What Science Says: Why Weight Isn’t a Reliable Indicator of Health Status (Part 1)
Even with progress in how we view and define health over the last few years, we still have a ways to go.
Think of how often we get hit with weight-centric approaches to "health", and if you were born before 2000, you know it all too well as part of your adolescent and adult years.
…The endless diets to help you lose “20lb” for New Year’s resolutions
…Your doctor telling you that you need to lose weight in order to solve XYZ health problem
…Weight-loss challenges at your local gym – or worse, your workplace
If you’ve ever felt “stressed” or hyper-focused on your weight, you aren't alone!
In Part 1 of my blog series, let’s review what weight bias is, 5 reasons why weight isn’t an accurate indicator of health, and why focusing on behaviour change and consistency with healthy behaviours can be more impactful instead.
Weight Bias in Healthcare & Society
Body weight is a very small part of the overall picture of our health. It literally tells us how much our body weight is in total.
But it tells us nothing about what’s going on inside our body. So, why do we place so much emphasis on it?
Well, for starters we live in a weight centred society. We’re constantly told to be smaller, and to look smaller.
The healthcare world is not exempt from weight stigma and bias. A study on 400 Canadian family physicians revealed a high prevalence of weight bias, as 49% agreed that individuals who were categorized as obese raises stress on the healthcare system, while 33% noted that they “often feel frustrated with patients who have obesity” [1].
As a consequence of these ‘implicit biases’ (aka unconscious stereotypes or opinions towards a certain group of people), there may be poor diagnosis and treatment for the patient, as well as their overall distrust in healthcare providers [2]. For example, someone may not get adequate investigation into a certain disease, because it is assumed that their problems are solely related to their weight, diet and eating habits alone.
Negative stereotypes and statements that can contribute to weight stigma and bias such as: ‘You need to cut out carbs’ or ‘You’re not moving enough’, place blame on the individual, rather than also considering other genetic and environmental factors. Because, truly, our health is affected by MORE than just our individual actions - our environment, upbringing, socio-economic status all play a role.
Therefore, individuals who experience weight bias are often more likely to avoid seeking medical attention to avoid stigma.
What is Health?
According to the world health organization, “health is a state of physical, mental and social well-being, not just the absence of disease or infirmity”
Health is holistic. Our body is complex, and so why wouldn’t health be as well?
The Issue With Focusing Solely on Weight Loss Goals
Have you ever been determined to “lose weight”? Here are 5 reasons why you should consider not focusing solely on weight loss, and more on your overall health and “desired behaviours” (aka healthy habits).
BODY WEIGHT DOES NOT TELL US ABOUT BODY COMPOSITION
Body Composition describes the makeup of the body concerning fat, bone, water and muscle. When just body weight is measured, it does depict a full picture of the overall composition of the body.
It does not differentiate between body lean mass and body fat mass or indicate body fat location. Therefore, a person may fit within the classification of a ‘normal’ body weight, but have a high body fat percentage.
Consider, individuals that are more muscular or are athletes, they may have a high BMI because of greater muscle mass.
2. WEIGHT FLUCTUATES ALL THE TIME
Body weight can fluctuate due to various factors. Within a day, your weight in the morning might differ from your weight at night simply due to water and food consumption, urination, digestion, etc. This makes constantly checking the scale redundant as it is not indicative of actual weight change. Most people fluctuate up and down 4-5 pounds each day!
Furthermore, weight is often affected by stress, mood, menstrual cycles, diet, physical activity, age, etc [3]. These are all long-term factors that affect weight. It is SO important to be aware that weight loss or gain can be indicative of many things, some of which are not controllable!
3. LOWER WEIGHT IS NOT ALWAYS HEALTHIER
An interesting pattern called the obesity paradox has demonstrated that obesity is not actually linear with mortality. In fact, obesity is associated with greater survival for diseases including cardiovascular diseases, hypertension, type 2 diabetes, etc. than thinner individuals [3].
This demonstrates that lower weight does not equate to being healthy. Body weight is simply one measure of health and is not able to define something as complex as your health or overall well-being.
4. WEIGHT LOSS CAN AFFECT MENTAL HEALTH
Research has shown that dieting can result in greater chronic psychological stress, as well as increased cortisol production [4]! Both are known contributors to greater disease risk such as diabetes, high cholesterol and more.
Additionally, placing value in weight loss quite literally gives us anxiety about our weight [3]. It can encourage disordered eating behaviours such as binge eating, and can result in decreased physical activity levels and greater weight gain long-term.
P.S. If you are interested in learning more about the correlation between mental health, wellness and nutrition?
Check out my Nutrition for Mental Health & Wellness webinar that includes an online training, mental health meal plan, and comprehensive guides!
5. WE LOSE FOCUS ON PAYING ATTENTION TO OUR BODY & BEHAVIOUR CHANGES
While, greater body weight and obesity is associated with adverse health risks, there is little evidence on the cause and effect relationship between these two factors.
To ignore other factors such as socioeconomic status, diet, physical activity levels, etc. would be ignorant of the variables that contribute to our overall wellness and health. Have you ever thought about this?
Studies that factor in these variables, when studying the relationship between obesity and disease have shown no greater risk or significantly reduced risk for disease [3].
Focus on Behaviour Change, Not Weight
When we use the weight on the scale to measure our progress, this is where issues can occur. Instead of focusing on habit changes and consistency with those changes to support our health, we become fixated on the number and it detracts from the holistic picture.
Rather than focusing on weight as the goal, focus on your consistency with the behaviours that will support health and your body.
For example, we know that sleep hygiene, movement, eating a protein and fibre rich diet, and managing stress all support our metabolism.
So focusing on setting goals in those areas would be key to supporting your overall well-being. For example: make your goals eating more protein each day, and limiting eating out to once a week. Focus on your consistency with this and track your habits each week. Make this your tracking goal, NOT the number on the scale.
Remember: if you’re only seeing the weight on the scale change as progress, this sets you up for failure long term.
P.S. This can be challenging alone, and if you’re struggling to determine what to do to best support your physical health, work with a professional. Working with a Registered Dietitian that can help you create healthy food habits, balance your activity, and create sustainable goals to feel your best in your body can be a game-changer for your health in the long term.
What if I Still Want to Lose Weight?
You may be at a size that feels uncomfortable, and you know that your habits aren’t currently supportive of your optimal health. Wanting to be the right size that feels good for you is absolutely OK. Perhaps you want to feel lighter and have clothes fit better. Or you know that you do carry some additional fat in your abdominal area, and this could be impacting your health.
Well, rather than worry about the weight number on the scale changing – ask yourself: how would my life be different if I lost X number of weight?
If your answer is along the lines of having more energy, feeling like clothes fit better, or fostering healthier habits, these are your measures of progress to monitor!
If you resonate with this, you’ll want to read: 10+ Ways to Measure Your Health & Progress Without the Weight Scale (Part 2)
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References
[1] Canada, P. H. A. of. (2020, December 9). Discrimination in the health care system among higher-weight adults: Evidence from a Canadian national cross-sectional survey [Research]. https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-40-no-11-12-2020/discrimination-health-care-system-higher-weight-adults.html
[2] Examining Weight Bias among Practicing Canadian Family Physicians. (n.d.). Retrieved May 8, 2023, from https://karger.com/ofa/article/12/6/632/240926/Examining-Weight-Bias-among-Practicing-Canadian
[3] Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1), 9. https://doi.org/10.1186/1475-2891-10-9
[4] Tomiyama, A. J., Mann, T., Vinas, D., Hunger, J. M., Dejager, J., & Taylor, S. E. (2010). Low calorie dieting increases cortisol. Psychosomatic Medicine, 72(4), 357–364. https://doi.org/10.1097/PSY.0b013e3181d9523c
[5] Fatigue: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved May 9, 2023, from https://medlineplus.gov/ency/article/003088.htm
[6] Mind & Mood. (n.d.). Harvard Health. Retrieved May 9, 2023, from https://www.health.harvard.edu/topics/mind-and-mood
[7] What Is Sleep Hygiene? (2009, April 17). Sleep Foundation. https://www.sleepfoundation.org/sleep-hygiene
[8] Colten, H. R., Altevogt, B. M., & Research, I. of M. (US) C. on S. M. and. (2006). Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. In Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK19961/
[9] Target Heart Rates Chart. (n.d.). American Heart Association. Retrieved May 10, 2023, from https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates
[10] Comprehensive Metabolic Panel (CMP): MedlinePlus Medical Test. (n.d.). Retrieved May 10, 2023, from https://medlineplus.gov/lab-tests/comprehensive-metabolic-panel-cmp/
[11] The Facts About High Blood Pressure | American Heart Association. (n.d.). Retrieved May 10, 2023, from https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
[12] How does the immune system work? (2020). In InformedHealth.org [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK279364/
[13] Your menstrual cycle and your health. (n.d.). Retrieved May 10, 2023, from https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle-and-your-health