Why Your Mental Health Matters More Than the Scale

It’s a truth universally acknowledged that losing weight will make you healthier and happier ... but is it, actually?

There’s more pressure than ever to be thin, now that GLP-1s are a thing. And that can take a toll on your body — and your mind. The stigmas and stereotypes about being in a larger body are real. And if you truly want to lose weight, it’s important that it’s a choice you make for yourself — while protecting your mental health.  

What everyone gets wrong about body size

Let’s get one thing straight: Weight and body size alone do not dictate how healthy someone is or what medical conditions they have.  

“Weight may be correlated with disease, but this is similar to other healthcare inequities where disease is correlated with an aspect of identity that is underserved,” says Lisa Erlanger, MD, clinical professor of family medicine at the University of Washington School of Medicine and a board member of the Association for Weight and Size Inclusive Medicine. “Clinical risks like elevated blood pressure and blood sugar are closely tied with the elevated stress of living in a marginalized body.” 

Simply losing weight (which isn’t simple, btw) usually won’t magically fix someone’s medical issues. While it may be helpful for some people, that conclusion can only be reached after a discussion with a doctor where your overall health, lifestyle, living conditions and medical history are taken into consideration.

Additionally, and contrary to popular belief, BMI has been shown to be inaccurate at determining how much body fat someone has.

“I never have patients target changing BMI as a goal,” says Laura Montour, MD, a specialist in obesity medicine at the UW Medicine Center for Weight Loss and Metabolic Surgery and a clinical assistant professor in the Department of Family Medicine at the UW School of Medicine. “Muscle is very important for metabolic health, so we don’t want patients to lose muscle just to get to a certain weight number or BMI.” 

How sizeism and weight loss affect mental health

While being in a larger body is often moralized as a bad thing, body size is actually just body size, neither bad nor good. However, it’s important not to dismiss the fact that living in a society that moralizes body size can cause real harm, from day-to-day things like not finding clothes that fit to life-threatening issues like not being taken seriously at the doctor’s office.  

Sizeism, aka discrimination against someone based on body size, puts people with larger bodies at an increased risk for emotional distress, including anxiety, eating disorders, substance use, depression and suicidality, according to a comprehensive overview from the American Psychological Association. It can also make people less likely to engage in helpful activities, like exercising and making social connections. Women, people of color, LGBTQ+ people and people who are marginalized in other ways are even more affected.

Weight-related stigma is unhelpful even if you are trying to lose weight. It can make you feel like you’re failing if your attempts don’t work the way you expected. You might try a fad diet for a while, give it up because it’s too restrictive, and then regain the weight you lost. Or maybe you talk with a friend about wanting to try weight-loss medications and they criticize that as being the “easy way out.”  

Which is to say, there are a multitude of ways sizeism can impact your mental health. And in general, fixating on losing weight as the main or only goal is bound to cause stress.  

“People often come to me with a specific weight goal or an idealized body image. I work to help them clarify what being healthier would look like for them. What activities are they hoping to do more? How will they know they are healthier?” says Ruth Foster Koth, MSW, LICSW, a mental health specialist at the UW Medicine Center for Weight Loss and Metabolic Surgery. “When we have targeted goals that line up with our deeply held values, we are able to see our path and our progress."

If you already struggle with your mental health, weight loss alone might not change that, even if some of your struggles are connected to body image. And in some cases, weight loss treatments might improve mental health not necessarily because of the weight loss, but because of other things, like the way weight loss medications might help quiet food noise, which is a constant internal dialog about food that can be distressing for some people.

For some people, though, losing weight might directly help improve their mental health.  

“I feel that weight loss can improve mental health since many patients can have improved mobility with even as little as 10% weight loss,” says Montour. “Also, with weight loss, sleep apnea can improve, and improved sleep can have significant improvements in mental health.” 

The healthiest way to approach weight loss

We’re not here to tell you if you should or shouldn’t lose weight. But if you do want to lose weight, it’s important to know how to do so in a way that doesn’t harm your health.  

“I’ve heard many people say we should abandon weight loss interventions because they perpetuate stigma,” says Katherine Hoerster, PhD, MPH, an associate professor in the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine and a researcher at VA Puget Sound who studies weight management, including a recent study on how to reduce disparities in behavioral weight management care for veterans. “But the problem is, then the people who want those interventions don’t get them and are likely to seek options that are harmful, like extremely restrictive fad diets.”

Here are some expert tips for focusing on your overall health and well-being if you’re trying to lose weight.

Figure out if you really want to lose weight

“Of course patients want to lose weight in a healthcare system and a society where weight is so stigmatized,” says Erlanger. “Patients also talk with me about ‘performing health,’ where in order to access unbiased care, they have to prove that they care about losing weight in order to engage their care team in other discussions about health.”  

If this sounds like you, don’t feel like you have to try to lose weight. The decision is a personal one that should be made by you alone in consultation with your doctor. And if your doctor isn’t receptive to this, it might be time to find a new one. There are Healthy at Every Size doctors who work in hospitals and clinics across the country.

Focus on your health

If your doctor focuses on your weight and ignores your health concerns, that is a problem. Even if your doctor thinks your weight might contribute to health issues, they should work with you to find treatment options for those issues that are not just about weight loss.  

There is no guarantee that making your body smaller is going to resolve any health issues you’re dealing with, Erlanger points out. So if you aren’t interested in losing weight but are concerned about how, say, your polycystic ovary syndrome (PCOS) diagnosis will affect your health long-term, that’s something you should ask your doctor about.

In a situation like this, Erlanger recommends asking what other options there are for treatment. There are many treatment plans, such as working on lowering blood pressure, exercising more, stopping smoking and limiting alcohol intake that can have significant positive health impacts regardless of how much you weigh. Even if you ultimately decide to try weight loss, that doesn’t mean you can’t get started on other things first.  

Seek out a program that’s likely to help

Evidence-based behavioral weight management programs typically support people to lose 1 or 2 pounds per week, aiming for about 5% to 10% loss of baseline weight over the course of about 4 to 6 months. They typically encourage eating a healthy plate meal; being mindful of portion sizes, calories and helpful nutrition like fiber; and meeting physical activity recommendations. 

Strategies like goal setting and behavioral monitoring are key to these endeavors. Research has shown that while strictly self-directly online programs don’t seem to produce meaningful weight loss, some form of accountability is important in the process.

“In the behavioral weight management programs I lead, we also focus on emotional well-being because of the role that stress and mental health play in health behavior change. So, for example, we’ll include strategies throughout that focus on identifying and changing unhelpful thinking patterns that lead to painful emotions and unhelpful behavior,” says Hoerster.

Seek out support from others

Losing weight won’t solve all your problems. If you’re struggling emotionally while on a weight loss journey, it’s important to seek help. This could be from a trusted friend, a therapist or even a support group. There are mental health specialists who work specifically with clients dealing with body image issues, just as there are support groups just for people struggling with weight loss.

Also, losing weight is not a treatment for mental health issues. You deserve compassionate and evidence-based care in the body you have now, Erlanager says. You don’t need to wait until (or if) you lose weight to seek help.

Find ways to truly care for yourself

No, we’re not talking bubble baths or meditation sessions (but more power to you if those things help you unwind). True self-care is about giving your body what it needs. Eat foods that make you feel good and provide your body with plenty of nutrients. Find ways to exercise that actually bring you joy. Take more nature walks with your favorite people.  

“One thing that can really help people is to clarify your values — to ask yourself what you care about most in the world,” Hoerster says. “Take time to investigate that and have that be your guiding light.”  

This advice may seem simple or obvious, but it’s easy to let self-care slip when your life gets busy or stressful. And remember that no matter what size your body is, it deserves care and respect.  

“It can be hard to feel positive about our bodies. I encourage people to aim for body neutrality, to accept the body as it is because today's body is the one we get. Being overly critical of ourselves may give the illusion of success, but those benefits are short-lived.” says Foster Koth. “What I really wish is for all of us to take care of ourselves in loving, meaningful ways every day. The gentle and consistent approach has long-term benefits."