“But What if I Need to Lose Weight for Health Reasons?”
As a Health at Every Size (HAES)-aligned dietitian, one of the most common concerns that I hear regarding the weight-neutral approach is something along the lines of “but what if I need to lose weight for health reasons?”.
From medical professionals to strangers on the internet, we are constantly fed the idea that being “overweight” and “obese” is unhealthy and that those in larger bodies should be doing everything they can to be thinner. But will being thinner actually make you healthier?
If you’re new here, hello and welcome! My name is Hannah and I am a non-diet dietitian and personal trainer here to help you improve your relationship with your food and exercise and finally find food freedom.
Before we proceed, I want to acknowledge my thin privilege. Although I have worked closely with hundreds of people in larger bodies, I have limited personal experience with fatphobia from medical providers, family members, or strangers. I too am a victim of diet culture and have felt the pressure to lose weight, but never from the perspective of someone who is experiencing weight stigma. While I am a HAES-aligned dietitian, I recommend learning more about HAES and fat activism from others in larger bodies. I have a list of some of my favorites in this post.
One more disclaimer: I typically put terms such as “overweight” and “obese” in quotation marks because such terms create the assumption that there is a correct or “normal” weight that people should be at, and it you are above it, you are abnormal or different. As we will discuss, this is not necessarily the case. I also do not use the word “fat” as a derogatory term. “Fat” is nothing more than a neutral descriptor, though diet culture has assuredly turned it into a word with negative connotations.
Table of contents:
The risks of intentional weight loss
A fun fact about me - I used to be a weight loss dietitian. Yes, you read that correctly. Every day, I was prescribing weight loss as a solution to my clients’ ailments.
I quickly found that pursuing intentional weight loss was not only physically and mentally difficult for my clients, but also nearly impossible to maintain and it came with many negative side effects, including:
Disordered eating and increased risk of developing eating disorders (dieting is the largest predictor of eating disorders)
Poor body image and body dysmorphia
Weight cycling (which is associated with many health risks including shorter life span and various chronic diseases)
Decreased metabolic rate
Worsened relationship with food and exercise
Mistrust of hunger and fullness cues
Not only is dieting risky, but it is also very challenging to maintain any “success” (aka weight loss). While most dieters are able to lose weight in the short term, most people who lose weight through dieting eventually regain the weight (and then some). This is known as weight cycling. It is possible that the association between weight and health risk can be better attributed to weight cycling than body size.
Is being overweight unhealthy?
If you have ever wondered if being “overweight” or “obese” is unhealthy (which I’m guessing you have if you clicked on this post), you are not the only one. We are constantly being told that larger bodies are an issue that must be remedied. Maybe you’ve even heard that stat about “obesity” costing our healthcare system billions of dollars (*cue eye roll and heavy sigh. What does this even mean?).
@dietitianhannah Replying to @pegbundy82 it’s pretty tough for people to eat “healthy” and “clean” when they don’t have access to food #socialdeterminantsofhealth #dietculture #wellnessculture #dietitian #dietitiansoftiktok #dietitianhannah ♬ original sound - Dietitian Hannah
It’s very important for me to point out here that health is not a moral obligation. You do not owe anybody “health”. Whether you are thin or fat, health is not something that should stand in the way of you receiving care and respect from others. Not to mention that “health” is very difficult to define and it looks different for every person.
Health also goes so so so far beyond a number on the scale. Even as a medical professional, I cannot just look at a patient’s weight and identify if they are healthy or not. Bodyweight is simply one data point, and a pretty finnicky one at that.
When discussing health, we also must discuss both mental health and the social determinants of health. Health is much more than just physical wellbeing. If a person lost weight but now struggles with an eating disorder, are they still considered healthy? I would have to say no, they are not.
I know some of you might be thinking - “Geez Louise, just give me a straight answer. Is being fat healthy or unhealthy?” But it truly is not that simple. Nuance is a critical part of any discussion regarding a person’s health.
Correlation vs. causation
Contrary to what you may have heard in the past, being at a higher weight has not been shown to cause disease. There are also not any health conditions that exist solely in fat people. Shocking, I know!
Despite what healthcare professionals and popular media will tell you, there is currently no research that provides that higher weight or body fat causes disease like heart disease, cancer, or type 2 diabetes. Even if these studies show higher rates of disease at higher weights, many other factors can be contributing to the increase in disease, such as genetics, environment, weight stigma, and behaviors like exercise and dietary choices.
Weight stigma and health
You know what may be worse for your health than being “overweight”? The fatphobia that you undoubtedly experience if you are “overweight”.
Weight stigma is internalized negative attitudes and discriminatory acts targeted towards individuals because of their size, shape, or weight. Examples of weight stigma include:
Receiving negative comments about your weight, including from healthcare professionals.
Poor treatment by coworkers or bosses because of your size or shape.
Higher insurance premiums because of weight.
Being required to lose weight for a medical procedure, such as a joint replacement, organ transplant, or infertility treatment.
Studies show that weight stigma increases the risk of high blood pressure, metabolic syndrome, diabetes, high cholesterol, and eating disorders. There is compounded stigma that exists for those in marginalized groups who are also stigmatized for disability, race, gender, age, and sexual identity.
Most of the differences we see in health outcomes between thin and fat people likely has more to do with weight stigma than weight itself. People with higher bodyweights tend to avoid going to the doctor because they are shamed for their weight and conditions may be dismissed due to their body size. I have heard countless stories from patients, clients, and people in my DMs that state they have gone to their primary care provider for something like a sore throat and left with a handout on what diet they should go on.
Those in larger bodies also experience a myriad of extra stressors that those who are thinner may not such as finding clothes that fit, being on the receiving end of fat jokes, and anxiety about fitting comfortably into a chair when they go out to eat or when on an airplane.
Will weight loss improve my health?
You have likely seen many dieting “success stories” on TV, in magazines, and on social media. You know what I’m talking about - people share their before-and-after photos with quotes about how much healthier they feel now that they are thinner. While it is easy to assume that shedding pounds made them healthier, was it actually the weight loss that made them feel better? Or was it the behavior changes that they made that also happened to result in weight loss?
Contrary to popular belief, there is never a good reason for a medical professional to prescribe weight loss. We don’t have any evidence that weight loss alone improves a person’s health or lowers their risk of disease. And even if we did, there are not any known weight loss approaches that come without risk.
Now, this does not mean that weight loss is inherently “bad” or “unhealthy”, just as weight gain is not inherently “bad” or “unhealthy”. Some individuals do lose weight when they stop dieting, especially if they were previously binge eating, emotionally eating, or in any other fashion eating more than what their body needs.
@dietitianhannah Not to mention that you don’t owe anybody health and some people do all the things “right” and are still “unhealthy”. #weightneutral #weightneutralapproach #weightcentric #foodfreedom #edrecocery #bedrecovery #intuitiveeating #type2diabetes #pcos #highcholesterol #antidietculture #nondietapproach #dietitiansoftiktok #dietitianhannah #greenscreen ♬ original sound - Dietitian Hannah
Does BMI matter?
Body mass index (BMI) is a very commonly used metric in healthcare used to assess health risk associated with bodyweight. BMI is used to classify individuals as “underweight”, “normal weight", “overweight”, or “obese”.
The truth is, BMI provides very little insight to health status. If you do not fit within the “normal” BMI classification, that is okay. As we’ve discussed, the size of your body does not paint the full picture. Learn more about the issues with BMI here.
If not weight, then what?
So if intentional weight loss is not the goal, how can we improve our health?
First of all, I’m gonna say once again that your health is not a moral obligation. While it is of course okay to try and make health improvements, it is also okay if you aren’t always “self-helping” yourself. It’s okay to just be.
That said, behaviors (note: weight loss is not a behavior) are what is shown to impact health the most. When someone incorporates joyful movement, manage stress, and eats nutrient-dense foods, disease markers like blood pressure, cholesterol levels, and blood sugar may improve even if weight is not lost.
Weight is frequently used as a measure of success. The common belief is that if we lose weight, we are doing things "right" and if we don't lose or we gain, we are doing things "wrong". This often leads to giving up on the beneficial behavior changes.
Rather than using weight as a measurement of health, I challenge you to focus on how you feel, your energy levels, your relationship with foods, your stress levels, and your sleep patterns.
How to let go of the desire for weight loss
We have been conditioned to believe that being thinner is better, so it is okay if you have the desire to lose weight, even after reading this post. This desire to be smaller won’t go away over night. Body image work is hard and it goes far beyond the concept of “just love yourself”.
Here are a few questions you can ask yourself to start unpacking the belief of the thin ideal:
What are you beliefs about weight and body size? Where did you learn these beliefs?
Has pursuing weight loss ever worked for you long-term?
How has pursuing weight loss made you feel? Is there anything you had to compromise to reach your “goal” weight? What physical and emotional harm did you experience while dieting?
What did you miss out on while dieting and pursuing weight loss?
Who is benefiting from making you feel like your body does not deserve love unless its smaller? Who profits from telling you that you need to change?
If you are thinking “If I don’t weigh myself, how will I measure my progress? If I accept my body then I won’t be motivated to make any health changes.” - just know that the opposite tends to be true. People are less likely to make long-term health-promoting changes when they are told they are “overweight” or “obese” and need to lose weight for “health”. The underlying message with this concept is that something is wrong with your body and there is a correct weight that you should be at. This is not very motivating if you ask me. And we also cannot know for sure what your healthiest weight truly is.
A number on the scale also does not paint a full picture. Weight loss is not always inherently health-benefiting. Instead of using the scale as a measurement of success, try focusing on health-promoting behaviors. How are you sleeping and managing stress? Are you able to sneak in more fruits and veggies? Are you drinking enough water? Have you found a form of exercise that you like and can maintain? Your weight will settle where it would like to be when you are taking care of your body to the best of your ability.
What is Health at Every Size (HAES)?
Health at Every Size (HAES) weight-inclusive approach to health with goals to promote health equity, support the end of weight discrimination, and improve access to quality healthcare regardless of size.
Can I really be healthy at any size?
Health at Every Size does not mean that every body is healthy at every size. For example, I would not be my healthiest if I was 75 pounds heavier or 75 pounds lighter than I am now. I personally feel my healthiest within my current weight range But this does not mean that everyone else should also weigh what I weigh. Everybody’s “best weight” is different.
All bodies are healthy at different sizes. This does not mean that your body will be healthy at every size, although you likely will experience weight changes throughout your life. Your “healthiest” weight will ebb and flow.
HAES has many critics and the concept is very controversial. I discuss HAES and its common criticisms in more detail in this post.
Bottom line
Pursuing weight loss for “health reasons” is a bit of an oxymoron. There are many health risks that accompany intentional weight loss from dieting.
Your health is not a moral obligation. You do not owe anybody “health” and you are deserving of care and respect whether you are “healthy” or “unhealthy”.
You are not alone if you believe that the best version of yourself is the smallest version. This is what diet culture tells us on a daily basis. If you are new to the HAES concept like I once was, I hope you can practice open-mindedness as you learn more about about the weight science without the stigma.
Disclaimer: this post is for informational and educational purposes only and is not a substitute for professional medical advice.
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