• Tue, Nov 8 2011

Health At Every Size: Is It Possible To Be Healthy And Obese?

In my time as an editor at Blisstree, I’ve been surprised to see heated debate between experts, writers and readers over the health implications of being obese. Like many, I assumed it was common knowledge that anyone within a certain weight range or body mass index (BMI) was unhealthy, and at serious risk of disease brought on by excess weight. Right? Wrong! Not everyone agrees. Especially not proponents of the Health At Every Size movement, which is based on the simple premise that healthy behaviors are more important than weight (no matter what the weight may be), and promotes healthy body image and a “no diet” policy. Is this thinking body positive? Yes. But is it avoiding the reality that excess body fat is the root of several health problems? Depends on who you talk to.

As with any controversial health issue, the facts are all up for debate: For starters, words like “healthy” and “obese” are problematic, to say the least. Most frequently, what qualifies someone as obese is their BMI, a common way of calculating the ratio between weight and height that many say is outdated and uninformative. And, likewise, healthy can mean a lot of things; there’s no single barometer for how your whole picture of health stacks up.

Nevertheless, it’s an interesting debate, and one that I wanted to learn more about, given the fact that we’re constantly writing about the obesity epidemic, nutrition, fitness, prevention, and let’s not forget body image, here at Blisstree. So I asked a bunch of doctors, nutritionists, trainers, and experts the one simple question that opens up a Pandora’s box of debate: “Is it possible to be healthy and obese?

Of those who got back to me*, their answers and approaches were as varied as their backgrounds, but none were simple or uninformed. [Update: A response from Natasha Turner, MD, who writes a weekly column on Blisstree, has been added to the gallery below.] Some had never heard of the Healthy At Every Size movement; one is a founding expert. Each is knowledgeable in their own right, and their answers prove it. Check out what they all have to say, and tell us what you think is the best measure of health in the comments section below.

*Editor’s note: Several doctors, nutritionists and fitness experts were consulted for this post. If you know any who would like to participate, but weren’t included, please contact me directly: briana [at] blisstree [dot] com.

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  • anxiousacres

    You cannot look at someone and tell what their medical history is. I’ve always been bigger, but a hormone deficiency has made it extremely difficult to lose weight and extremely easy to gain weight. The only time I was ever in my “target weight” was when I was 14 and anorexic.

    BMI is a fundamentally flawed and arcane system.

    • Briana Rognlin

      Definitely agreed – I’ve been roughly the same weight at my healthiest and at my unhealthiest; weight and BMI isn’t the whole picture.

      But I think a lot of the experts that got back to me for this post still offer a pretty convincing argument for trying to keep body fat percentage below a certain max to lower certain health risks and side effects of having a high fat %, which says to me that instead of constantly pushing diets and workout programs that focus solely on weight loss, we should really be learning more about body composition and how to achieve the right balance between healthy behaviors and a healthy amount of fat.

  • menis

    Dr. John Dempster has the worst English I have read in months. It hurts my eyes and brain. Didn’t you proofread this, for lack of a better word, rant?

    He sounds upset and raging.

    • Briana Rognlin

      Dr. Dempster spoke with me on the phone, and I transcribed his answer to the question. I’ve edited to make it easier to read (he, like most people, doesn’t speak exactly how someone would write).

      But on another note, I have to disagree that he was on a rant. For starters, he was pretty calm and not upset or “raging” when we spoke, but he is really interested in the topic and agreed that it was an important one to discuss. Personally, I think he outlines some really interesting points in support of thinking about weight and health differently, which is a lot more constructive than a “rant” would be. Just my two cents!

  • michelle

    Though I agree in theory to the premise that healthy eating is more important than focusing on how much someone weighs, being overweight still goes hand-in-hand with a lot of the health problems afflicting Americans today. I’m sure that the percentage of people who would be considered “overweight” who would also be considered healthy are very low. I don’t think attention should be taken away from the important link obesity shares with bad health.

  • Erma

    I would really like to know where the last image in the slideshow came from. In what world is that woman on the far left a size 6? Are those European sizes?

  • Hannah

    Before I comment on the experts’ responses (thank you for providing those, by the way), what’s the source of the graphic accompanying Joe Dowdwell’s response?

  • Briana Rognlin

    Ladies, the last photo/photo that correlates with Joe’s comment is from Australian Marie Claire. Just added the link to the slide so you can see the full article if you want!

  • Jenny

    Joe Dowdell sounds like an absolute idiot! Where did you dig him up from?

    • Briana Rognlin

      Hey Jenny, I didn’t “dig him up” – he’s a prominent (and well-qualified) personal trainer in New York City. He trains top athletes and celebrities in the top-rated gym that he founded here, and he also wrote a book in conjunction with Dr. Brooke Kalanick, whose opinion is also part of this post (although hers varies from his).

      Say what you want about his opinion on this matter, but he really does his homework when it comes to his line of work, so I wouldn’t call him an “idiot”—although I would like to hear what you disagree with and why! The point of including so many different opinions was to spark some debate and thought here at Blisstree (because, like I pointed out in the post, it’s an issue that I continue to find confusing and difficult to approach on a site that prizes BOTH body positivity and optimum health). So please, have at it!

  • David Spero RN

    It’s one thing to say “keep body fat below a certain percentage.” It’s a completely different thing to say “live a healthy life.” In my experience working with people with diabetes and metabolic illness, the #1 factor, by far, is physical activity. Obsessing over what you eat or what you weigh doesn’t help.

    The #2 factor, again by far, is stress. Feeling threatened all the time will increase insulin resistance, abdominal fat, and blood pressure. So those fat people with normal blood pressures who one doctor reported probably ARE less likely to become sick than normal weight people with high BP. Why? Because they’re probably less stressed. So stressing people about their weight is NOT helping them.

  • Deb Burgard, PhD

    One thing your readers should know is that the only “expert” you interviewed who has research on their methods long-term with the population that is most typical of your readers is Dr. Bacon, whose study showed that after two years, people who were following a HAES(r) model were still doing the practices that supported their health and still enjoying the health benefits of those practices. The control group followed a traditional diet, lost weight initially and then regained it, and stopped doing the practices. This failure of long-term benefits from weight loss (we should really call it weight cycling) is an almost universal finding (see Mann et al., 2007). Even bariatric surgery is really best described as a weight cycling intervention, since almost everyone regains most of their weight loss (though slower for some than dieters).

    As a psychologist treating eating disorders I ask myself, what is the set of practices that people can do for the rest of their lives? You can say, wow, I could be so happy and so healthy if I made a million dollars, and I could show you studies of millionaires that show better health than non-millionaires, and we could train doctors to consider net worth a “vital sign” just like they have done with the laughable BMI – and still, most people will not become millionaires no matter what they do. So do we keep telling them to be millionaires and have them waste money on lottery tickets and pyramid schemes or do we say, look, here are some practices that have helped people become financially more stable. Do we look at the world we live in and say, how do we change the unfairness of the forces that make it impossible for this person to make a living wage while this other person has never lifted a finger?

    The HAES model focuses us on the practices people can do, and the environment we live in, to make ourselves as healthy as we can, rather than making ourselves a certain weight. Weight diversity has always existed and will continue to even when people are thriving. We should not be making people sick by imposing weight stigma on them. There is a tremendous amount of weight stigma and bias among your “experts” – and what passes for “common knowledge” about fatness.

  • Kimber Simpkins

    It’s sad that so many health professionals repeat the old line of “healthy=thin, fat=sick.” It makes you wonder, do they look at who funds the research that supposedly proves this? Diet and pharmaceutical industries fund most of these studies in support of their billion dollar industries that make money off of every person who’s afraid that one pound of extra fat is going to shorten their life span. I don’t know where your one doctor got her evidence, but the allegation that more fat people die of cancer just isn’t true. The folks who make money off diets and dieting drugs WISH it were true, and try to crunch numbers to make it seem believable, and then get doctors like this one to repeat their nonsense. Get the facts. Try reading Linda Bacon’s book, for starters: Health At Every Size: The Surprising Truth About Your Weight.

  • crispen dzvene

    My grandmother was 130cm tall and she weighed 115 kgs,she died when she was 92years old .She was extremely obese ,what made her live this long

  • Chris

    The thing is – does it matter whether it’s possible to be healthy and obese when we don’t have consistent and reliable methods of getting people thin for the long term? People give up on exercise when they fail to lose weight, because our emphasis is all on the weight, as if that’s the most important determining factor when it comes to health. But even if you don’t shed a pound, exercise still increases your insulin sensitivity, it’s still good for your heart and circulation, all the other benefits still apply. If we encourage people to adopt healthy behaviours, surely this is better than giving up on health if we fail to lose any weight.

    The other issue I see frequently (I’m a personal trainer) is people adopting very unhealthy behaviours in order to lose weight. The question then becomes which is the lesser of the “two evils” – is it more unhealthy to be obese, or is it more unhealthy to be starving? I personally believe you’re better off being fatter than malnourished, and I encourage everyone I train to focus on nourishment and nurture and support, rather than depletion and deficiency. There are a number of reasons I take this overall approach – in my experience, more often than not, short term dieting makes you fatter in the long run – so who the hell is that serving? Whereas focusing on your nourishment and health in a positive way enables you to do more stuff that is good for you, rather than taking things away in an attempt to become somehow ‘better’.

    When it comes down to it, I believe how you live will always impact your health more strongly than how big or small you are. We know it’s possible to be thin and unhealhty, so why the hell wouldn’t we also see that it’s possible to be fat and healthy. Clearly being thin is not the prime determinant of your health – if it was, why do thin people still get sick? Maybe, for the sake of argument, maybe they get less sick. Maybe. But in a world where we are told that you have to be thin, I see so many thin people come to me for training advice, because they got a blood test and are surprised to discover their cholesterol is way up, or whatever. The fat prejudice hurts everyone – thin people think they don’t need to get health checks, fat people feel marginalised, and none of that is actually helpful.

    What’s helpful? Adopting healthy behaviours is always going to improve your situation, no matter what your size is. Adopting unhealthy behaviours is going to do you harm. Is it worth it? Are you prepared to give yourself an eating disorder in an attempt to get thin? Because even that doesn’t guarantee thinness – more often than not the opposite happens.

    If we just try to focus on actually being healthy, surely that will give us the best chance at being healthy. To use a shaky analogy – you don’t polish a car when what it needs is an oil change, and expect that to improve the way it runs.

  • Ms BooLahLah

    Haha… Dr Bacon.

  • Marilyn

    I know that a lot of people are fat from diet and inactivity, but I know a professional ballroom dancer who is obese. I have a friend who is obese and runs marathons. I am obese, but have a cholesterol level that would make most middle aged people seriously green with envy. I don’t have diabetes, any heart disease or other illness.