Rethinking Fatness: Why Everything You’ve Been Told About Weight May Be Wrong

Low-fat, low-carb, paleo, keto, intermittent fasting—the list goes on. Given that our culture idealises thinness and shuns larger bodies, it’s not surprising that nearly one in five midlife women has dieted in the past few years, according to the Australian Bureau of Statistics, and more than 2.3 million Australians over the age of 15 were reported to have been on a weight loss diet. The numbers increased by age group, and females were over represented. Many have regained the weight and see themselves as having failed. 

Some medical experts are now saying what many of us have been desperate to hear: It’s extremely tough to drop weight long-term, for reasons that have nothing to do with willpower—and it may not even be necessary.

“The dominant message people get from government, health organisations, and the media is that weight and health are connected. But really, there is no strong evidence to suggest that higher weight automatically leads to poorer health,” says Jeffrey Hunger, Ph.D., a longtime weight-stigma researcher (and yes, that’s his real name!).

If you’re extremely large-bodied, dropping some kilos can protect your joints from arthritis and make it easier to exercise. But for most women over the “ideal” weight, focusing on other health measures may be much more important than what the scale says.

So why isn’t that a message you’re likely to hear from your health care provider? “The evidence has been piling up for years, but experts are so stuck in their beliefs, they don’t accept anything to the contrary,” Hunger says. Add to this all the people and companies with financial interests in pumping out anti-fat messages, from diet purveyors to pharmaceutical companies to book authors. Plus, the message that body fat is bad and needs to be diminished as much as possible is such gospel in our society that it’s hard to believe it may not be true.

Here are eight important facts that many are overlooking. These realities may be just what you need to feel better about your body, whatever your weight.

1. Weight is not an accurate measure of health.

Researchers evaluated nearly two dozen studies and concluded that there was “no clear relationship between weight loss and health outcomes.” In other words, shedding kilos didn’t meaningfully lower blood pressure, diabetes risk, or cholesterol.

Meanwhile, a full 30% of the “normal-weight” participants in a major health study were found to have unhealthy levels of markers for blood pressure, diabetes and cholesterol. 

The bottom line: Weight alone is not indicative of health, so nobody can tell whether or not a person is healthy based on their weight.

2. Healthy behaviours are more important than the number on the scale.

Hunger and colleagues reviewed many studies on weight and health and discovered that healthful behaviours, not fitting into our skinny jeans, are what make us healthy—and help us live longer. Heavy people who do healthy things are as likely to thrive as anyone else. On the list: being physically active, eating nutritious foods, and quitting smoking, of course—but also socialising enough to avoid isolation, minimising stress, and managing depression.

“Your attention should be not on a target weight, but on how many days you intend to exercise this week and how much produce you’ll be eating,” says Mary S. Himmelstein, Ph.D., a researcher specialising in understanding how biophysical mechanisms influence health and disease.

3. You can be fat and also fit.

Our culture regularly equates carrying extra body fat with being out of shape, but plenty of large-bodied women can easily run laps around their thinner counter­parts at the gym. That’s because in reality fitness and weight have little to do with each other, Himmelstein says.

A team of international researchers proved this when they followed 43,000 participants across the weight spectrum. Those who were metabolically sound and also fit had the same mortality rates during the next decade regardless of their weight. Those who were considered obese and unfit, however, were more likely to die.

4. Shedding kilos doesn’t always lead to health gains.

If low weight equaled good health, dropping kilos would automatically make people healthier—but that’s not what happens. Hunger points to a meta-analysis that found that even after dieters lost weight, their blood pressure, glucose, and other blood markers weren’t significantly better when they were re-evaluated two years later. 

5. Weight is way more complex than 'kilojoules in, kilojoules out'.

“So many things go into the weight you are,” Himmelstein says. Genes, ethnicity, medicines you take, where you live, what your income is, and how much you sleep all play a role, even if most doctors focus only on kilojoules. Weight is so complex that even longtime researchers don’t yet understand all the variables involved. People might be heavier because these days food is so easily available. 

6. You can in fact be too thin.

There may be no upper limit to how rich you’d like to be, but there’s definitely a floor for how thin you should be. Having a body mass index (BMI) below 23 (less than about 59 kilos for a 160cm woman) is linked to greater mortality than being a few kilos heavier, a team of international researchers discovered when they examined hundreds of studies with over 30 million participants. 

7. Many health care providers are dangerously biased.

Most people with high body weight have a story about how their doctors judged or blamed them or didn’t listen, Himmelstein says. This is true with all types of providers—even ones who specialise in weight management! It can lead to a vicious cycle in which women avoid going to the doctor because they don’t want to be fat-shamed, then miss out on treatment or early detection, Himmelstein says. In other cases, health complaints that have nothing to do with weight are inaccurately blamed on a person’s size, so patients miss out on the correct treatment.

Problems like diabetes, cancer, and autoimmune conditions are especially important to identify early, when they are more easily treated, and health professionals’ putting too much emphasis on body weight seems to be keeping people from getting the best care.

8. Eating healthily will get you farther than a weight-loss diet.

Dieting can help you trim kilos, but keeping them off is another story. The low nutrition levels and excessive exercise of many weight-loss plans aren’t sustainable, Hunger says. Plus, when you cut back on kilojoules, your metabolism slows to a crawl. “Our body’s biological architecture doesn’t understand what the thin ideal is—it’s doing all it can to protect us from what it perceives as famine,” he notes.

Because of these factors, a European analysis of large-bodied women calculated the chances of their reaching a “normal” BMI as less than 1 in 100! “Rather than make a drastic temporary change for a short-term goal like how you’ll look at a class reunion, focus on small, sustained changes, like eating more whole grains and plant-based foods and less red meat and processed fare so healthy eating becomes your new lifestyle to set you up for long-term health,” advises Dr Ruwanthi Titano, a renowned cardiologist. 

Even thin people benefit from ditching the focus on weight, Himmelstein says. A lot of brainpower goes into monitoring calories or carbs, she notes—time and energy we’d all be better off spending elsewhere. “Instead of trying to shrink your body, start to appreciate everything it does for you,” Hunger suggests. You’ll be healthy and feel good—the things that matter—no matter what your dress size.

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This article originally appeared in the May 2021 issue of Prevention USA.