Weight Loss: The Big Picture
So we have explored that weight loss is complicated. It’s more than short term starvation and it’s controlled by a multitude of hormones (see my two previous posts on weight loss here and here). Weight can be a really interesting data point, but it in no way should be the only data considered. Achieving a healthy weight and maintaining weight loss is associated with other factors associated with good health, like social interaction and a good sleep at night. My question is; what is a healthy weight?
Over and over again I have patients coming in with a goal weight in mind:
“I want to get back to 130 pounds.”
“I want to lose the 40 pounds I gained with pregnancy.”
“I want to be the weight I was when I was in my 20s.”
“I’m 5 pounds away from my goal weight but I’ve plateaued”
The problem is, they aren’t the same person they were then. Why that number? Why is 135 pounds not acceptable? The truth is, the number on the scale doesn’t matter. I often don’t even ask. And I have never ever suggested to a patient that weight loss SHOULD be their goal. I can be a helpful marker, don’t get me wrong, but it can change because of so many things other than fat loss. The number on the scale can be affected by if you’ve peed or pooped today, how much you’ve sweat, your overall hydration status, where in your cycle you are, or how much you ate yesterday. That number can swing 10 pounds in either direction and have absolutely nothing to do with fat. So if you weigh yourself every day, and get frustrated with the fact it’s always changing, perhaps you shouldn’t be weighing yourself every day. Instead, only weigh yourself once a month (around the same time in your cycle if you’re a person with a cycle) and you’ll have a much more accurate representation of your progress. Better yet though, don’t weigh yourself at all.
What outcomes do you measure if not weight?
What are better indicators of your progress you ask? The ways your clothes fit, for one! Or your actual measurements. Or a percentage of your starting weight (5-10% body weight loss has been shown to have massive benefits for health and fertility for men and women). Or how well you’re sleeping. Or your energy and mood. My favourite measurement is that you’re getting stronger and faster in your workouts and able to go about your daily life with energy and ease.
My biggest issue with weight loss is that our society tends to tie weight with beauty, health and fitness. The problem is, a person can be “overweight” and healthy, and “overweight” and beautiful. These aren’t mutually exclusive concepts. Need proof?
A study on older adults found that overweight adults in this category had a 13% less risk of death than those in the normal and obese categories, and those in the normal and obese categories had the same risk of death. They also found that being sedentary had a greater mortality risk than those who were active, and this effect was especially prominent in women. This is seen in other age groups as well. A BMI between 25-29.9, which is in the “overweight” category, is associated with the lowest risk of cardiovascular disease and mortality. So combine this with the research that activity lowers risk of disease, we can assume being active matters more than the weight you reach. So maybe we got the definition of a healthy BMI wrong.
Healthy = Weight = Fit = Beauty? Not so fast!
Basically, I’m saying fat can be healthy. Can fat be fit? Heck yes it can. Olympic athletes are considered to be the fittest in the world and look at the variation in these bodies and weights. If you haven’t seen the documentary Embrace on Netflix, I highly recommend you watch it. This woman was happier and running marathons at a heavier weight than she was as a “fitness” competition participant. Additionally, there was a meta-analysis done in 2014 looking at the relative influence of weight and fitness on the risk of disease. It was found that fitness had a much larger impact on health. They found that people with low physical fitness had an increased risk of disease and death, regardless of what their BMI was. So this tells me that what matters is a person is moving and is physically fit, no matter how heavy they are.
Separating weight and beauty
Lastly, we NEED to separate weight and beauty. They aren’t related. We need to stop telling ourselves they are. Attractiveness is an incredibly complicated concept, and its definition changes from year to year, culture to culture, and person to person. On of my favourite classes in my psychology undergraduate degree was Evolutionary Psychology. Which was basically a class about sexual selection. The biggest lesson was that attraction usually has more to do with indicators of health (ability to reproduce) and wealth (ability to provide for children), which is going to differ at different times, in different places, and to different people. Which tells me, it’s hot to be healthy and have your sh*t together. And there are cultures and times in history where higher weights were LITERALLY the standard of beauty. I think we as a society need to realize a one size fits all beauty standard doesn’t make sense. If the “in” body type can change, why can’t we start accepting all body types as beautiful all the time? I think we need to start recognizing that there are many ways to define beauty, and that there are no types of beauty are lesser. Don’t get me wrong, it’s not that I don’t look in the mirror sometimes and wish my skin was clearer and my love handles would go away. Those thoughts are brief though, and quickly replaced by what I love about my body and what amazing things it is capable of. And I hope that this is something everyone can start doing, because it makes life so much better.
What’s even more complicated about today’s beauty standards is that the bodies we are exposed to in media are a very small proportion of the population who are naturally skinny, or starving themselves to be skinny, have had surgery to look like they do, and on top of that are photoshopped. Not even models look like the cover of magazines. Which is why I love this movement of real bodies in advertising. We need better representation of body types in media, so kids can grow up without thinking only a few body types are acceptable.
Health is the ultimate goal
Sudden increases or decreases in weight can indicate a hormonal or health problem, absolutely. And that is good data to have. But I don’t think having a specific goal in mind is particularly helpful. So if you need to reach 130 pounds on the button because you think you will be healthy, fit, or beautiful at that weight I urge you to pick a different goal. A way healthier and more effective way to think about weight loss is to start improving areas of health and wellness that are associated with maintained weight loss and decreased risk of disease; like eating lots of veggies and little processed food, sleeping well, having a fulfilling social life, decreasing stress, and engaging in moderate physical activity. Maybe if you plateaued 5 pounds from your goal and you’ve done all the above things, and your hormones are in check, you should take that as your body’s sign that this is a good place to be. If to lose those 5 pounds you have to do unhealthy things, maybe being 5 pounds less isn’t a healthy weight for your body. I think we should enjoy feeling good in our bodies and celebrate the amazing things they can do, instead of trying to find happiness in 5 pounds less.
References
Flicker L et. al. Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc. 2010; 58:234-41
Kennedy AB, Lavie CJ, Blair SN. Fitness or FatnessWhich Is More Important?. JAMA. 2018;319(3):231–232. doi:10.1001/jama.2017.21649
Kort JD et. al. A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril. 2014 May; 101(5): 1400-3.
Mir J et. al. Impact of weight loss on sperm DNA integrity in obese men. Andrologia. 2018 Feb.
Romero-Corral A et. al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006 Aug 19; 368(9536):666-78.
Sim KA, Partridge SR, Sainsbury A. Does weight loss is overweight or obese women improve fertility treatment outcomes? A systematic review. Obes Rev. 2014 Oct; 15 (10): 839-50.
