No Such Thing as a Healthy Weight

Greetings from LA! I decided to write a post about how there is no such thing as a “healthy weight”.  Then I realized that I wrote one two years ago, so I’m updating and re-posting because I think it bears repeating:

There is no such thing as a “Healthy Weight”.  People have a certain level of health (which can be judged through metabolic tests or physical fitness etc) and people have a weight (which can be judged in pounds, kilos, stone etc.).  These are two separate measurements.

One easy example of this is the girl who ate a diet of almost exclusively chicken nuggets for most of her life, and then got very sick. News stories actually said that it was surprising because she was at a “healthy weight”, as if this incident wasn’t an indictment against the concept.

The idea of conflating weight and health has a lot to do with the use of Body Mass Index (BMI) (a simple ratio of weight and height) as a measure of health by  insurance companies who wanted to save money by not having to perform actual tests. Helping them out were diet and pharmaceutical companies who found that if they could convince people that anyone over a certain BMI would have dire health consequences, it was easier to convince them to buy their stuff.

They got on committees within the CDC,  and soon 3 people with ties to pharmaceutical companies that create diet drugs, in concert with the chief “scientist” at Weight Watchers,  managed to convince the CDC to lower what was considered a healthy BMI and then recommend their products as a solution to the problem that they had just created.  This process meant that about 25 million Americans became “overweight” overnight and we were off to the races. The next day newspapers ran the story “Millions of Americans Don’t Know They’re Overweight”, but failed to mention it was because those millions Americans had been a “healthy weight” less than 24 hours ago.

Now despite having good health by any measurement, many fat people (including me) can’t get health insurance.  Healthy fat people who do have health insurance are often encouraged to undergo a risky major surgery with an extremely poor success rate at 20K a pop so that their bodies can be smaller, and the diet industry makes over 60 Billion dollars a year. Meanwhile plenty of sedentary thin people who eat a poor diet are constantly sold the idea that they are healthy simply because of the ratio of their weight and height.

And we are hearing from everyone and their dog that we need to get to a “healthy weight”.  Often it’s suggested that we should do this by any means necessary, the implication being that it doesn’t matter what crazy unhealthy things we do to get thin, because once we get there we’ll be automatically healthy just because our bodies are smaller.

Except it doesn’t work that way. (Just ask someone who got thin from using heroin.) The best suggestion that doctors can give us if they are being honest and practicing evidence-based medicine is that healthy behaviors have the best chance of creating a healthy body. But even that’s not guaranteed.  Most of us know someone who followed every health guideline and got sick.  Most of us know someone who eats like crap, never exercises and is as healthy as a horse. At the extreme ends Marathon runners drop dead of heart attacks at 45 and sedentary Grandmas eat frozen dinners, smoke unfiltered cigarettes, and live to be 102, in the middle it’s an even grayer area.   There are healthy and unhealthy people of every weight, shape, and size and the medically responsible thing would be to look at each person as an individual and recommend evidence based interventions specific to their health issues, instead of trying to stereotype people based on how they look and then try to find a way to blame them for their health conditions instead of treating them.

If doctors were honest with us, they would say that the human body is extremely complex and they haven’t yet scratched the surface of everything that is involved in being “healthy”.  They would also ‘fess up that even if they could prove that weight loss makes you healthier (which they can’t) they don’t have a single proven method of weight loss.  They would tell us that the caloric restriction method (aka “eat less and exercise more”) has an abhorrently poor success record.  Were it a prescription, doctors would be forced to remove dieting from the shelves for its complete lack of efficacy and all of its safety concerns. But it’s not, so they just keep recommending the same thing, even though it just doesn’t work. More and more we are finding that physical fitness is a much better indicator of health than is weight.

There are so many things to be improved in this system, but let’s do one simple thing today:  Let’s decide to eliminate the phrase “healthy weight”.

As always, this is your decision.  If you’re in for this then I suggest that we start with ourselves – check our own assumptions about people’s health based on their size, including people who are very thin.

Then I suggest the following scripting as an example when this comes up:

Person who still buys into the healthy weight myth:  “blah blah blah healthy weight blah blah blah”

Enlightened person (that’s us) “Actually, there is no such thing as a healthy weight, and I wish people would stop spreading that myth.  There are people who are healthy and people who are unhealthy at every shape and size.”

Now, this can often lead to the VFHT:  Vague Future Health Threat.  This is when someone suggests that even if I, as a fat person, am healthy now (and it doesn’t seem to matter how old I happen to be) “it”  will catch up to me “someday” cleverly using the fact that everyone will die, but insisting even if I die when a group of trained bald eagles drop a piano on my head, it will be because I was fat.

For now:  No more saying “healthy weight”:  Never ever, never ever, never ever.

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28 thoughts on “No Such Thing as a Healthy Weight

  1. You are right and you are wrong. There is no such thing as an objective, general healthy weight. A healthy weight is one which does not stress the body – this is not to say that the body won’t be stressed by other conditions that are unrelated to weight. But each person has a different weight at which this happens, and I would even venture to assert the probability of that target weight range changing over the person’s life.

    1. Dah,

      Even if one subscribes to the theory that you are espousing, I disagree that it is the person’s weight that makes them healthy. I also think that if that theory is true, the weight range is quite wide and, as you mentioned, might change with time and circumstances. It also doesn’t change the fact that almost nobody is able to reduce their weight and therefore it’s still about the best you can do with the body you have and the size you are. Therefore attempting to manipulate weight as a means to create health is still not indicated by the evidence.


      1. Oh, I am not saying that the weight of a person is the sole determinant of their health, just that it is one factor. You seemed to be arguing that weight is not a factor at all, which is what I am disagreeing with. There is a weight range which is healthy for your body, and anything outside that is, by definition, unhealthy (note that this applies to underweight as well as overweight). Unfortunately, and the sentiment I do agree with, is that that healthy weight range is extremely subjective and personal, and so no standardised numbers can possibly cover the majority of the population.

  2. It’s a challenge, but it’s doable. Re-training my head to believe (and ACT on those beliefs) what’s true and real vs. what’s been forced on me my entire life is really tough. It’s tough for all of us. You’re a hero, you know that?

    My [twin] sister and I just had a short conversation about the healthy weight myth. She studied tropical fish for a while over a summer on an island in the Caribbean, and they did a lot of hiking and swimming. She said she’s never been so fit in her life as she was then, but she never managed to lose more than ~ten pounds anyway. And it was the same for me when I did an internship for 3 months in Utah; all I did for those three months was hike in Canyonlands and Arches, and I lost about ten pounds as well. We both got down to the 155/160ish range, which borders on “overweight” and “obese” on the BMI scale. I have a suspicion that is what our NATURAL weights are supposed to be. And I think I’d be okay with it. I just need to start exercising and eating better.

    I just wrote a few questions, but I think I’ll email you instead!

      1. Yeah–eye color can actually be indicative of certain health problems, like mineral deficiencies or jaundice.

      2. Oh? How is it wrong? There are conditions that can change the color of eyes, and that change is often one of the first indicators of the condition. Jaundice, for example. There are conditions that can change your weight, and that chance can be an early indicator. But health doesn’t actually rely on either.

      3. If we are talking about eye health conditions, yes. I thought you were speaking in a way that says eye color (those that are health eyes) has a little do do with one’s health than weight. I know health doesn’t reply on weight. It’s not even a main indicator of health, but I do believe it still is one for what it’s worth.

      4. Weight is only usable in diagnosis if the person either gains or loses weight rapidly without any change of habits, or with only minor changes to their habits. For instance my weight is about the same when I am fit enough to run around like a maniac for 2 days or feeling really crappy as back pain has had me limiting my exercise and general movement for 6 months – the doctors treat me the same in either case (except I rarely need to see the doctor when I’m fit and healthy).

        Weight should only factor into health if it changes in unexpected or dramatic ways. You cannot look at someone and say they are/not at a healthy weight as they might be at the weight where they have the healthiest habits and eating pattern.

        I have a friend with a very thin build, if she put on a large amount of weight I’d be worried as it would be unusual, just as it would be unusual for me to rapidly lose 2 stone (which I have done in the past after coming off a specific medication).

      5. I think there are additional instances where weight can factor into the health status of a person, including birth weight of a newborn among other things but I would rather not discuss here. This is not to say I don’t think a lot of people who are classified as overweight can and are healthy.

  3. I used to use the phrase “healthy weight” as a shortcut to explain “the weight my body is when my food intake is things my body uses best in amounts that it likes best and when my exercise levels are enough to make me feel energetic and alert but not so much or so little I feel lethargic and icky.” Or, in other words, “the weight at which I feel most healthy.”

    But this post makes me realize that that number is illusory, because where I want to be is “where I feel most healthy,” and I’m going to push to stay in that zone regardless of the number on the scale. If the number on the scale suddenly goes up or down X pounds but I still feel energetic and strong and alert, I’m going to keep doing what makes me feel that way, not what would change the scale number back.

  4. “One easy example of this is the girl who ate a diet of almost exclusively chicken nuggets for most of her life, and then got very sick. News stories actually said that it was surprising because she was at a “healthy weight””

    That’s just idiotic. Chicken nuggets don’t contain all of the nutrients that human beings need to survive. It’s likely she got sick from *malnutrition*, and that’s not surprising no matter what her weight might have been.

    Good grief!

    1. All the news coverage expressed surprise that she was thin. But somehow none of them thought to question the Bad Fatty paradigm that says fat people eat only junk food, while thin people must not eat much junk, or else they’d be fat.

      1. Well, of course not! We can’t question *that*!

        I’m thin with high blood pressure (yes, it’s possible – imagine that!). But I *do* have *excellent* cholesterol. My doctor said I must be eating really healthy, and I was like, “LOL, no.”. My favorite sandwich is steak with cheese and mayo. I should have the highest cholesterol on Earth!

        Obviously there’s more going on here than, “calories in = body weight and/or health”. But you’ll never get most doctors/health professionals to believe/admit that. Hell, you’ll never even get them to *question* it.

        And yeah, I’m fully aware that if I were “overweight”, I’d have been told to lose weight rather than given a prescription for blood pressure meds. Reading this blog has been a real eye-opening experience for me!

  5. Oh, I believe in healthy weight. I also believe that it only applies to individuals, and can vary throughout one’s life. I believe in it in the sense that if you stray far from it without explanation, there’s a good chance that something’s wrong.

    1. The key phrase here is not “healthy weight” but “Without explanation.” Yes – if you gain *or lose* weight without any obvious reason, that can be a marker that something is wrong. Only a marker, though – not the cause.

      I’ve gained a lot lately, as a result of a chronic illness. (I’m blessed, I guess, to have one of the few illnesses that no one tries to blame on weight…) Telling me I need to eat less and exercise more to lose the weight – as some relatives have – just adds to the stress level – which is one cause of the weight gain… (In fact, I am both eating and exercising correctly for *my* condition. Changing either is… unhelpful at the least, and potentially dangerous.)

      Meanwhile, a friend’s mother started inexplicably losing weight. That turned out to be cancer… She was thin to begin with, but if she’d been fat, no one would have seen this as a problem – until much later.

      The weight change itself was not the issue in either case. The problem is that, in my case, many people see it as the cause – not a symptom – and in her case, if she’d been fat, they would have seen it as a good – not a symptom of serious disease. (And – in her case – they have been very worried that she is *too thin* to have the resources to get through chemo… but no one ever mentions that unless you are right up against it.)

  6. So many well-meaning body image activists use the phrase “healthy weight” and it always makes me cringe. If people want to say I don’t need to be a slim as a supermodel but still try to tell me what I SHOULD weigh they are no activist of mine that’s for sure…

  7. Amen, Lindsay. I agree. Frances Berg used to edit a journal about health, as related to fat people, etc., called “Healthy Weight Journal”. I thought that had no place in the world of fat acceptance & I still do not think so. People can be healthy or unhealthy at any weight. People of any size can & likely will be healthier at times than at others &, insofar as lifestyle can influence health, MAY be healthier &.or feel better & more energetic by getting more rest, exercising moderately on a regular basis, & eating a good enough variety of foods to be well-nourished. Their weight may or may not change in the course of these behaviors. We are not necessarily healthier when we lose weight or unhealthier when we gain.

    The one point on which I can agree is that if you either gain or lose a significant amount of weight without any known reason for it happening, there may be something wrong which needs attention. Sudden unexplained changes do need to be investigated, but that has nothing to do with precisely what you weigh. For instance, my younger son has been losing some weight recently & it appears that he may have an overactive thyroid, so he is going to see a doctor tomorrow. If indeed he has issues with his thyroid & he is started on a medication to regulate its function, he will certainly feel better & be healthier, whether he loses weight, gains it, or stays the same.

    Yes, the person who claims that we can be fat ‘up to a point’ or that ‘your body cannot handle more than x amount of weight’ is not a fat acceptance activist or indeed a body acceptance advocate. He or she is an advocate of the same old, same old, just with the ‘acceptable’ bar set a bit higher. Worth is not a number & health is not a number.

  8. Ah Ragen. I hope that you have found health insurance since originally writing this post (don’t know if that was an update or from the original). I’ve been there. It sucks. Sending much love.

  9. “Even if I die when a group of trained bald eagles drop a piano on my head, it will be because I was fat.”

    Well, girth DOES make one an easier target to aim for… Sorry, couldn’t resist! 😉

    1. That just leaves a few loose ends, like who trained the eagles and where they got the piano. Also who picked the target…

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