Does Weight = Health?

Weight has long been used as an indicator of health – for doctors, Dietitians, personal trainers – hell, even Pete Evans uses it (and that is a heckin’ concern my friends). It’s always been a simple message, right? Overweight = Poor Health.

We learn as Dietitians at university to obtain a patient’s height and weight, then calculate their BMI. From here, we calculate their ‘Healthy Weight Range’ from the ‘Healthy BMI Range’ (20-24.9kg/m2 for healthy adults) and make a comment in their documentation as to whether the client is ‘under, within or over’ their healthy weight range.

We do this before we even meet the person.

We don’t know their build. We don’t know their physical activity level. We don’t know their eating habits. We don’t know if they smoke, drink, take drugs or are on the Carnivore Diet (Diet-Jesus help us all).

But we have a preconceived idea of their ‘health’ before we even meet them.

Should we use weight as a measure of health?

CONTROVERSIAL (all my Health at Every Size readers, please don’t exit out yet!)

Tracking weight can be a great measure of health:

• For tracking normal growth and development in infants

• Weight loss in the elderly is usually an indicator of reduced food intake, leading to a loss of muscle mass (which ultimately leads to a decline in their health and physical function)

• Supporting client’s recovery from living with an eating disorder, where gaining body mass may be essential for their health

• In Australian hospitals (arguably some of the best in the world), up to 40% of patients are malnourished, leading to prolonged hospital stays and poorer health outcomes

• Weight tracking can help to measure and manage fluid overload in patients with conditions like Renal Disease and Heart Failure

• Elite athlete performance is also often strongly linked to their body composition (way beyond my scope - the.end.)

Consequences of using weight as a measure of health

For those who don’t fall into one of those categories (sorry weekend warriors, a game of Squash on Sundays doesn’t make you elite – just really sweaty with a high chance of headbands):

There are a number of reasons why using weight as an indicator of health can be very damaging:

• Incorrectly assuming that someone who is in a smaller body is healthy, and someone who is in a larger body is unhealthy – consider smoking, alcohol and drug use, mental health, aerobic fitness, strength, bone density – these all contribute to a person’s ‘health’, but cannot be determined by weight

• Using weight as a measure of success when implementing healthy lifestyle behaviours

  • Weight changes are often slow, unpredictable (i.e. you could gain ‘weight’ [muscle] when commencing weight training) and provide only a momentary feeling of ‘success’, but a lingering feeling of ‘failure’

  • There are so many other intrinsic and extrinsic measures of success, like energy levels, strength, endurance (see below for more!) that can be experienced almost immediately when implementing healthy lifestyle behaviours, which do not rely on weight

• Focusing on weight can foster disordered eating, over-exercising and/or a fixation on body size

• Focusing on weight can discourage people in larger bodies from seeking healthcare, as they are made to feel like health conditions are their own fault

Focusing on weight as an indicator of health can encourage people to turn to non-health promoting behaviours to achieve a specific weight and can discourage people from seeking healthcare all together.

If not weight, then what?

Some examples of non weight-centric measures of health progress include:

• Improved energy levels

• Improved bowel movement patterns (frequency, consistency etc.)

• Improved strength, speed, endurance (or other performance-based achievements)

• Increased enjoyment and participation in exercise

• Improved mood

• Eating to a point of content fullness in a situation where you might previously eat beyond comfort

• Incorporating more fruit and vegetables into your diet

• Doing more groceries and cooking more at home

• Enjoying a meal at the dinner table with friends or family

• Smoking less or taking fewer recreational drugs

• In a clinical setting, improved biochemical markers (e.g. reduced LDL or 'bad' cholesterol, lowered blood pressure)

Health and Weight

The Oxford Dictionary defines health as ‘the state of being free from illness and injury’.

I honestly don’t know anyone who fits that definition.

Do you know anyone who doesn’t have a sore back OR bowel problems OR anxiety OR high blood pressure OR high cholesterol OR … you get it.

If you look at two people – same gender, same age, same height, different body weight – can you honestly look at them and determine one person’s health over the other? Isn’t that just short-changing the complexity of the client as a unique individual? Isn’t that disregarding the amount of education that we as health professionals have completed to BE health professionals? Isn’t that just lazy practice?

Our whole lives we have been told that larger bodies are unhealthy. But now that we have established that body size DOES NOT equal health, how are you going to unlearn this belief? It's not easy. It's not comfortable. But if you call yourself a health professional then you damn well need to address it.