Can you be healthy at any weight?

Imagine a world where the bathroom scales no longer exist, because your health is simply determined by how you feel rather than measurements and numbers. There’s a growing social movement towards accepting all shapes and sizes, focusing on well-being rather than weight loss. Lucy Arthur reports.

Many of us can relate to finding food challenging and wanting to be thinner. It was US researcher and author Linda Bacon’s experiences of this that prompted the research project and subsequent best-selling book that led to the movement of the same name: Health at Every Size (HAES).

“I used to have this idea that if only I were thinner, everything in life would be better for me,” Professor Bacon says.

But diets and exercise made her miserable and she gained weight in the long run.

The combination of restricting food and exercising isn’t sustainable, she suggests.

“The whole idea of dieting [restricting food] and exercise is not based on science. What science does tell me is my experiences were normal. That’s how the body reacts to deprivation. Short-term weight loss leads to long-term weight gain.”

Professor Bacon has degrees in physiology (specialising in nutrition), psychology and exercise science. She is committed to furthering social justice and education about the scientific evidence that underlies our understanding of weight.

Is there an ideal weight?

“It’s not something you are going to learn from looking at a BMI chart,” Professor Bacon says.

BMI, or Body Mass Index, is a measure of body fat based on your weight in relation to your height, and can be used for most adult men and women aged 20 and over. To work out your BMI, you take your weight in kilograms, and divide it by the square of your height in metres, or use an online calculator.

University of Auckland professor of epidemiology Rod Jackson says the ideal body mass is between 20–25. But, as Professor Jackson’s colleague Boyd Swinburn warns, BMI is just one measurement that provides clinical information about health. Professor Swinburn is the professor of population nutrition and global health at the University of Auckland and Alfred Deakin professor and director of the World Health Organization (WHO) Collaborating Centre for Obesity Prevention at Deakin University in Melbourne.

Health professionals rarely look at BMI in isolation to other measurements such as waist circumference, blood pressure, blood lipids and blood glucose as well as social and physical factors, Professor Swinburn says.

“People tend to get hung up on BMI, because it shows that people like All Blacks are obese. It’s not meant to be used to work out which All Blacks are fat or not. It’s just one piece of information,” Professor Swinburn says.

Indeed, according to the Heart Foundation, adults with a very athletic build (eg. professional athletes) could show as overweight. This is because muscle weighs more than fat and the BMI does not take this into account. Ethnicity plays a part too. Maori, Pacific and Asian people have different body composition to Europeans which means ‘normal’ BMI ranges don’t apply. To be considered overweight, you would have a BMI of more than 23 if you are Asian, 25 if you are European, and 27 if you are Pacific or Maori.

It’s about risk and chances

“If you take a snapshot of people with overweight and even obesity, you find a significant percentage of them seem metabolically normal (eg, no raised blood pressure, blood lipids, blood glucose). So, this is a very narrow definition of ‘healthy’ – it does not take into account non-metabolic problems such as bad knees, stress incontinence, depression, social sigma, risk of cancer. So, branding them ‘healthy’ is problematic. It is also a snapshot in time so it does not mean that the person with a BMI of 35 and normal glucose will not develop diabetes in the future,” Professor Swinburn says in an email.

“Sure, someone with a BMI of 30 can live to 100 and then get hit by a bus. It’s about risk and chances.”

Despite all this, BMI is commonly used as a measure of whether you are overweight or obese and subsequently determining your health risk.

According to the WHO, being overweight or obese are major risk factors for a number of chronic diseases, including diabetes and cancer.

There are also health risks in being underweight, such as having a vulnerable immune system, reproductivity dysfunction and increased risk of osteoporosis. Or if you are underweight and malnourished in childhood, you are more likely to be overweight in adulthood, Professor Swinburn says.

For Professor Jackson, a raised BMI is something to take notice of. He cites an analysis of 900,000 adults that finds BMI is a strong predictor of overall mortality both above and below the apparent optimum BMI of about 22.5–25. The study shows if you have a BMI in the range of 30–35 life is reduced by 2–4 years; at 40–45, it is reduced by 8–10 years (which is comparable with the effects of smoking).

“If you are an ideal weight (BMI 23) but you smoke, your health risk is the same as someone who has a BMI of 37. A smoker with the ideal BMI of 23 has the same risk of dying in the next year as someone with a BMI of 37. Smoking is the equivalent of 12–14 BMI points. Some people say they smoke to reduce their weight, Professor Jackson says, “but you are way better off not smoking”.

What’s more, there’s a US study of about 85,000 nurses aged between 30 and 55. They had their BMI measured and followed over 16 years.

If you have a BMI of 23–25, your risk of diabetes is three times that of someone with a BMI of 20–23. If your BMI is 25–30, your risk is eight times higher, at a BMI of 30–35 your risk is 20 times higher and if your BMI is over 35, your risk of diabetes is 40 times higher.

Professor Jackson says more specific health risks of having a raised BMI are largely determined by age, gender and other factors such as what you eat, how much, and what kind of exercise you do.

“In the mid-1960s we were dropping dead from heart disease and stroke at about 10 times the rate we are today, despite being leaner back then and eating less processed food and less sugar.

“That’s because we had a diet very high in animal and dairy fat and ate a lot more salt,” Professor Jackson says.

Forget BMI, dieting and the bathroom scales

It’s for all these reasons, Professor Bacon isn’t a fan of BMI, dieting or focus on weight.

Socioeconomic status is a much stronger predictor of health risk than BMI, she says. Diabetes is much more prevalent among those living in poverty.

What’s more, evidence is emerging that fitness is a better predictor of mortality than fatness. One study that reviewed 10 academic articles found that when compared with normal weight fit individuals, unfit individuals had twice the risk of mortality, regardless of BMI. Overweight and obese fit individuals had similar mortality risks as normal weight fit individuals.

Professor Bacon would like to see weight removed from the health equation and encourages learning about your own body needs as a basis to adopt healthy behaviours and mindful eating.

“Eat when you feel hungry and stop when you are full,” she says. The trick is to be mindful about it and focus on how particular foods make you feel. “For example, if you have a low-fibre diet you may feel constipated and tired,” she says.

But what about chocolate? “It’s healthy to eat what you enjoy,” Professor Bacon says. “But high quantities of chocolate would be problematic and that might contribute to less health. Your body will tell you this.” So, the answer is to eat that chocolate truly mindfully. Eat it slowly so it melts in your mouth and describe the taste and really appreciate it. Professor Bacon uses this technique in her support groups.

“What everyone notices is the first few bites were amazing and as they took more bites, it was still good but it wasn’t amazing anymore,” she says.

Professor Bacon focuses on non-diet approaches that don’t result in weight loss, but instead produce similar improvements in metabolic fitness, psychology and eating behaviour while, at the same time, effectively minimising the drop-out rate that is common in diet programmes.

Can you really be healthy at any weight?

The simple answer is kind of. The experts agree, dieting is bad, learning your own body’s cues and increasing your feelings of self-worth are healthier behaviours than focusing on self-doubt and what the bathroom scales tell you. Health is clearly much more than what you weigh.

Tips for ditching the scales and focusing on health

• Use BMI with caution, it’s just one crude measure.
• Try to be mindful when you eat.
• Learn to love yourself as you are so you make healthy choices as an act of self-kindness.
• Do things often that make you sweat and make you smile – yoga, beach walking or chasing the kids.
• Set yourself attainable goals and celebrate achieving them.

What is Health at Every Size?

Health at Every Size is a peace movement. It supports people of all sizes in addressing health directly by adopting healthy behaviours. It is an inclusive movement, recognising that social characteristics, such as size, race, national origin, sexuality, gender, disability status and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well. Find out more at haescommunity.com.