Have you ever heard these?
“If you just try hard enough you can lose weight.”
“If you live in a bigger body, or gain weight, even a few pounds, you should lose weight. It’s simple and 100% within your control.”
If your Body Mass Index (BMI, which is simply your height to weight ratio,) labels you as “overweight” or “obese,” societal assumptions are made that you’re lazy, lack willpower, don’t care about your health.
Oversimplified and inaccurate ingrained beliefs like these have led to cultural weight bias, an obsession with the number on the scale and weight-centered approaches that are harming, not helping, health.
“Humans are not machines,” says Registered Dietitian and Licensed Clinical Social Worker Mary Ryan. “Sending the message that weight loss is simple, straightforward and promises improved health without cost is harmful when we have no proven long-term strategies for safe, effective weight loss that work for everyone.”
Business owner Kris Shean agrees. Having tried many approaches to “healthy eating” since high school like Weight Watchers, Whole30, Paleo, often more than once, she says she could have written a book. Shean blamed herself for her diet “failures,” believing she had a self-control problem, leaving her feeling frustrated and a “bit depressed.”
Despite owning the local Haagen-Dazs for over 20 years, Shean wouldn’t allow herself to have more than spoonfuls of ice cream — she had a no cups rule. She remembers the shame felt when swim coaches threatened extra workouts if she didn’t lose weight and when a strength coach took $20 from her unless she lost at least five pounds a week.
In 2019, Shean said, she was borderline pre-diabetic and now sees how dieting (which is disordered eating according to the National Eating Disorders Association) contributed. The stress of restrictive eating followed by inevitable backlash eating and weight gain, known as weight cycling, occurred due to simple biology — she wasn’t providing her body the necessary nourishment to fuel her athletic endeavors.
An avid skier, hiker, cyclist, Shean says “I had so many thoughts around not being thin, trying to fit in with what I thought everyone wanted me to look like. How I wanted to look — to look like the athlete that I was.
“But now I know good health and wellbeing is complex and not dependent on weight, nor the stigmatizing word that the BMI labels me as.”
In fact, evidence that supports a weight-neutral approach to health found that people with a BMI in the overweight category have the lowest mortality rates, and those in the normal weight and obese weight categories have the same mortality risk. Furthermore, using BMI as an indicator of metabolic health will misdiagnose 24% of normal weight people, 51% of overweight people and 32% of obese people.
And Ryan notes that assuming people with a “normal” BMI are healthy is also problematic, leading medical providers to miss harmful disordered eating and exercise.
Weight stigma researcher Rebecca Puhl reports that weight bias is stressful on the body — increasing the risk of hypertension, diabetes, hyperlipidemia, metabolic syndrome, unhealthy eating behaviors, lower physical activity, weight gain, depression, anxiety, low self-esteem and leads stigmatized people to avoid healthcare.
A June 2021 study of approximately 14,000 people in six countries participating in a weight management program assessed interpersonal sources of weight stigma. Researchers found that over half the participants experienced weight stigma and that it mainly came from family members (76–87.8%), classmates (72–80.9%), doctors (62.6–73.5%), co-workers (54.1–61.7%), and friends (48.8–66.2%).
As a community, in our homes, schools, workplaces, and wellness and health care spaces, we can facilitate a weight neutral approach for better overall health outcomes. Dr. Louise Metz of Mosaic Comprehensive Care in Chapel Hill, North Carolina, offers “Health at Every Size” guidelines:
• Not weighing people unless necessary for rare medical indications like weight-based medication dosing, patients with eating disorders actively restoring weight, child growth/development.
• Pursuing health and wellness independent of body size.
• Discussing behaviors rather than body size.
• Practicing an evidence-based approach to evaluating and treating health conditions independent of weight.
• Having people-centered, compassionate, respectful discussions about health goals that do no harm.
“It is time that our health community more fully honors the foundational principle in medicine: First, do no harm,” Ryan says.
Ryan feels positive that our community is starting to move in the right direction. In June she was invited to present information on how “Disordered Eating and Exercise Can Harm Physical and Mental Health” to Urgent Care health care professionals and for the Teton County Health Department.
And Shean reports that with a Health at Every Size approach, in which she explored weight stigma, dieting and weight cycling as stress, her blood sugar numbers have been good. Furthermore, inspired to educate and facilitate this new community narrative with health and weight, Shean recently founded All Bodies Adventure Club Facebook Group.
Shean dispels the ingrained societal myths about people living in larger bodies. She isn’t lazy. She doesn’t lack willpower. She is a Jackson Hole athlete who cares a great deal about her overall health and wellbeing. And now that Shean has ditched the false belief that in order to be healthy she must be thin or labeled with a “normal” BMI, she’s so much happier.
This is a call to action: Let’s take a “do no harm” approach to health and wellbeing.
This article was originally published in the June 23, 2021 edition of the Jackson Hole News and Guide.