Do I Need to Be Thinner to Be Healthy?

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It's no longer politically correct to admit you want to be thin(ner) for appearance sake. Now it's all about "healthism."

Many women I work with are absolutely convinced that they can only be healthy if they are thin(ner). Usually, these are women who have been dieting, hating their bodies, being obsessed with food, binge eating, compulsive overeating, or who identify as emotional eaters or individuals with food addiction. They may be as young as 25 or as old as 70. What they have in common is the desperate need to be thin(ner). But they also realize that dieting hasn't worked for them, at least not as a way to reduce their weight.

Many now hold out the hope that they can still be thin(ner) as a way to be healthy. This is called "healthism"—defined as the preoccupation or obsession with personal health as a primary focus for the definition and achievement of well-being, a goal which is to be attained primarily through weight loss. In other words, the feeling that you can't be healthy without being thin or thinner. This has come up even more strongly during the pandemic, where weight is being identified as a risk for coronavirus infection.

But as for other medical conditions linked to weight, that's not the whole story. The focus is only on the number on the scale. Maybe your doctor told you how much you weight is a risk factor for diabetes, heart disease, cancer, and now, COVID-19. But research that focuses only on the number on the scale rather than on the numbers that matter most doesn't tell the whole story—the measures of good health that actually matter—physical activity, your metabolic fitness, and your overall heart and lung fitness. Because you can be healthy no matter your size.

No matter what you've heard, let's get real about the myths vs. the facts.

1. Myth: Fatness takes years off your life. In a large review of studies on the impact of weight on health, it was found that:

• Eighty-seven percent of studies on people with body mass index (BMI) of 30-35 showed that the majority were as healthy as people in the "normal" weight category.
• Sixty-seven percent of studies on people with BMI of 35-40 and over 40 (representing just 6 percent of the U.S. population) showed no difference in health risks from "normal" weight categories—including having no decrease in longevity (Flegal et al. 2013).

2. Myth: Fat causes disease. While rates of obesity (as determined by BMI) have more than doubled, the rates for diabetes (often used as an example of this myth) have only gone up 9-11 percent. If fatness causes diabetes, the rates of diabetes should have gone up a lot higher. Also, rates of heart disease have actually gone down even as obesity (as determined by BMI) rates have doubled.

3. Myth: We have evidence that weight loss improves health. The National Institutes of Health ran a 15-million-dollar, 15-year study and were unable to prove that a therapeutic diet and weight loss could reduce the risk for strokes, heart attacks, and heart disease. Some good things happened in this study: Participants were able to keep off 6 percent of their weight (better than most diet programs), and diabetics were better able to manage their diabetes without medication. But this huge study was not able to show that weight loss improves health risks.

In her book, Health at Every Size, Linda Bacon wrote, "We've lost the war on obesity. Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier." She goes on to say that: "extensive collateral damage” has resulted (from the war on obesity), including food and body preoccupation, self-hatred, eating disorders, discrimination, poor health, etc. Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat."

So, where does that leave you if you really want to improve your overall health? It could lead you to make peace with food and with your body because we know from Traci Mann's book Secrets from the Eating Lab that:

1. Exercise lowers health risks, even without changing the number on the scale.

2. People who are active, no matter their size, have lower rates of sickness and death than those who are thin(ner) and not active.

Other research has shown that:

1. Cancer risks are more related to what you eat than what you weigh. We know that increasing foods high in antioxidants lowers cancer risk.

2. For diabetes, exercise lowers your risk even without weight loss.

3. To lower heart disease risk, don't smoke, keep blood pressure under control, and exercise.

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A few more sobering facts:

Being more satisfied with your body has been associated with better health outcomes, no matter what your weight is.

Yo-yo dieting is thought to be the cause of differences in health between those living in larger bodies and those in "normal" weight bodies. In other words, dieting makes weight go up in the long run, not down.

Not all of us have blonde hair or blue eyes or are tall. In the same way, not all of us will be thin, no matter how hard we try. This is just plain Poodle Science.

This knowledge could lead you to make peace with food and with your body because it can enable and empower you to find the root cause of your problems with food and your body, which often has to do with toxic stress or adversity in childhood—abuse, neglect, living in families struggling with addiction or mental illness, witnessing domestic abuse, divorce, or having a family member who was incarcerated.

Research from the Adverse Childhood Experiences Study demonstrates that the true cause of diabetes, cancer, heart disease, and other chronic diseases may start in childhood.

Getting thin(ner) won't fix your childhood experiences. But healing from these experiences can give you help with food addiction, freedom from emotional eating, and fewer food obsessions from food addiction. You get to choose: What do you want to spend your time and money on?