Can You be Overweight and Healthy? – A Dietitian’s Review

Can You be Overweight and Healthy and the same time? One of the most common questions regarding health! Is body weight the true reflection of a person’s health?

What does the evidence say? Can you be overweight and healthy at the same time?

Should we aim for a lower bodyweight or focus on healthy eating? Let us get straight to one of the most debated topics with what the evidence says.

What Do We Mean When We Say Overweight?

People often experience shame, embarrassment, and unworthy and feel like they need to change their size to make them feel more worthy in society. Medically speaking, when we use these words, we justify it using it a clinical setting – From the BMI (Body Mass Index), but how accurate is the BMI

A research by Catherine Flegel completed a meta-analysis of the relationship between BMI and health and at the time hadn’t been conducted even though BMI was being widely used in health settings and they identified hazard ratios – a relative risk of death in different BMI groups and they compared the groups to the risk in the normal BMI group.

What they found the risk of dying in the overweight BMI group was 94% of the risk of dying in the normal weight range. They found that it was lower interestingly. In the obese grade 1 range, they found that the risk of mortality was 95%, still lower in the normal BMI group however this one was not statistically significant. In obese grade 2 and 3 groups, they found the risk of dying was 129% – where it was found to be a little bit higher.

So what we see is that although overweight is associated with a lower all-cause mortality and grade 1 obesity is not associated with increased risk of mortality, we are often forcing bodies in this weight range to be smaller. When we get to the higher BMI category of 35 and higher, we do see a higher risk of mortality – So this is where we should be focusing on weight loss.

It is important to note, that within every BMI category, there are healthy and unhealthy people. So we can never make individual recommendations based on someone’s BMI alone. Body diversity is normal.

Even if we feel that weight loss is beneficial, most research shows that people gain the weight back within 1-5 years especially if healthy habits are not established first.

A study by Matheson showed that healthy habits are associated with a reduction in health risk regardless of BMI. These healthy habits in the study were: fruit and veg intake, daily exercise, consuming alcohol moderately, and not smoking.

With an increase of these healthy habits, the health risk is the same with all groups. So why is weight often the marker of success rather than the health or well-being change themselves?

How much of diet culture influences our perspective on weight and health? It promotes that a thin-ideal body evidences health however this is not the case.

We should be focusing on healthy habits if you are focusing on health as chasing weight loss with constant dieting is causing us to have negative health consequences such as lower energy levels, poor mood and self-esteem,  and a poorer relationship with food. So are we actually chasing health?

Weight Stigma

Weight stigma is stereotyping based on a person’s weight. It refers to the discriminatory acts and ideologies based on someones size which can occur in families, societies, and even in health care.

Examples of weight stigma

In healthcare: – Seeing patients as weak willed, lazy, and non-compliant. In one study in 2012 by Puhl and Brownell, 53% of people with overweight and obesity reported to have received inappropriate comments from their doctor about their weight.

In the workplace: Obese people are also less likely to be placed in sales or customer-facing positions and are paid less than their healthy-weight counterparts for the same work – This is more pronounced for women with obesity.

(https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma)

Weight Stigma in itself when we control for BMI has been associated to promote poor health. It is associated with a 50% increased likelihood of mortality, systemic inflammation which underlies many chronic diseases, 2.48x risk of having a mood disorder and 2.62x risk of anxiety disorder, high allostatic load, and weight stigma is manipulated for studies, it is shown to trigger blood pressure reactivity and cortisol secretion. Cross sectional studies link weight stigma to oxidative stress and poor quality of health care.

Weight stigma can become so internalised where we start to begin to believe stereotypes about ourselves to be true. This can influence our behaviours such as if someone believes that a person in their body size is lazy, they are more likely to adopt sedentary behaviours which is linked to overeating, binge eating, depression, poorer health, and lower quality of life.

If you do have weight stigma, it is not your fault. We live in diet culture which idealises thinness and tells us our worth is based on body size and weight and stigmatises those who do not meet these cultural ideals around eating or appearance.

‘The sociocultural idealisation of thinness is the best-known contributor of eating disorders. – Culburt et al., 2015’

Why We Should Not Celebrate Weight gain or Weight loss

It is important to note that this does not mean we should avoid weight gain or avoid weight loss at all costs. The focus should be on not celebrating or putting weight change on a pedestal.

Behaviours of celebrating weight gain or weight loss can place our worth in an external focus and we are finding our worth and other peoples’ worth based on their body size which make it much more difficult to build a connection towards healthy eating habits.

We truly do not know whether someone’s weight loss is unintentional or not. People may have lost weight due to an illness such as cancer, an eating disorder, not eating due to trauma or stress, or more. Celebrating this can encourage them to lose more weight no matter what illness they have because all of us want to be accepted in some form.

If your goal is to improve your health and to aim to be free from constantly thinking about food, having distressing thoughts of seeing every single food as a calorie number then eating intuitively with focus on healthy eating should be the goal.

Benefits of Focusing on Healthy Habits Rather than Weight

• Increased mood
• Increased energy levels
• Lower levels of inflammation
• Improvements in chronic illnesses

The Harms of Diet Culture

Meta-analyses into long-term studies on dieting and pursuing weight loss show that 80-98% regain the lost weight or more within 1-5 years – especially if sustainable, healthy eating habits are not established. The national eating disorder association reports that those who start dieting, about 35% go on to chronic dieting which can lead to a disconnect about our body. This can lead to shame and low self-worth, obsessive thoughts towards food and out of control eating, erratic mood, weight cycling, and more.

Of those who go on to chronic dieting, 20% go on to develop a clinical eating disorder. Of all mental health conditions, eating disorders have the highest mortality rate out of all mental health conditions after opioid addiction as well as significantly reducing the quality of life of the individual and those around them.

Disordered eating is also very common in those with larger bodies and the national eating disorder association estimates that 40-60% seeking commercial weight loss support meet clinical criteria for binge eating disorder.

Therefore, it is really important to create a non-judgemental space to open up about their experiences and be able to recognise a traditional approach may not be appropriate.

Summary

Weight alone is a poor indicator of health and even at a higher body weight, if we are adopting healthy habits such as increasing our fruit and veg intake, stopping smoking, reducing alcohol intake, and engaging in physical activity, we can have a greater quality of life, reduced risk of mortality, a postive relationship with food, and improvements in chronic illnesses.

Constantly dieting – especially with a poor relationship with food can lead to worse health outcomes such as poor mood, low self-esteem, anxiety around food, and periods of overeating and/or bingeing. If you struggle with a poor relationship with food, adopting an intuitive eating approach can help by focusing on listening to what your body needs and to honour your cravings and hunger until you reach a balance of healthy eating and actually enjoying foods you fear or that trigger anxiety.

That doesn’t mean I am against weight loss. What I am saying is that we put way too much focus on weight that we begin to throw out healthy habits which can overall go against what we are actually trying to do – aim for health. If we are chasing weight loss for approval from others, we would never be satisfied and fall into a cycle of falling into a poorer relationship with food. We have to dig deep into our internal motivators to why we are actually aiming for weight loss.

If you are struggling with consistently being in a binge-restrict cycle, you may find my post on ‘6 Proven Ways to Stop Binge Eating’ helpful

BMI alone should not be used to dictate whether someone is healthy or not. It is important to recognise any weight stigma in ourselves and in other health professionals. It is important to note, that within every BMI category, there are healthy and unhealthy people. So we can never make individual recommendations based on someone’s BMI alone. Body diversity is normal and true health is determined by many factors rather than just weight alone.

If you are interested with my Binge Eating Freedom course, click this link here to find food freedom and to escape food guilt because we no