Some argue that obesity does not necessarily increase your health risks. Science suggests otherwise.
Some argue that obesity does not necessarily increase your health risks. Science suggests otherwise.
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Turning down the food noise, with Dr. Nina Crowley (Nutrition Diva #760)
Ozempic plateaus, muscle loss, and more (Nutrition Diva #738)
Why Weight Loss Is Harder for Some than Others (Nutrition Diva #616)
Mentioned in this episode:
Separate and combined associations of obesity and metabolic health with coronary heart disease
Cardiovascular risk of metabolically healthy obesity in two european populations
Hello and welcome to the Nutrition Diva podcast. I’m your host, Monica Reinagel, and today I want to talk about the role that body weight plays on health–because this is a subject of some debate.
The Health at Every Size movement promotes acceptance and appreciation of one’s body, regardless of your body size. It encourages people with overweight and obesity to shift their focus from losing weight to other healthy habits, such as eating healthy foods and getting more exercise. Some physicians and dietitians who embrace this philosophy even refuse to counsel people on weight loss. It’s OK if their clients lose weight as a result of changing their health habits. But that shouldn’t be their goal.
Part of this is a response to the harmful stigmatization and discrimination that people living in larger bodies have long experienced. People with overweight and obesity face bias and discrimination in many aspects of their lives, including health care. Numerous studies have shown that people with larger bodies receive substandard care and less support from their health care providers. Because obesity is more prevalent among low-income individuals and minorities, a bias against patients who are overweight can disproportionately affect these disadvantaged groups and contribute to a downward spiral of poor outcomes.
The Health at Every Size movement is also a pushback against so-called diet culture. And I get it. The relentless pressure to be thin and the means by which this ideal is promoted and pursued has caused untold psychological and physical suffering.
However, this philosophy also came of age in an era when available treatment options for obesity were pretty ineffective. Short of bariatric surgery, most attempts to achieve and maintain significant weight loss failed.
But over the last few years, we have seen a dramatic sea change in the treatment of overweight and obesity, triggered by new medications known as GLP-1 agonists. I’ve discussed various aspects of these medications in previous episodes and we’ll include a link to those in the shownotes.
These medications have not only been found to be remarkably effective in promoting weight loss but also in reducing risks from a range of other conditions, including Type 2 diabetes and cardiovascular disease.
Nonetheless, some self-described “fat activists” continue to insist that overweight and obesity are not diseases that need to be treated. Rather, these are perfectly healthy, natural body types that have been unjustifiably pathologized. They argue that you can be what the medical world considers obese but still be “metabolically healthy” if other indicators, such as blood pressure, blood sugar, and cholesterol, are in healthy ranges.
Let’s take a closer look at the science.
Now, it is true that the number on the scale does not tell the whole story about your health.
Body weight and body mass index (BMI) doesn’t take into account body composition. A very muscular person may have a BMI that’s considered overweight or obese, when they are no such thing. On the flip side of the coin, someone with a low BMI may still have a high amount of visceral fat—the so-called “skinny-fat” phenomenon—which increases disease risk.
It’s also worth pointing out that the conventional criteria for healthy body weight are based primarily on Caucasian body types and may not be appropriate for people of all races and ethnicities.
However, a study involving over half a million subjects, published in 2018 found that even for those with normal blood pressure, blood sugar, and cholesterol levels, simply being overweight increased the risk of heart disease by 28%. “We conclude that there is no such thing as being healthy obese,” said lead researcher Camille Lassalle.
More recently, a 2023 study observed that indicators of metabolic health, such as high blood pressure, high blood sugar, or a high waist to hip ratio, were a stronger short-term predictor of cardiovascular events than BMI. But even for those considered metabolically healthy, a higher BMI signaled a higher risk of trouble ahead.
In other words, simply being in a so-called healthy weight category does not guarantee smooth sailing, if you have other risk factors. But all things being equal, those in a healthy weight category have a lower long term risk.
So, your weight does matter. But it’s certainly not the only thing that matters.
If you are carrying extra weight, losing some of it would likely decrease your risk of various diseases, especially if you go about it in a sane and sustainable way. But choosing healthy foods and being active can also help you be healthier at your current weight.
Being as healthy as you can be at your current size may also be a bridge to a healthier size in the future. Many years ago, I profiled a reader who quit smoking cold turkey after being a heavy smoker for more than a decade. After she quit, she was surprised to find that she was suddenly more interested in nutrition and health—something she’d never really paid attention to before. She started going to the gym and eating healthier.
As she explained it to me: “I knew smoking was about the worst thing I could do and because I was smoking, it just didn’t seem worth doing anything else for my health. So I never bothered about nutrition or exercise or anything else. I figured I was a lost cause.”
In the same vein, the Health at Every Size philosophy tries to upend the attitude that exercise and vegetables are only for thin people. It encourages people to pursue healthy habits even if they are overweight, and offers ways to evaluate and measure progress other than simply stepping on the scale. For those who have been demoralized by a history of failed weight loss attempts, that may be especially valuable.
Indeed, research shows that interventions based on Health at Every Size principles, led to improvements in eating attitudes, perception of body image, physical capacity, and health-related quality of life, without significant changes in body weight and physical activity levels.
That’s a goal absolutely worth pursuing. But it doesn’t have to be one or the other. We can and should support people in living the healthiest life they can enjoy living, regardless of their body size. As I often say to my own clients, every step in the right direction is a step worth taking. And, in many cases, the more steps you take, the more possible those next steps become.
If you have thoughts you’d like to share about this topic, I’d love to hear them. You can email me at nutrition@quickanddirtytips.com You can also leave me a message at 443-961-6206
If you’re looking for more support for healthy weight management, please check out the tools and resources at weighless.life, where my goal is to help people create habits, mindset, and lifestyle that help them weigh less without dieting. That’s at weighless.life
Nutrition Diva is a Quick and Dirty Tips podcast made possible by the contributions of Brannan Goetschius, Nathan Semes, Davina Tomlin, Holly Hutchings, Morgan Christianson, and Kamryn Lacy.
That's all for this episode. Thanks for listening! I'll see you next week.