Beyond the BMI: Is it time to redefine what “healthy” means?

Weight Management

by Alessandra Stasnopolis, RDN, LDN

Aug 19, 2021

Maybe you’ve heard of the body positive or weight neutral movement that has been gaining momentum in social media in the last couple years. Health at Every Size means exactly how it sounds: moving toward the idea of exploring health for all bodies without weight loss, advocating for proper care regardless of one’s size and demanding respect for all bodies.

There is a growing body of research showing that weight loss may not just be ineffective at producing healthier bodies but also damaging both physically and mentally.

Thus far, many Health at Every Size based clinical trials have found that participants saw improvements in physiological measures (like blood pressure and blood lipids), health behaviors (like physical activity and reduced eating disorder risk) and psychosocial outcomes (like improvements in mood, self-esteem and body image).

What you might not know about BMI

Now you may think, but what about BMI? BMI, or Body Mass Index, dictates our healthcare standards—and if we’re being honest, our social standing. It’s often mentioned in clinical research and at your doctor’s office. For those who live in larger bodies, this metric is almost like a tattoo; it’s as if it’s a part of your permanent health record.

Here are some facts you may not know about this metric.

  • It wasn’t originally created to be a health metric.
  • It was created by an astronomer, not a doctor or health professional.
  • It mostly used data from Caucasian, male, white collar and middle-aged people.
  • The data was only taken at one point in time and there was no follow-up.
  • Insurance companies have had a hand in the development of weight-based health standards since the early 1900s.

Knowing this about BMI, it makes the validity of its significance moot, in my eyes and the eyes of many other health professionals. However, it is a value that is often referred to and dictates how people are treated at the doctor’s office.

Related: 10 ways to embrace a body-neutral mindset

Battling weight stigma

This is where we enter into weight stigma—a huge reason why Health at Every Size exists.

Weight stigma is when a person’s health is judged solely based upon the size of their body and how they look. Weight stigma impacts people at the doctor’s office, in public, on an airplane, interviewing for a job and getting health insurance amongst other situations.

Those who experience weight stigma are less likely to go to the doctor due to ridicule and are more likely to be labeled as “non-compliant” patients. This means their access to care and quality of care are less than their smaller bodied counterparts that fit in the “healthy” BMI category. Those who experience weight stigma also experience increased stress levels, which can overtime lead to poorer health outcomes.

Is weight loss always the answer?

Weight loss is often prescribed to patients, but is that actually the best route for every person? Here are some things that you may not know about weight loss.

  • 95% of diets fail.
  • Most diets aren’t sustainable.
  • Cutting your calories doesn’t always work and doesn’t mean it’s healthy for you.
  • Weight loss can increase risk for eating disorders in all ages, shapes, genders and races.
  • Yo-yo dieting has been correlated with increased risk for mortality and increased risk for chronic diseases.
  • Weight loss can potentially cause muscle mass loss, nutritional deficiencies, gastrointestinal discomfort, poor body image and low self-esteem.
  • There are over 100 things that impact why you are the weight you are; it’s not as simple as many think.

Some of these facts may surprise you based upon what you hear in the media. But it’s true. We can’t guarantee weight loss and we can’t guarantee that it improves our health nor improves our chronic disease management in the long run. We also know that pushing weight loss only coincides with the message that if you don’t look fit or thin, you are lesser than because you aren’t considered “healthy.”

Health can be defined by so many different things. Ultimately, you decide what healthy means to you and what is right for your body. So instead of focusing only on weight loss as a way to improve health, let’s talk about all the other things we can do to promote health, including:

  • Sleep hygiene
  • Increasing movement
  • Focusing on adding nutritious foods to your diet instead of taking away
  • Stress management and burnout prevention
  • Mental health
  • Financial health
  • Physical therapy (if you suffer from arthritis or injuries)
  • Socializing
  • Medication management
  • Body image work
  • Annual physicals and preventative screenings

There is no shame if you do decide weight loss is right for you, but just know that it’s not your only option. Also know that you aren’t giving up on your health if you decide to stop dieting. Again, there are many ways to enhance our health, and health is not a size.

Next steps

About the Author

Alessandra Stasnopolis, RDN, LDN, is a clinical dietitian and wellness coordinator in the Baylor Scott & White Health wellness department.

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