“But the Doctor told me I needed to lose weight for my health…”

So, you went to your annual check-up, and you received “the talk” from the Doctor about your BMI and how you need to lose weight for your health, right? And now you’re googling, “best way to lose weight” and considering trying that newest fad diet…maybe even one your Doctor recommended (yikes!) Or even thought about hiring a Dietitian to help you lose weight. Well let’s take a quick pause, I want you to hear me out. 

One of the biggest misconceptions we’ve been taught whether its from diet culture, or the medical field, is that we need to “lose weight for health”. Let me give you some background and the research-based evidence as to why I don’t offer weight loss services.

1. BMI is an inaccurate measure of health.

• BMI, or the Body Mass Index, is a ratio of the proportion of your weight (body size) to your height. It has been used as a simple measure of health categorizing your BMI into 3 different main categories: underweight, overweight or obese.  But, as you’ll come to learn, it is incredibly flawed and CANNOT accurately measure anyone’s health. You may have seen your BMI on a handout/sheet from your Doctor’s office after a visit, or seen a BMI chart in your physician’s office.
• BMI was invented over 200 years ago by a mathematician, not a health professional or doctor, whose name was Adolphe Quetelet. It was created as an easy way to measure the degree of obesity for use in allocating resources to the population. For its inventor, the BMI was a way of measuring populations, not individuals — and it was never designed or intended to be uses as a measure of health. Not to mention, it only was created/studied on a certain group of individuals! The formula was derived based ONLY on the size and measurements of French and Scottish participants. That is, the BMI was made exclusively by and for white Western Europeans. And yet here we are 200 years later, using it on both genders and all cultural ethnicities when it is completely flawed for use.
• Weight was never linked to health and used in healthcare until the early 20th century. This was when life insurance companies in the U.S. started to compile a list/table of heights and weights to determine what to charge policy holders. Then health insurance companies jumped on the bandwagon and realized they could charge more and make more money when using BMI as a measure of health status. (Using BMI=more money for insurance).
• By 1985, the National Institutes of Health changed their definition of “obesity” to be connected to patient’s BMIs. From then on, BMI has been an unfortunate, widely used,  stigmatizing force in healthcare.
• Then in 1998, the National Institutes of Health (NIH) lowered the guidelines for BMI cut-offs for overweight and obese categories, literally overnight pushing Millions more Americans into the overweight or obese categories (talk about stigmatizing..). An “obesity epidemic” was claimed just a year earlier, all on one. simple. flawed. number. Nuts! But it pays big bucks for the health insurance companies…
• It also simply can’t account for body composition. Muscle, fat, water…it would be like weighing a steak at the butcher shop to determine how much fat or leanness the cut has…you simply cannot tell by weighing it! It can only tell you the overall mass. An extreme case for this argument is body builders…they could have an “obese” BMI but have a higher muscle to fat ratio and can be completely healthy.

2. And research has proven it…

• According to studies published by the Endocrine Society, the BMI overestimates fatness and health risks for Black people. Meanwhile, according to the World Health Organization, the BMI underestimates health risks for Asian communities.
• Wildman and colleagues (2008) found that using BMI as a measure of health resulted in the misdiagnoses of more than half of people (!) as unhealthy. AKA using BMI to associate with health is NOT accurate, and you CAN be healthy with different BMIs.

3. Weight loss doesn’t automatically mean better health. Thinness doesn’t equate to health or wellness.

• Numerous studies have shown that a higher BMI of 23.0–29.9 in older adults can be protective against early death and disease.
• Simply put, you can be thin and healthy. Thin and unhealthy. You can also be fat and healthy. And fat and unhealthy. Higher body weights certainly correlates with certain health conditions (such as Diabetes or Heart Disease), but it is not causation. What is people in higher body weights are more likely to develop Diabetes because people in higher body weights are also more likely to experience a lower socioeconomic status, which causes more stress? 
  • An example of how correlation is not equal to correlation is the icecream fight example. Sometimes two things are correlated because they are both influenced by a third variable that you might or might not be aware of. For example, there might be a correlation between ice cream sales and physical assaults. When ice cream sales are higher, assault rates are higher, and when ice cream sales are lower, assault rates are lower. However, it is rather unlikely that eating ice cream causes people to get into fights. What is more likely is that there is a third variable we are missing and that we may not control in the study. Maybe it is heat. On hotter days more people buy ice cream, and also on hotter days more people are short-tempered and get into more fights. The correlation between ice cream sales and assaults is evidence that ice cream might cause fights, but it isn’t definitive proof and more evidence of that hypothesis would be needed to convince anyone.
• Studies have shown that those in the overweight BMI category actually have the LOWEST mortality risk. This is just one of the many reasons that debunk the “thinner is healthier” myth.
• Ever seen someone who lost some weight and you complimented them? You don’t know what could’ve actually caused their weight loss….and there’s many time when weight loss actually is linked with WORSE health. Here are some examples…
  • cancer 
    • since when does getting chemo, having nausea and vomiting, and losing weight make someone healthier? UGH.
  • anxiety & depression
    • anxiety can cause lack of appetite in someone, leading to unintended weight loss. Does this person become healthier with this? No.
  • loss of a loved one/grief
    • same as above. 
  • eating disorders
    • obviously weight loss in an individual with an eating disorder is NEVER healthy. With eating disorder clients, most often they may gain weight with a reduction in eating disorder behaviors, and they are getting healthier. Another reason why weight gain doesn’t automatically mean worse health either. Bodies are supposed to change throughout life.
  • dieting (quick weight loss, which then results in further weight GAIN)
    • sure, you may lose some water weight or weight quickly, but dieting is actually linked with long-term weight gain and weight cycling. Not good for your health.
  • malnutrition
    • As a Clinical Dietitian in a hospital setting, we get screened for any patients who have lost weight. Almost all of these patients lost weight due to health conditions such as GI issues, depression, difficulty swallowing, hospitalizations, and many more reasons. We see these patients because weight change such as significant weight loss is a POOR sign of health, and we have to intervene with nutrition therapy. You only have to lose 5% of your total body weight in a month to be at risk for malnutrition. (That’s just 7.5lbs for an average 150 lb woman!)

4. Weight loss gets all the credit, but it’s the healthy habits that improve health. (If weight loss does occur, it’s a side effect).

• Sure, there are some research studies showing improvement in certain health conditions like Diabetes with modest weight loss — but it’s not exactly due to the actual weight loss….it’s likely due to the actions or behaviors that happened to result in weight loss. Eating more fruits and veggies? Moving more? Drinking more water? Managing stress? Sleeping better? Weight loss may be a side effect, but it’s not WHY the health condition improved, it’s from the behaviors! Weight gets all the credit, when it is healthy habits and behaviors that matter first and foremost. And guess what? This is proven as there is also research showing that engaging in healthy habits and behaviors also reduces risk of chronic disease and improves health, regardless of BMI or if you lose weight! Once again, proving that it’s the behaviors that matter, not the number on the scale. Behaviors matter the most in regards to improving health, and this may or may not result in weight change.

5. Even if we did need to lose weight for health, there is currently NO proven way how to do so that lasts long-term and doesn’t have a myriad of side effects.

• Diets simply do not work, and they will never work. Research has shown this time and time again, over 95% of people who go on a diet will gain the weight back (and 2/3 of dieters regain even MORE weight than they lost by year 4 or 5!). There is not one single study that shows sustainable weight loss. NOT ONE. Most research studies showcasing successful weight loss are short-term — usually cut off by 6 months, but weight slowly is regained after this time period, which is conveniently when most studies stop.
• And there are many reasons to this –
  • 1. When we restrict our caloric intake, our metabolism slows down to try to maintain homeostasis. It views it as if we are in a famine and we need to conserve our energy. A famous study from the biggest loser show showed that participants’ leptin levels had plummeted, so that they had very little of the hormone, rendering them constantly hungry. Their thyroid hormones decreased, also resulting in  a slow metabolism, even lower than when they started!  Six years later, their metabolism still never rebounded back to what it was prior to losing weight. So not only did they regain weight, they now had to eat even less just to maintain their weight. When you try to diet and lose weight, you are more likely to lose lean muscle mass, which is a main contributor to a fast metabolism! The more lean muscle mass you lose from dieting and under-eating, the further your metabolism will slow. 
  • 2. When we eat less and try to lose weight, our hunger hormone steps in and gets louder. This hormone is called ghrelin, and it increases with food restriction, causes us to be hungrier, and ultimately giving in and overeating. 

6. Focusing on the number on the scale most often prevents you from engaging in healthy habits and behaviors.

• Ever tried to lose weight and engage in healthier eating, only to have the scale not move and become frustrated and give up altogether? I have seen this time and time again in my clients. When we use an external cue to regulate our eating, we are ultimately going AGAINST our own own body. 
• Also, if you have to restrict your eating to try and force your body to lose weight, you’re much more likely to end up overeating, binge eating, or developing disordered eating than actually sustaining weight loss long-term.
• As quoted from Tracy Tylka et. al, “There is considerable evidence that the focus on weight and weight loss is linked to diminished health.”

7. And the most important point in my opinion…focusing on weight increases weight stigma and further harms health.

• Experiencing weight bias in health care settings may discourage higher-weight patients from making healthy lifestyle changes and behaviors and seeking routine or preventative care and encourage lower psychological wellbeing. This then leads to patients avoiding going to the doctor, which leads to worse health and delayed diagnoses for health conditions. Another argument for the fact that higher body weights are correlated with poor health – possibly due to weight stigma and its effects, not from the “fat” itself!
• Weight-based victimization among overweight youths has been linked to lower levels of physical activity, negative attitudes about sports, and lower participation in physical activity among overweight students. Among overweight and obese adults, those who experience weight stigmatization engage in more frequent binge eating, are at increased risk for eating disorder symptoms, and are more likely to have a diagnosis of binge eating disorder.
• Weight stigma can trigger physiological and behavioral changes linked to poor metabolic health and increased weight gain. In laboratory experiments, when study participants are manipulated to experience weight stigma, their eating increases, their self-regulation decreases, and their cortisol (a weight gain promoting hormone) levels are higher relative to controls, particularly among those who are or perceive themselves to be overweight. Additionally, survey data reveal that experiences with weight stigma correlate with avoidance of exercise.
• In one study, 79% of weight-loss program participants reported coping with weight stigma by eating more food.
• Weight stigma poses a significant threat to psychological and physical health. It has been documented as a significant risk factor for depression, low self-esteem, and body dissatisfaction.
• Across both the nationally representative Health and Retirement Study including 13,692 older adults and the Midlife in the United States (MIDUS) study including 5079 adults, people who reported experiencing weight discrimination had a 60% increased risk of dying, independent of BMI. Wow.
• Overall, weight stigma has been linked to increased levels of stress, depression and anxiety, weight gain, increased allostatic load, disordered eating, poor body image, decreased physical activity, an increased risk of diabetes and heart disease (independent of body size!!), and more. We could argue that it is weight stigma that could cause those in higher weights to be more at risk for certain health conditions, not their actual weight. 

8. Dieting comes with a multitude of unhealthy side effects.

• yo yo weight cycling – dieting is linked with yo-yo weight cycling, that is, when your weight goes up and down by 10+ lbs. Studies have linked yo-yo weight cycling to increase risk of poor cardiovascular health.
• disordered eating – 35% of “normal dieters” progress into pathological dieting, and 20-25% of those individuals develop an eating disorder. Dieting is the number 1 predictor of developing eating disordered in adolescent girls. Ince one study, those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.
• food stress/food obsession – dieting and under-eating only furthers obsession around food and increases cravings.
• long term weight gain – Dieting is the #1 predictor of future weight gain. Dieting itself, independent of genetics, is significantly associated with accelerated weight gain and increased the risk of becoming overweight.  
• worse body image
• slowed metabolism
• altered hormones
• increased inflammation

So…are you ready to quit dieting and obsessing over your weight? Focus on positive, sustainable healthy habits that work for YOU, and let your weight find its natural balance. Work 1:1 with a HAES, Intuitive Eating Dietitian for support.

Want an even deeper dive into all the side effects of dieting and harms of weight stigma? Check out the book Anti-Diet by Christy Harrison, MPH, RD. A fabulous resource!

• Sources:
• Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring). 2016 Aug;24(8):1612-9. doi: 10.1002/oby.21538. Epub 2016 May 2. PMID: 27136388; PMCID: PMC4989512.
• Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649 

• Grodstein, F., Levine, R., Spencer, T., Colditz, G. A., &Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: Can you keep it off? Archives of Internal Medicine 156(12), 1302.

• Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. J Exp Soc Psychol. 2014;51:74–80.

• Neumark-Sztainer D., Haines, J., Wall, M., & Eisenberg, M. ( 2007). Why does dieting predict weight gain in adolescents? Findings from project EAT-II: a 5-year longitudinal study. Journal of the American Dietetic Association, 107(3), 448-55

•  Neumark-Sztainer, D. (2005). I’m, Like, SO Fat!.New York: Guilford.
• Andreyeva, T., Puhl, R. M. and Brownell, K. D. (2008), Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity, 16: 1129–1134. doi:10.1038/oby.2008.35
• Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol. 2010;115(5):982-988. doi:10.1097/AOG.0b013e3181da9423
• Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity. 2011;19(10):1957–62.
• Sutin AR, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci. 2015;26(11):1803-1811. doi:10.1177/0956797615601103

• Tribole E. & Resch E. (2012-in press). Intuitive Eating (3^rd edition). St.Martin’s  Press: NY,NY.

• Tylka, T. L. (2006). Development and psychometric evaluation of a measure of intuitive eating. Journal of Counseling Psychology, 53,  226-240.