People can be obsessed about weight, both their weight and the weights of others. Diet fads come and go frequently. About half of Americans have been trying to lose weight. Meanwhile, fat shaming is pervasive. Fat people have plenty of stories of being emotionally wrecked by people who see weight as a primary metric of worth. Some even advocate for shaming as the ethical thing to do, claiming that it will motivate them to get healthier, even though the evidence suggests that fat shaming might actually have the opposite effect.
Being healthy is good. So, what helps people be healthy?
It’s clear that obesity often has significant negative health effects. Obesity is associated with a higher risk of stroke, diabetes, cancer, body pain, and overall mortality risks compared to those who have a healthy weight. So, it makes sense to be concerned with helping obese people lower their weight. The mainstays for this are exercise and diet. Problem is, those kinda suck. One 2015 study found that “patients who engage in a PA [physical activity] program may experience modest weight loss(<2 kg [~4.4 lbs]), but no weight loss is possible.” In general, diets were more consistently associated with weight loss. How well do diets help with weight loss, then? A 2014 study found that after six months, the best diet they looked at found a loss of about 22 pounds. That’s not as great as it sounds. The average American is about 5 feet 6 inches tall. If their BMI is 30, just barely registering as obese, they’ll be 186 pounds. A loss of 22 pounds puts their BMI at 27, or still firmly overweight. In addition, people tend to gain back the weight they lost: a person on the same top-performing diet for six months tends to lose progress over the following six months, regaining eight pounds, for a net weight loss of 14 pounds.
To be clear, this is a significant amount of weight loss. The average 5’6” person at 164 pounds is healthier than the average 5’6” person at 186 pounds. My point isn’t “diets don’t make you healthier” but rather “diets probably won’t make an obese person lose 40+ pounds.” And certainly, some people can successfully lose enough weight to go from obese to what’s considered a healthy weight, but for most that’s an extremely high bar to clear.
What if we didn’t center weight as the primary metric of health? What if we accepted that it’s incredibly difficult to lose weight and considered losing weight as just one of several ways to be healthy?
While it’s true that obesity typically is associated with a number of problems, one can be obese and healthier than a skinny person. “Healthy obesity” is the term for when an obese person has normal levels of blood pressure, blood glucose, and blood lipids. A 2016 study found that healthy obese people had lower risks for stroke, diabetes, and general mortality than unhealthy people. As it turns out, the three metrics of blood pressure, blood glucose, and blood lipids are a stronger measure of risk than obesity!
One of the earlier cited studies says the following: “Exercise training, regardless of weight loss, provides numerous health benefits especially for overweight and obese individuals at risk for CV diseases or with current CV conditions.” Meeting the CDC’s recommended exercise levels helps reduce the chances of heart attacks, diabetes, cancer, and general mortality, among other benefits. These guidelines aren’t too hard to reach! They’re very achievable, and the majority of Americans aren’t achieving them yet.
We can do better than obsessing about weight. We can see better results easier by changing our diets to push our lipids and glucose levels down and exercising to meet CDC guidelines. We don’t have to be jerks to fat people in the process of making society healthier.