Our society is fixated on weight — the “quarantine 15” jokes since the pandemic began are just one example — and we tend to assume that the more someone weighs, the less healthy they are.
“It’s easy to make a judgment based on how someone looks, but there’s good evidence that someone’s health isn’t something you can see in their body,” says Dr. Sarah Halter, a family medicine physician at UW Medicine.
Plus, fixating on one aspect of identity, such as body size, as the sole determinant of health can be physically and mentally harmful to yourself and others.
The truth is, health and body size aren’t the same thing — a fact the Healthy at Every Size (HAES) movement recognizes.
Halter, an advocate for the HAES movement, says that she has patients in larger bodies who get regular physical activity and eat lots of fruits and vegetables, while she has thin patients who are sedentary and smoke — and everything in between.
Society might see the thinner person as healthy solely by virtue of their weight and the larger-bodied person as unhealthy for the same reason. But, when you look past someone’s physical size and at their behaviors, those assumptions might prove to be untrue.
“There are cultural expectations about how we should work, eat and live our lives. I think that plays a role in naturally creating bias,” Halter says.
Correlation, not causation
Researchers in all fields emphasize the difference between correlation and causation. Correlation means that two things occur together, but one doesn’t necessarily cause the other. Causation means that one thing directly causes the other.
For Halter, it’s helpful to use correlation instead of causation as a framework when considering someone’s health and weight.
“I don’t think anyone is saying that health and weight have no connection; what we’re arguing is that it’s not this direct, clear relationship, so we shouldn’t make assumptions,” she explains.
Research has proven that someone’s Body Mass Index, or BMI, isn’t always an accurate indication of their health — even though it is often treated that way. Medical definitions for obesity and being overweight rely solely on BMI, for example, though doctors are starting to recognize that BMI doesn’t say much about a person’s health.
Treating weight like the cause, and then telling someone to lose weight, rarely helps. If they have underlying health conditions, losing weight won’t automatically fix those.
Instead, Halter says, people in larger bodies can be more at risk for health conditions such as cancer, diabetes and high blood pressure — but one doesn’t necessarily cause the other.
Why fat shaming is harmful
Aside from being mean and unnecessary, fat shaming can also be detrimental to someone’s health.
“If you go to a doctor because you have belly pain and the first thing you’re told is that you should try losing weight, that’s harmful because the doctor is simplifying things and could be missing important signs that something is wrong,” says Halter.
If someone has been discriminated against at a medical appointment because of their weight, they may also be less likely to seek care in the future, which only further risks their health, Halter says.
Fixating on someone’s weight can lead people to try things such as restrictive dieting, which is rarely effective and can be harmful both mentally and physically.
Additionally, if someone feels bad about themselves because of their weight, that can lead to mental health problems such as eating disorders.
Focus on health behaviors and their causes
Instead of talking about weight alone, Halter likes to focus on health behaviors: What someone can do (or not do) to improve their health.
This is key to the HAES movement, looking holistically at how fueling and moving our bodies, maintaining emotional and mental health, forming relationships and practicing spirituality affect physical health.
“When you give up your attachment to weight loss as a mediator of health, the goals are more attainable. If your only goal is weight loss, you’re setting yourself up for failure,” Halter says. (Research has shown that it’s incredibly hard for most people to maintain weight loss.)
It’s important also to look beyond individual behaviors and understand what might cause them, especially ones that are considered less healthy.
Take someone who doesn’t get a lot of exercise, for example. Why don’t they? First of all, this is really no one’s business but theirs, and they have no obligation to explain their life to others. The assumption might be that they’re lazy, but in reality they may have kids, work long hours and not have any parks or affordable gyms nearby where they can move around.
Economic status, location, access to places to exercise, access to healthy food, racial discrimination and even genetics — all of these things can (and do) play a role in someone’s health behaviors and thus their overall health.
How to be healthy at any size
While Halter believes that people in larger bodies shouldn’t have to advocate for themselves — doctors and society as a whole should do a better job — she recognizes that many people will have to do so at some point in their lives. Here are the tips she gives patients.
Ditch the scale, ditch the diet
If the only purpose your scale serves is making you feel bad about yourself, it’s time for it to go in the trash. Likewise for food-tracking apps that make you anxious or clothes that are too small but that you swear you’ll fit into one day.
Another thing to let go of? Diet mentality, which says that things your body needs — like carbs and healthy fats — are off the table. Instead, try to cultivate a healthier relationship with food and see it as fuel for your body instead of something that is either good or bad.
Find a HAES-friendly doctor
Halter added “HAES-friendly physician” to her bio, an indicator to potential patients that she won’t discriminate against them because of their weight. If you’re looking for a new doctor, this language or something similar is a small way to distinguish between providers who might be better partners in your care.
“Patients tell me they didn’t feel safe getting care, but that they did with me because I have that in my bio,” Halter says.
One place to start looking is the HAES website, which has a registry of physicians, psychologists, physical therapists and other healthcare providers who have taken the pledge.
Empower yourself to say no
“You have the right to say you don’t want to be weighed at the doctor’s office,” Halter says.
You can also ask not to have your weight listed on your follow-up instructors or visit summary, though not all offices may be able to do that. (The office where Halter works can.)
Most of the time, someone’s weight isn’t actually necessary in order to provide care, Halter says. There are a few exceptions, such when you are prescribed a new medication that is dosed by weight or if weight change is related to an existing medical condition you have.
Focus on overall health
Try fitting in “exercise snacking” breaks each day and come up with creative ways to eat more veggies. Prioritize getting better sleep, practicing self-care, getting outside and doing hobbies and activities you enjoy. Consider finding a therapist if you want to work on your mental health.
Your health is so much more than your weight. And while all the factors affecting your health probably aren’t within your control, many are. Even small changes can lead to healthy habits and make a big difference in your life.