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Why We Need to Stop Equating Thinness with Health

The “Thin is In” zeitgeist has maintained an iron fist on our collective psyches for at least the past 60 years. From waif-like images of Twiggy to impossibly tall and thin models to celebrities who maintain their physique through a combination of personal trainers, chefs, and questionable health practices, many people have long assumed that being trim is synonymous with attractiveness, good health, and personal character.

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Although these assumptions have been under question for decades, they are so embedded in our shared belief system that we find it hard to believe they aren’t accurate. As a psychologist, I routinely lecture on stress and health and emphasize the fact that measures of health including blood pressure, cholesterol levels, blood sugar levels, and physical activity are more reliable markers of health than thinness alone.

This was driven home to me this year as I have lost 35 pounds due to a series of unfortunate health events. Losing weight without trying is not typically a measure of health and is often indicative of underlying physical problems, as it was for me.

Despite being open about my health issues with my friends and colleagues, many were voluble about how “great” I look now that I am thinner. While I viewed most of their comments as complimentary, it also began to seem as though they were really saying that I have been much less attractive at my former normal weight. Others expressed envy at my easy weight loss, although in reality dealing with surgery and an uncooperative digestive system is anything but enjoyable.

Rather than reflecting willpower or self-control, my weight loss reminded me of being pregnant. Subconscious parts of my brain and body were making changes in how I looked regardless of what I wanted to have happen, and I had no way of knowing how long the changes would last, or even how to cope with them.

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Although we like to think of body weight as something we can control by regulating what we eat, it is actually determined by a host of complex factors. The hypothalamus, a structure deep in the middle of the brain, is responsible for regulating thirst, appetite, satiety, body weight, temperature, sleep patterns, immune function, and reproductive cycles. It uses complex sequences of transmitters, hormones, and nerves to interact with the body based on feedback from the body, including the stomach and adipose tissue, and other areas of the brain as well.

Not only is this process under the control of our genetic programming, but it is influenced by our metabolism and our gut biome which is increasingly being seen as a key player in our body weight. Combined with our more sedentary lifestyles due to technology, temperature-controlled buildings (which mean we expend less energy maintaining our body temperature), unhealthy sleep schedules, and access to high-calorie food that may reprogram our hunger system, the assumption that we can control our body weight simply by counting our calories seems increasingly simplistic.

Furthermore, we aren’t even sure what a healthy weight is for a given individual. While we know that the extremes of starvation and obesity have negative health outcomes, there is far less clarity for those of us who fall in the middle.

While Body Mass Index (BMI) is often seen as a quantitative standard, there is debate about the cut-offs for the various body weight descriptions and it doesn’t take into account body type or age. As a result, professional athletes are sometimes classified as overweight despite having very low body fat, very tall and short people may be misclassified, and age-related changes in weight, which could even be protective in the face of illness, are seen as negative. There is even evidence to suggest that older individuals actually live longer when they fall in the “overweight category’ on the BMI charts.

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Despite all of this uncertainty about body weight and health, the majority of Americans have been on a diet at least once in their lives, and often far more often. We are inundated by ads touting weight loss, exercise programs, and dangerous diet suggestions; our entertainment is saturated with images of people who are far thinner than most of us have the genetics, time, money, or Photoshopping capability to maintain.

Dieting itself is not a benign practice either. While restricting calories will typically cause weight loss, most people struggle to maintain the loss and often gain more weight than they lost, resulting in the so-called yo-yo effect. While the research on the link between dieting and depression is contradictory, there is evidence to suggest that restricting food can impact our mood, trigger irritability and depression, and increase our focus on food.

While eating a healthy balanced diet, and exercising regularly are associated with good physical and mental health, far too many of us still assume that weight alone is indicative of our physical status, and therefore dieting to reduce excess weight is always a beneficial practice.

Clearly, it is difficult to feel comfortable in your own body in our appearance-based, media-driven world. While our focus can and should be on engaging in healthy eating practices to optimize our health, we shouldn’t be using body weight as our sole measure of success.

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Instead, we need to be more honest about how hard it can be to lose weight, more supportive of people who are trying to improve their physical health, even if they are still overweight, and less willing to judge people on appearance alone. We also need to talk more to our kids and teens about the internet, social media, false appearances, and constantly comparing ourselves to someone else’s curated image.

Our bodies are incredibly complex organisms, and we are operating them in an environment that differs greatly from the ones where we evolved, so we are literally having growing pains. As we strive to understand how to help people stay healthy, we need to remember that weight is only one measure of health, and it’s not a measure of worth.

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