The eternal question
Honestly, probably not.
And I don’t even know you!
But don’t worry, I can back that up.
The first thing to know is that the concept of a healthy weight is so rooted in attractiveness trends (and these are trends not facts), racism, sexism, and most of all shame. And not data based information correlating weight with health.
Even “healthy” diets aren’t rooted in health. Low fat? Low fat means higher carb and higher chemical. Low fat came from the fact that fat has more calories per gram than protein or carb. So if weight loss is purely calories in and calories out, then lowering your fat intake should also lower calories therefore weight loss. And data shows that low fat diets actually led to higher weight over time, because we didn’t have all the information about how insulin works and what it is affected by. Low calorie, same thing. Our bodies are going to think we are starving and pump out more insulin.
A key part of working with patients where weight is concerned is to separate how we feel about how we look and how we FEEL in our bodies. Counselling is hugely important when navigating these concepts. It’s hard to reprogram ourselves to think positively about our bodies when there are huge industries out there profiting from us feeling badly about ourselves and pumping out massive amounts of marketing to get us and our wallets. Not only do we need to separate health and weight, but also value as a human and beauty from weight. The fact is these aren’t the same things, and once we become more comfortable with that, our mental health improves.
BMI is stupid
BMI was just dividing people into 4 categories of weight and arbitrarily deciding which one the healthy one was and labelling the rest varying degrees of not healthy. Ok that’s not exactly how it happened, it was more like some old dude in the late 1800s/early 1900s used math to put a number to a body type for life insurances purposes, and then used a small sample of men to determine what average was and then we have been stuck there ever since. We have done some more research in the modern time but it’s still really limited and doesn’t take muscle or genetics into account.
If we look at how health outcomes are affected by fitness, we find a really interesting effect; BMI matters way less. Many studies have shown that if someone is in the obese category their risk of mortality is drastically decreased, like HALVED, if they are fit and active. But these people are still in the obese category. So it is not necessary to be in the normal weight category in order for health outcomes to improve.
There are some weight measures that are more associated with poor health, and that is abdominal fat distribution, or waist circumference. I think it’s important to understand why this is associated with health. The tendency for fat to get stored around the belly and organs is associated with poor insulin function. Fat cells themselves have hormonal function and can be very inflammatory for various reasons, but what is more impactful here is that insulin is a hormone and has a ton of effects beyond just stimulating weight gain around the middle. The health issue then is the insulin, and not inherently the waist circumference. You can have healthy insulin and not have a flat stomach. Which is one of the many reasons that I am here to help you get healthy, but I’m not using your weight to track our treatment progress.
What does weight indicate?
There are several different systems that I’m looking at when unexplained weight changes happen. But before I get into that, let’s define what unexplained means. So did you used to be a marathon runner and you recently stopped? Did you start lifting really heavy weights? Did your diet change (for the worse)? These would be explainable. If you starting lifting really heavy, then your weight will go up with your muscle mass increasing. Which I’m really happy about! Good for you! If you used to run marathons and you stopped, then your body was used to a certain amount of activity and your diet may not have adjusted for less activity. In addition, an excessive amount of cardio is similar to a very low calorie diet, and when you take a break your body thinks you went from a famine to feast and it’s going to try and protect you by putting on weight. So unexplained means that absolutely nothing in your life changed, or the things that usually affect your weight are no longer having that effect.
So if there isn’t any change that would explain a weight change, we look at sleep, stress, insulin, gut health and thyroid as our main systems. I use a combination of lab work and symptoms to determine which or how many of these are issues, and then which strategies we use to tackle them. However, my outcomes are that your labs look good and you feel energetic and good in your body. Not a number on the scale.
If you shouldn’t lose weight, what should you do?
So let’s stop promoting unhealthy behaviours to reach a “healthy” weight, let’s stop having a goal weight, and let’s learn to love our bodies all the ways it looks over our whole lives.
Church, T. S., LaMonte, M. J., Barlow, C. E., & Blair, S. N. (2005). Cardiorespiratory Fitness and Body Mass Index as Predictors of Cardiovascular Disease Mortality Among Men With Diabetes. Archives of Internal Medicine, 165(18), 2114. https://doi.org/10.1001/archinte.165.18.2114
Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N., & Taylor, H. L. (2014). Indices of relative weight and obesity. International Journal of Epidemiology, 43(3), 655–665. https://doi.org/10.1093/ije/dyu058
Koster, A., Harris, T. B., Moore, S. C., Schatzkin, A., Hollenbeck, A. R., van Eijk, J. Th. M., & Leitzmann, M. F. (2009). Joint Associations of Adiposity and Physical Activity With Mortality: The National Institutes of Health-AARP Diet and Health Study. American Journal of Epidemiology, 169(11), 1344–1351. https://doi.org/10.1093/aje/kwp053
