happen. If her blood sugar and knee pain reduce, how do we know if these changes are due to the weight loss or whatever it was she changed; perhaps it was due the changes in diet and activity level, perhaps aided with some mindfulness/meditation work which then influenced stress levels and her relationships with others? Unless a person has liposuction, intentional weight loss occurs along side a change in behaviours, the weight loss is a side-effect as opposed to a behaviour change; i.e. weight is not a behaviour.

Essentially there is no one singular change that we can pin the medal on in terms of reduced blood sugar and knee pain, the human body is very complex and humans rarely ever change just one behaviour without this influencing other health factors.

EYE OPENER – just because Marie’e blood glucose and knee pain is reduced doesn’t mean she is experiencing better health. Many people would assume this, but chances are Marie has put herself into calorie deficit to achieve the weight loss, which results in a range of physiological and psychological disturbances. These disturbances are key drivers in the weight regain that happens to almost everyone, and why so many people find themselves obsessed with food and thoughts about food to the point of distress and anxiety – you can read more about this here. Not to mention the shame people feel around their body, their health issues and their perceived “failure” to manage things – shame is a powerful emotion experienced by most, if not all, who try to lose weight and a powerful factor that has been shown to directly impact metabolic health.

This brings us to vital and often overlooked factors that affect a person’s health and which may explain why Marie is in a bigger body. While these factors may influence current eating and/or exercise habits, they can affect health independent of diet and exercise.

To assume diet and exercise are the key factors to address when helping someone manage their health is misguided and in most cases, plain insufficient. I want to pause for a moment here and acknowledge that this is more or less what I was trained to do and what I did for the first part of my career. I’m not saying that I ignored, or that other practitioners who still work this way ignore a person’s psychology or life circumstances, I certainly didn’t, but I did not address them adequately, particularly with regard to body image, weight stigma, weight bias and shame, and I did not understand the implications of continuing to place focus on body weight.

Some of the reasons people end up with a higher body weight

• Concern about weight from a young age, be that underweight or “overweight” as per growth charts. There is evidence that parents who worry about their kids weight, end up with bigger children.
• Natural human size diversity – their genetic blueprint for size is a bigger body
• Medication
• Hormonal disturbances
• Mental health issues with or without medication
• Economic and social circumstances
• Adverse childhood events, including traumaand the most common reason I see with my clients…
• Through the pursuit of weight loss – a large number of my clients have dieted themselves to a heavier weight, research shows that up to 2/3 of people end up heavier through dieting in an attempt to lose weight.

Regardless of the reasons, placing the focus on weight and encouraging people to pursue weight loss is more likely to lead to the following, than it is to improve a person’s health long-term…

• Weight loss followed by regain (weight cycling/yoyo dieting), often to a higher weight.
• Engaging in diet behaviours that are generally not sustainable and may lead to a poor relationship with food over-time, disordered eating behaviours such as restricting and bingeing.
• Engaging in exercise behaviours that are generally not sustainable and may lead to a poor relationship with exercise over-time, injury or a general dislike of exercise.
• An increased sense of shame over body size and perceived “failure” to control their weight, eating behaviours and maintain a certain level of exercise. Shame has been identified as an independent risk factor for health.
• Perpetuating our cultures weight bias (that thinner people are more worthy, healthy, attractive etc) and the social stigma that accompanies this.

To state Marie is unhealthy because of high body weight or to keep this as the focus for her health issues, is at best misguided and very simplistic, and at worst, serves to further damage Marie’s health through the continued pursuit of weight loss, weight cycling and weight stigma. Those of us who work in the Health At Every Size paradigm work to take the focus off bodyweight and instead focus on addressing health behaviours (and the many factors that influence these), body image, weight stigma and the shame that usually comes in bucketloads.

Note: HAES and the non-diet approach are not anti-weight loss, just anti-pursuit of weight loss. Some people may lose weight through changing health behaviours, we just can’t predict for whom this will happen and therefore can’t promise or expect it will happen.