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How do you feel about your body? And how is that perspective working for you?
Body weight and body image are among the most challenging and perplexing health and wellness issues we face. You may have noticed the tension between these two familiar messages:
- Being underweight, overweight, or obese may be problematic for our health.
- Controlling our weight is difficult and may be stressful. Our efforts may backfire and increase our risk of anxiety and depression, disordered eating, obsessive behaviors, and other health problems.
Why weight and health are difficult to navigate
In part, it’s because of the negative judgment attached to some body types. Some health experts say the medical focus on body mass index (BMI)—a person’s weight measurement divided by their height measurement—plays into this stigma. “Weight dissatisfaction” makes people less able to adopt healthy behaviors, according to a 2015 study in Current Obesity Reports.
How body image affects our health
On college campuses, these risks are evident. “There is this cultural belief that people have to be dissatisfied with themselves in order to make behavioral changes to improve their health,” says Sara Stahlman, marketing and communication coordinator of Campus Health Services at the University of North Carolina at Chapel Hill. “In fact, the opposite has been shown; people take better care of their bodies when they hold their bodies in high regard.” Many health care professionals agree. Stigmatizing body size makes people “sicker, poorer, lonelier, and less secure,” says Dr. Deb Burgard, a psychologist in California who specializes in body image, weight, and health issues.
How weight is (and isn’t) relevant
Some experts say we should take weight out of health advice altogether. Others say that is unrealistic because weight is related to health. The evidence seems to come down to this:
- Can body weight and size negatively affect our health? Yes, but it’s complicated. Body type/weight is one of many factors that influence our well-being. Someone of “normal” weight is not necessarily healthier than an overweight person.
- Is weight change a useful and effective goal? In practice, probably not, since focusing on weight may introduce other health-related risks. Other benefits of self-care—such as improved energy, stress relief, and pleasure—can be more consistently and positively motivating.
“We can reduce the likelihood of disease without ever talking about weight or BMI,” says Stahlman. This approach, she says, “gives everyone permission to feel good about themselves and good about their process of becoming healthier, even if their weight never changes. And when people focus on the process toward health—the behaviors they have control over—their risk of disease goes down.”
How can I care for my own health and support others?
“Those looking to improve any aspect of their health need a squad. A proper squad should include a medical and/or fitness pro; a friend to relax and have fun with; another friend who’ll throw shade if you let go of what’s been working for you; and, finally, an everlasting cheerleader.”
—Roslyn Mays (Roz the Diva), a fitness trainer and pole-dancing instructor, New York (to SH101)
“Here’s how I imagine the idyllic campus environment. Think about how living in a place like this would impact our motivation to take care of ourselves. All of us can work to create communities that are more like this, and in doing so, we shift towards improved health for everyone,” says Sara Stahlman, marketing and communication coordinator of Campus Health Services at the University of North Carolina at Chapel Hill. A campus that supports students’ health and wellness could offer the following, she says:
- Regardless of how peoples’ bodies look or how much they weigh or how much space they take up, everyone has permission to be a healthy, well-liked, and engaged student. People are told in a million ways that they are great just the way they are.
- Free, accessible, high-quality health care and mental health care that focus on holistic well-being.
- Accessible nutrient-dense food options and a culture of mindful eating (eating when you are hungry and stopping when you are full).
- Many fun ways for people to be active and build friendships while doing it.
- A culture of valuing sleep, in which students support each other in getting the sleep they need.
- A culture that values finding a balanced life and avoids competing over who is the busiest.
“Many people at my college are obsessed with body image; [they are] mostly coming from a middle-class perspective which idolizes the body and makes people who do not, or cannot, fit into their concept of ‘healthy’ very uncomfortable.” —Andy K., fourth-year undergraduate, Wheaton College, Illinois
Does being overweight or obese increase my risk of disease?
“Weight is not a behavior, or a choice; it’s an outcome, and not entirely under our control. Genes exert an effect, as does the microbiome [micro-organisms in the body]. So there are problems with a focus on it, but there are problems ignoring it as well, as it does correlate with health risk.”
—Dr. David Katz, founding director of the Yale-Griffin Prevention Research Center at Yale University and president of the American College of Lifestyle Medicine (to SH101)
- Being underweight, overweight, or obese can increase the risk of certain diseases, though the exact role of body weight in influencing disease is not well understood, says the Society for Science-Based Medicine, an organization that evaluates the evidence relating to medical treatments and illness.
- Being overweight is a risk factor for some diseases, including type II diabetes, obstructive sleep apnea, and heart disease, according to the National Institutes of Health and the Centers for Disease Control and Prevention. A risk factor is anything that influences our chance of developing a disease and how that disease affects us. Chronic diseases involve multiple risk factors.
- Some studies of certain diseases suggest that overweight people survive longer than those in the “normal” weight range. However, the data are complex, says Science-Based Medicine (the website). Just as weight can be falsely blamed for causing health problems, it can also be mistakenly exonerated.
- For people who are more than moderately overweight, the health risks increase, according to the Canadian Medical Association Journal, 2011.
“We have seen problems in both directions: people suffering the ill effects of [weight] stigma, and people suffering the ill effects of ‘oblivobestiy,’ i.e., denial of the importance of weight to health. Weight…should be taken seriously, but without any stigma, like an indicator light on the dashboard of your car.” —Dr. David Katz, president of the American College of Lifestyle Medicine
Why is body mass index (BMI) controversial?
“Science supports trying to control weight in general but it doesn’t support forcing every individual into the same mold of an ideal BMI range of 20–25. Fitness may be as important [to health] as fatness.”
—Dr. Harriet Hall (“The SkepDoc”), a family physician writing at Science-Based Medicine
- Body mass index (BMI) is a number used by health care providers. To get your BMI, divide your weight in kilograms by the square of your height in meters. The resulting number puts you into one of these categories: underweight, normal, overweight, or obese.
- BMI is commonly used because it is easily accessible. All it requires is a person’s weight and height.
- As a measure of health and even body type, BMI is somewhat crude and can be misleading. For example, lean athletes may be categorized as overweight because of their heavy muscle. Increasing lean weight (muscle and bone weight) is beneficial to health.
- BMI does not necessarily correlate with other measures of health, such as blood pressure, blood sugar, and cholesterol. People whose BMIs are in the overweight or obese categories may be healthy by other measures, and people with “normal” BMIs may be unhealthy by other measures, according to a 2016 study in the International Journal of Obesity.
- BMI may come to be replaced by other measures of body composition that may be more meaningful for health (e.g., waist circumference, lean body mass index, frame size, and percent fat).
“Body size/shape is a simple indicator of a complex characteristic. It cannot be measured accurately by visual measurement, but by physical activity, ability, and medical tests.” —Joshua W., fourth-year undergraduate, Truman State University, Missouri
“At age 12 I was told I needed to lose 10 pounds. I had issues with body image and food for 20 years after that, until I learned about Health at Every Size. However, I still struggle with body image. I’m going into health care and I worry people will think I don’t know what I’m taking about, since I am in the overweight BMI category.” —Crystal V., second-year graduate student, California State University, Chico
“Being slightly overweight does not mean that I am unhealthy. I’m in fact quite healthy.” —Male second-year undergraduate, University of Guelph, Ontario
What’s the risk in focusing on my BMI and weight?
“The stigma of [being] overweight—in the media, society as a whole and even the medical profession—can hold people back from getting help. The over-focus on shape and size can lead to unhealthy practices and even a sense of helplessness and hopelessness.”
—Dr. Ramani Durvasula, clinical psychologist and professor of psychology at California State University, Los Angeles (to SH101)
- Standard health care practice emphasizes the value of the “normal” BMI range and encourages us to manage our weight as a means of being healthier.
- Categorizing some body types but not others as “normal” or “healthy” arguably leads to judgment about personal behaviors, and blame and discrimination based on body type. “Weight dissatisfaction” is an obstacle to healthy behaviors, and is linked to worse health outcomes, according to a 2015 study in Current Obesity Reports.
- Even health care professionals exhibit “weight bias” (negative judgments about heavier people); this may discourage heavier people from adopting healthier behaviors and seeking health care, says a 2014 study in the Journal of Obesity.
- Weight management can be difficult. Studies highlight the challenge of sustaining weight loss over the long term, and link dieting to “yo-yo” weight cycles and disordered eating. The focus on weight control may promote a sense of “learned helplessness,” says the same 2014 study.
- Body type and weight are about more than personal behaviors, research indicates. Scientists are exploring the roles of genes, our environment, socioeconomic factors, our microbiology, and other factors.
“[People criticizing my weight] made me more depressed and less motivated to make myself healthier. I ended up just eating more unhealthy food.” —Male fourth-year undergraduate, Temple University, Pennsylvania
“I am an obese person with social anxiety working on a BS in kinesiology. I was seeing a doctor and he told me, ‘No offense but you might want to lose weight; you don’t want to enter your program looking like that.’ If a doctor was willing to judge me for my weight, how much more would the people around me judge me? I became very anxious about starting the program and nearly dropped out. Even in my third year, I still find it hard to participate in class, due to the fear of being judged negatively.” —Female third-year undergraduate, University of New Brunswick
Is there a more effective way to set health goals?
“Healthy at any weight means an evaluation of one’s overall self and body, instead of just reducing oneself to a number. If a person feels that, at any weight, their choices promote their overall health and well-being (rather than engaging in unhealthy practices to ‘get the number down’), they can establish lifelong health habits.”
—Dr. Durvasula (to SH101)
- The “weight inclusive” approach, which does not focus solely on weight or body shape, lends itself better to self-care and health, its proponents say. This approach is represented by the Health at Every Size (HAES) movement. “A person’s health is determined by so much more than willpower and lifestyle habits. HAES recognizes this,” says Stahlman.
- Weight-inclusive approaches identify health and wellness as the goal, regardless of weight. They emphasize healthy behaviors, such as intuitive eating, and the broader benefits of physical activity, such as pleasure and improved energy.
- Weight-inclusive approaches aim to reduce the shame and stigma associated with body type. This makes healthy behaviors more accessible and sustainable, suggests a 2014 review of studies in the Journal of Obesity.
“What really matters is your health. If you have a little extra fluff, who cares? As long as your health is not at risk, you shouldn’t care what others think of your body image. Rock it!” —Lacy O., second-year student, University of Wisconsin, Richland
“As a skinny person I know I have societal privileges that fat people don’t. But a lot of ‘body positivity’ campaigns revolve around shaming skinny people rather than criticizing the culture that says skinniness is the only beautiful/healthy body type (looking at you, Meghan Trainor).” —Alex C., second-year student, University of Wisconsin, Waukesha
- “Silencing the inner critic is a key step in the process [of accepting your body]. But it also involves being willing to let go of that critic,” says Dr. Megan Jones, clinical assistant professor at Stanford University, California, and chief science officer at Lantern, an evidence-based program for improving body image and reducing disordered eating behaviors.
- Practice shifting your thinking. “Whenever possible, challenge yourself to think about your body in terms of what it can do instead of in terms of how it looks,” says Dr. Renee Engeln, psychology professor at Northwestern University, Illinois. “For example, if you find yourself feeling bad about how your legs look, remind yourself of all the things those legs do for you. They move you around in the world. They let you dance. Focusing on the functions of your body is a great way to treat your body with more kindness and respect.”
- Incorporate walks, yoga, or other physical activities into your day. Almost any type of regular physical activity can help people feel better about their bodies, regardless of the effects on their fitness and body shape, according to a 2009 meta-analysis of studies by researchers at the University of Florida.
- Intuitive eating—learning to align your eating habits with internal appetite cues—can lead to a positive relationship with food, health benefits, and improved weight management, according to a 2014 review of studies in the Journal of the Academy of Nutrition and Dietetics. See Find out more today (on the page).
- Keep healthy options easily accessible and make less healthy options inconvenient. Much evidence points to the power of environmental tweaks in changing our behavior, including our eating habits. See Find out more today.
- In conversation, don’t focus on appearance. You may think you’re complimenting someone by saying, “Have you lost weight?” or “You look like you’ve been working out.” But you’re reinforcing the stereotype that thin means beautiful or that muscular means good-looking. Also, you don’t know what unhealthy behaviors you may be complimenting. Instead, ask your friend whether the dance classes are helping him feel stronger or sleep better.
- Never criticize someone else’s body, even obliquely. “You cannot shame someone into healthy habits,” says Roslyn Mays (Roz the Diva), a fitness trainer and pole-dancing instructor in New York. “Sure, the potential for embarrassment can motivate change, but ultimately, if you feel bad, you’ll treat yourself badly.”
- Accountability and support are key. “Work with groups of people who are going through the same process,” says Dr. Durvasula.
“I’ve always been a bit resentful of how telling someone they’ve lost weight is seen as a compliment.... It’s like imparting one’s own insecurities on another. I hear it often enough to detest it.” —Brendan G., fifth-year undergraduate, University of Mount Union, Ohio
“As someone who has struggled with disordered eating and body image since my early teens, I understand the temptation to punish my body. It is very easy to hate yourself in a world that trains you to critique and loathe your body for what it isn’t instead of appreciate it for what it is. Physical exercise forces you to come to terms with the fact that your body is a miracle, and can lead to positive body image and an increased sense of accomplishment and self-worth.” —Female second-year undergraduate, Mount Allison University, New Brunswick
Wellness, Not Weight: Health at Every Size and Motivational Interviewing: Ellen Glovsky [ed.]
Cognella Publishing, 2014