If you have ever started your morning by weighing yourself, anxiously hoping for a “good" number, only to feel a wave of shame that sets the tone for your day if the number isn’t what you hoped for, then you‘re already familiar with the power of the almighty scale. The number on the scale has become a universal measure by which health and well-being are often judged—both in others and in ourselves. When you arrive at your doctor’s office and are called back to begin your appointment, no matter the reason for your visit, the first thing the nurse typically does is take you to the scale. That order of events gives us a glimpse into how much importance is placed on a person's weight as it relates to health. Unfortunately, this fixation on weight as the primary indicator of health is deeply flawed and lacks scientific validation. While body weight can be a factor in assessing health in very specific circumstances, it is just one piece of the puzzle, and focusing solely or primarily on weight overlooks the complex interplay of factors that contribute to overall well-being. Ignoring this fact can have dangerous and devastating consequences.
The Unscientific Nature of Weight as a Measure of Health:
The belief that weight is synonymous with health has become deeply ingrained in our societal norms over the past century or so, perpetuated by media, advertising, and sadly many healthcare professionals. However, this belief is not supported by empirical evidence. I’ll repeat: this belief is not supported by empirical evidence. Before you say (as I did years before my own unlearning/relearning process), “But wait! I’ve seen several articles and studies talking about how being at a higher weight causes [insert list of health problems]!” I would ask you to look a little closer at any of those studies you are quoting. First, are they using the word “causes” as in, “Being overweight causes diabetes?” Or are they using phrases like “is associated with” or “linked to” as in, “Being overweight is associated with higher risk for diabetes?” It is easy to generalize and use those terms interchangeably, but there is a very important difference: as you learned back in statistics, research, or many science classes, correlation does NOT equal causation. Just because two variables have a relationship does not mean one causes the other, and if we are really worried about improving health outcomes, we must distinguish between the causation vs correlation and find out where we need to focus our efforts. If I want to find out what causes diabetes and why it may be related to nutrient consumption or socioeconomic status, for instance, I need to control for other confounding variables (such as genetic factors, biological contributors, access to health care, participation follow through, weight stigma, etc).
A confounding variable is an outside factor that affects the relationship between the variables being studied, making it tricky to determine their true connection. Increased salaries is associated with increased spending—does that mean getting a raise at work causes you to spend more money? Hair loss and prostate cancer are highly correlated---does that mean we need to invest in hair growth supplements in the fight against prostate cancer? People who walk slower have been found to die at younger ages—guess we better start putting some pep in our step and buy some running shoes to ensure we live to old age! You can probably begin to see how dangerous and futile it would be if we used research that way; instead of figuring out what is causing some people to walk slower (such as underlying health conditions) and treating that, we would only pay attention to the variable we can see (walking pace) and miss an opportunity to treat the variable that’s actually causing both walking slower and higher mortality rates. This type of misunderstanding of research related to weight and misattribution of weight as the be all end all of health is done on a daily basis, disproportionately to people in larger bodies, and with grave results. Instead of looking at the role that weight cycling and weight stigma has on health, as will be discussed in this article, we often focus on the number on the scale and miss causal factors we could have actually used to help people truly make positive changes in their health.
Here are an example of some questions you should ask when evaluating the empirical quality of an article or research study: Did the studies the researchers conducted control for other confounding variables? Is this source peer reviewed for validity and accuracy? Are the researchers using the gold standard in research studies, RCTs (Randomized Control Trials)? Is the organization that is funding the study or conducting the research backed by the diet and weight loss industry (who may have clear ulterior motives for keeping people hyper focused on the weight loss train)? How long were the participants followed in the study? What were the attrition rates? Numerous studies have demonstrated that weight alone is an insufficient predictor of health outcomes and does not even come close to capturing the full spectrum of health risks or protective factors.
By reducing health to a single number on the scale instead of being properly guided by quality medical research, society perpetuates harmful stereotypes and stigmatizes individuals based on their body size, leading to discrimination, bias, and disparities in healthcare access and treatment. Instead of getting the guidance and help they need, people continue to get sicker.
Weight Stigma and Its Health Implications:
Weight stigma, the societal devaluation and discrimination against individuals based on their weight, is a pervasive and harmful consequence of society's focus on the "number on the scale." Weight stigma operates on multiple levels, including interpersonal, institutional, and internalized, and has significant effects on both physical and mental health.
Individuals who experience weight stigma are at increased risk of developing psychological distress, including depression, anxiety, low self-esteem, and disordered eating behaviors. The constant stream of negative messages about body size and weight can lead to feelings of shame, guilt, and worthlessness, which in turn can exacerbate stress and contribute to the development of mental health disorders. Weight stigma has been linked to physiological stress responses, including elevated cortisol levels, increased inflammation, and dysregulation of metabolic processes. These physiological changes can contribute to the development of chronic diseases such as cardiovascular disease, diabetes, and metabolic syndrome, further exacerbating health disparities and inequalities. More on the role of stress in part 3 of this 3 part series.
The Pitfalls of Weight Cycling and Dieting:
Another consequence of society's preoccupation with weight is the phenomenon of weight cycling, also known as yo-yo dieting. Weight cycling refers to the repeated loss and regain of weight through cycles of restrictive dieting and weight regain. The process of repeatedly losing and regaining weight is harmful to the body and may actually increase the risk of poor health outcomes.
A study published in the American Journal of Epidemiology found that weight cycling was associated with increased risk of coronary heart disease and cardiovascular mortality in women, independent of body mass index. Similarly, a meta-analysis published in the Journal of the American Heart Association revealed that weight cycling was linked to higher risks of hypertension, dyslipidemia, and insulin resistance, all of which are risk factors for cardiovascular disease. Furthermore, weight cycling has been associated with adverse metabolic effects, including changes in body composition, increased visceral fat deposition, and alterations in lipid profiles, which may further contribute to cardiovascular risk. I’ll discuss how rare it is for anyone who embarks on a diet to keep the weight off and avoid weight cycling long term in the next blog post (spoiler alert—extremely rare). But with just what you’ve learned so far, you can begin to see the dangerous fallacy in simply saying that going on a diet is going to improve your health. Overall, these findings highlight the importance of adopting sustainable lifestyle changes and promoting a non-restrictive, holistic approach to health to minimize the potential health risks associated with weight cycling.
Embracing Health At Any Size and Intuitive Eating:
In contrast to the narrow focus on weight and dieting, approaches such as Health At Every Size® (HAES) and Intuitive Eating, both of which are used here at Nourished Minds Therapy, offer a more holistic and evidence-based approach to health and well-being. HAES® emphasizes promoting health and well-being through compassionate, inclusive, and sustainable practices, rather than focusing on weight loss or achieving a specific body size.
Empirical research supports the effectiveness of HAES® principles in improving physical and mental health outcomes, including reducing risk factors for chronic diseases, improving metabolic markers, and enhancing body image and self-esteem. By adopting HAES® principles, individuals can cultivate a positive relationship with their bodies, engage in health-promoting behaviors, and pursue meaningful goals that align with their values and preferences.
Similarly, Intuitive Eating encourages individuals to listen to their body's internal cues of hunger, fullness, and satisfaction, rather than following external rules or restrictions. Research has shown that Intuitive Eating is associated with improved psychological well-being, reduced disordered eating behaviors, and better metabolic health outcomes compared to traditional dieting approaches.
Read more about intuitive eating https://www.nourishedminds.net/intuitive-eating and HAES® https://www.nourishedminds.net/haes
Conclusion:
Society's focus on the "number on the scale" as a measure of health is both unscientifically validated and harmful to individuals' physical and mental well-being. Weight stigma and weight cycling, often perpetuated by dieting, are significant predictors of poor health outcomes and contribute to health disparities and inequalities.
In contrast, approaches such as Health At Every Size® and Intuitive Eating offer evidence-based, non-discriminatory, and attainable alternatives that prioritize holistic well-being over weight loss. By adopting compassionate and sustainable approaches to health, we can create a society where all individuals have the opportunity to thrive, regardless of their size or weight. Join me for part 3 of this 3 part series, where I dive into how the “weight” of this topic can itself lead directly to poor health outcomes, and some additional steps we can take live a truly healthy lifestyle.
If you would like to read more information and view studies related to the science behind Intuitive Eating and Health At Every Size®, this can be found here:
