Weight Loss and Health: My doctor told me to lose weight, now what?

Every day, I hear from folks who have realized that fad diets and rapid weight loss just aren’t sustainable. Maybe they’ve dabbled in intuitive eating or learned a bit about Health at Every Size (HAES) and feel a spark of hope that they don’t have to be at war with food forever. But then the worry creeps in:

“I get that diets don’t work long-term, but shouldn’t I lose weight for my health?”

It’s a fair question. Perhaps it’s easier to let go of the desire to lose weight when your goals feel aesthetic. But when your doctor is telling you that weight loss is the key to better health, that feels like a bigger dilemma.

But what does the science actually say about weight loss and health? Was your doctor right in recommending weight loss? Or is it possible to pursue better health using alternative, more sustainable behaviors?

But first, my standard disclaimer: This post is for informational and educational purposes only. It is not a substitute for individualized medical or mental health care. It does not constitute a patient-provider relationship. The content of this post might not feel useful to you right now—please take the information that serves you and leave the rest.

And a second note that this post contains references to BMI categories and "o" words.

Is Having a Higher Body Weight Bad for Your Health?

The assumption that a higher body weight automatically leads to poor health is deeply ingrained in our culture. It’s such a ubiquitous belief that it feels almost instinctual. Pay attention for even a single day and I suspect you’ll notice multiple news stories, conversations, or social media posts that link weight and health. But does the research support our cultural beliefs?

Turns out, the answer is no.

Multiple large-scale population-based studies across several countries have found that the lowest risk of all-cause mortality (aka overall risk of death) is in the “overweight” BMI category. The “normal weight” and “obese” categories carry similar risks, while the highest risks were seen in those who were “underweight” or in the higher end of the “obese” category. That’s right—being in the “overweight” category is consistently associated with the longest lifespan. Oh, and by the way, the protective impact of an “overweight” BMI was noted in CDC data regarding COVID outcomes. I remember hearing a lot of fear mongering about weight during the pandemic. And yet, when the data is examined without bias, we our assumptions challenged.

Not sold yet? Large scale studies have also found that being “overweight” or “obese” is protective against osteoporosis while being “underweight” increased osteoporosis risk. And a study of more than 250,000 participants with coronary artery disease found the same U-shaped curve, with folks in the “overweight” category at the lowest risk, while the “normal weight” and “obese” categories had similar outcomes, and people in the “underweight” and “obese class II” categories at higher risk.

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While the risks of being “overweight” or “obese” have been vastly overblown in diet culture, research supports that there may be increased health risks associated with being at a BMI of 35kg/m2 and above. So, does that mean folks who’s BMI fall in this range should lose wight to improve their health?

Not necessarily.

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Correlation Does Not Equal Causation

Even when research does show a relationship between higher body weight and certain health conditions, that doesn’t mean weight is the cause of those conditions. There are other factors to consider, like:

Weight Cycling

Most people who intentionally lose weight will regain it (often plus some) within a few years. This repeated losing and regaining, known as weight cycling, has been shown to increase inflammation, worsen cardiovascular health, and raise the risk of chronic disease—independent of weight itself. One study following patients for 32 years found increased cardiovascular and total mortality risks in patients with highly variable body weights (i.e. frequent weight fluctuations.) Another 15 year study examining weight in men found that risk of death due to weight gain or “stable obesity” was not increased compared to “stable non-obese” men. Men who lost weight across the study had a slight increased risk of death. While men who experience weight fluctuation experienced the highest death rates.

Medical Weight Stigma

People in larger bodies often receive lower-quality medical care due to weight stigma. Doctors exhibit the same levels of implicit bias as the wide population though they often perceive themselves to be less biased. Doctors may attribute symptoms to weight rather than thoroughly investigating other causes. This leads to delayed diagnoses and poorer health outcomes—not because of weight itself, but because of how weight impacts the care people receive. Additionally, medical weight bias contributes to avoidance of care and provider mistrust, often resulting in years long delay of care and decreased feelings of self-efficacy for folks in bigger bodies.

It’s hard to live in the world in a bigger body

Finally, it’s critical to acknowledge how hard it is to move through the world in a bigger body. Fat icons Aubrey Gordon, Virgie Tovar, and Virginia Sole Smith (to name just a few) have described in heart breaking detail the socially acceptable abuse they’ve experienced just out trying to live their lives. Comments from strangers about what they should eat, hateful messages online. And then the day-to-day challenges: finding clothes that fit or comfortable chairs in restaurants. People at higher body weight, especially women, are paid less – a phenomenon known as the obesity wage penalty. And there is a documented association between PTSD and obesity although more research in needed to fully understand this link. In any case, it’s clear that being fat is stressful. And we know that stress, especially stress accumulated over the lifespan, can have a profound impact on health.

So, What Now?

Ok fine, your doctor told you to lose weight. But with all due respect, your doctor was wrong. Instead of focusing on weight, consider these health-promoting behaviors:

• Eating consistently throughout the day (we love breakfast, lunch, and dinner

• Moving in ways that you enjoy and that are accessible to you.

• Managing stress and prioritizing sleep.

• Seeking supportive, weight-inclusive healthcare providers.

Body size does not determine health. If you’re feeling stuck in the belief that weight loss is the only path to wellness, I hope this post offers an alternative perspective.

With compassion,

Stephanie

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