Beyond Obesity: Living Healthy in a Larger Body

Redefining obesity: Why we want to talk about body size differently

We hear plenty about the “obesity epidemic” and the dangers of being overweight. But having a larger body does not mean someone is unhealthy. In fact, a person’s body size may not be an issue at all. 

About 40% of Americans qualify as “obese” based on their body mass index (BMI) — an imperfect measure of health based on body size. Health experts around the world have worked to reduce this number through countless weight-loss campaigns. Yet, these programs have had minimal success. 

One large study found that less than 1% of people with an “obese” BMI were able to achieve or maintain a “normal” weight during the 9-year study period. One reason is that many people don’t have as much control over their body size as we’re led to believe. 

Research shows your BMI is largely determined by your genetics and environment — not your personal choices about what to eat or how much you exercise. In fact, restrictive diets and weight loss regimens can lead to serious health threats, like:

• Malnutrition

• Disordered eating

• Mental health conditions

Long story short, body size is complicated. Despite this, people with larger bodies are often exposed to harmful weight bias and discrimination. 

We’ll never tell you what’s best for your body, weight, or health. Instead, we want to help give you a clearer picture about what it means to have a larger body size, especially if: 

• You’re tired of diet culture or weight bias.

• You have never been able to lose weight and maintain it.

• You just want to focus on accepting the body you have.

• You’d like guidance on healthy habits that aren’t all about weight loss.

What Are the Medical Care Costs of Obesity?

Written by Sana Khan MBA, MPH

What to know about the drivers of obesity and weight

There isn’t a single cause of having a larger body size. But we do know that your body size is largely determined by genes and the world around you. These factors are often completely outside of your control. 

Research suggests that genetics are up to 80% responsible for your body size. And researchers have identified hundreds of potential genetic factors that may be associated with larger body size.

Perhaps an even more important contributor to your body size is your environment. This is especially true if you experience negative social determinants of health. 

Social determinants of health include things such as:

• Access to nutritious food

• Clean drinking water

• Safe places to exercise outdoors

• Financial resources

• Education level

• Access to healthcare

• Community safety

• Racial and gender discrimination

For example, people who have limited financial resources may opt for ultra-processed foods, because these foods are usually more affordable than more nutritious ones. Or, if you live in a community that lacks a park or is exposed to a lot of pollution, you may not have a safe outside area to exercise.

And negative environmental factors can turn on genes that predispose you to a larger body size. This is called epigenetics, which refers to how your environment influences your genetic risk for characteristics (like body size) or health conditions. 

Here’s one example of epigenetics. Say a pregnant mother can’t afford enough nutritious food. As a result, her baby develops permanent changes to their insulin metabolism while they’re still in the womb. This change is designed to help the baby survive, but it also makes them more likely to have a larger body size as they grow.

The Social, Mental, and Economic Costs of Obesity

Written by Sana Khan MBA, MPH

What are the health risks of weight discrimination?

It’s common to hear about the way weight contributes to certain health conditions. But weight discrimination and fat bias can pose more health risks than weight itself. Here are some examples of how weight bias or discrimination have a proven negative effect on people with larger bodies:

• Discrimination — or unjust treatment — may increase the risk of people with larger bodies dying earlier. This risk has nothing to do with weight.

• People who experience weight stigma are over twice as likely to experience anxiety and depression as people who don’t. 

• Weight bias can contribute to additional weight gain.

• Dieting and weight loss are strong predictors of future weight gain. 

People with larger bodies often have negative experiences with healthcare providers. They may feel disrespected or embarrassed because of how their provider talks about their body. Or they may experience “medical gaslighting,” in which a provider dismisses their health concerns because of their weight. 

In some cases, people with larger bodies do not receive adequate — or any — care from healthcare providers. As a result, it’s common for people with larger bodies to avoid seeking medical care and preventative screenings altogether.

In addition, extreme weight loss efforts can have serious negative effects. For example, people who experience high rates of weight fluctuation may be more at risk of heart attack or stroke. And restrictive dieting can lead to eating disorders.

Fast weight loss — such as through crash diets or after bariatric surgery — increases the risk for gallstones. Losing and then gaining weight repeatedly (weight cycling) similarly increases this risk. 

Does Being Obese or Overweight Affect Your Mental Health?

Written by Emily Guarnotta, PsyD

Living healthy regardless of your body size

Regardless of body size, there are steps everyone can take toward living a healthy life. Yes, these include eating nutritious food and getting regular exercise. But it’s also important for people to enjoy the things they eat and the way they move their bodies.

Below are seven evidence-backed suggestions to improve your well-being at any size.

1. Eat a nutritious diet

Focus on incorporating plenty of fruits and vegetables, add in whole grains when possible, and don’t forget protein. But keep in mind that you need some fat in your diet, too.

2. Exercise regularly

Experts recommend getting at least 2.5 hours of aerobic exercise — such as walking, bicycling, or jogging — each week. It’s also beneficial to build in some strength training twice a week.

3. Address any health conditions

If you have been diagnosed with a health condition, keep up with your regular provider visits and medications.

4. Get routine health checkups and screenings

Staying on top of preventive care is essential for good health. This includes getting vaccinations, cancer screenings, and tests for high blood pressure or diabetes.

5. Evaluate weight-loss claims with a critical eye

Be skeptical about any weight-related claims you see from advertisers, influencers, and people on social media. There’s a good chance their claims may be false or misleading. 

6. Find social support

Connect with others and build your social network. Strong relationships, especially with people you can trust, help you manage stress.

7. Take care of your mental health

Your mental health is just as important as your physical health. Rely on your social network for support and reach out for professional help if you need it.

How Do I Create Healthy Habits for a Healthy Lifestyle?

Written by Karen Hovav, MD, FAAP