This New Year’s, look beyond the scale
For most of us, “lose weight” has likely been on our list of New Year’s resolutions more than once.
While a well-balanced diet and physical activity are important to a long and healthy life, in 2023 we want to focus less on numbers and more on feeling our best. And that begins with understanding what “healthy” means to each individual.
Weight does not equal health
Before the scale became popularized in the late 1700s, weight was not equated with health, explains Peggy Norman, MS, RD, health promotion program manager at Mary Bridge Children’s Hospital.
But as access to scales grew, so did our focus on numbers and comparing ours to those around us.
Created nearly 200 years ago to measure populations for statistical reasons, the body mass index (BMI) has since more commonly been used to assess if an individual was underweight, normal, overweight or obese, based on their height and weight. Since its creation, researchers have come to understand its many shortcomings — BMI doesn’t account for other aspects of the body like muscle versus fat, or body composition differences between genders and races.
There are also a number of health risks for those striving to live in the lowest BMI ranges, Norman adds, which is where many celebrities and public figures fall into.
“Many individuals feel pressure to conform to a certain standard around weight,” says Jeff Eisen, MD, MBA, chief medical officer of MultiCare Behavioral Health Network. “That is certainly exacerbated by media and especially social media, which presents many unrealistic views of body image and weight.”
Stigma and blame
“The best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness,” according to data collected by the National Eating Disorder Association (NEDA).
NEDA reports that by age six, girls especially start to express concerns about their own weight or shape, and by elementary school age, 40 to 60 percent of girls are concerned about weight.
“Weight stigma is the biggest health risk of all for a person in a larger body,” Norman says. “The constant societal drone that thin is superior and a larger body is a personal failure can be a constant stressor. Comments like ‘I’m so fat’ or ‘I need to diet’ are common in our every day speak, but those are what’s perpetuating weight stigma.
“Most people don’t have a clue their statements would be offensive,” she continues. “That is what moved me as a provider and to change the way I practice.”
Oppressive language is everywhere, Norman says, but is most common between family members, in the health care setting and in our self-talk.
A person’s approach to weight and body image is everything, says Shobhana Gaur, MD, non-surgical weight loss specialist with the MultiCare Rockwood Clinic Weight Loss and Bariatric Surgery Center.
“Our society is blame and shame –— this person is lazy, not exercising,” she says. “But what I’m seeing with patients more and more is that it’s not their fault. It’s genetics, joint problems, socioeconomic status or their environment affecting their gene expression. But we tend to think it is their fault.”
Body positivity
A major driver in the fight against weight stigma is the body positivity movement. Based on the fat acceptance movement of the late 1960s, it was led predominantly by Black and feminist activists to end weight shaming and discrimination.
While no ideology is perfect, there are many ways people can find space and support within the movement.
According to NEDA, there are three general ideas around body image:
- Body positivity encourages unconditional body love, no matter what your body looks like.
- Body neutrality prioritizes the body’s functions and achievements rather than appearance and stresses that liking your body is not a requirement for loving yourself.
- Body liberation promotes freedom from systems of oppression, including weight stigma and size discrimination, to create a safe space for all bodies to exist.
Dr. Eisen says a major aspect of body positivity is recognizing the many attributes we bring to the world outside of our physical being.
“The reframing happens when you think holistically about a human and everything that you bring to the table, despite what society may place an emphasis on,” he says. “We think less about weight specifically and focus on wellness. How can we be the best in our own lives — socially, professionally, mentally and physically?”
Whole-body wellness
“To me, healthy is body and mind, not necessarily a number or being ‘skinny,’” Dr. Gaur says. “How you feel is very important. I see people with higher BMIs who are doing so well in life and following a healthy and active lifestyle.”
Dr. Gaur explains that when she first meets with a patient, they assess any other medical conditions and talk goals. For those with comorbidities, she emphasizes addressing those first, as they can damage the body in other more aggressive ways.
Oftentimes we want to set high goals, she says, like losing a set number or dropping sizes, but she encourages patients to start simple — 5 to 10 percent of a person’s body weight because that’s when you start to feel changes.
Once we feel that positive momentum, it’s easier to see what works for our bodies, Dr. Gaur says. Then we can address ripple effects, such as the impact on other health conditions, lifestyle and mental health.
“Mental health plays an incredibly important role on our overall health and well-being,” says Dr. Eisen. “Sometimes we might think that behavioral health is separated from physical health, but that isn’t the case. Mental health affects our physical well-being, and vice versa.”
For example, people living with depression may eat more while others may lose their appetite entirely, he says. Or those with anxiety can experience stomach pain or gastrointestinal problems that result in lessened appetite, while others may use food as a coping mechanism.
3 habits for a fulfilling life
1. Diets aren’t sustainable
When we’re not giving our bodies enough fuel, it sends us a message to eat. We can overpower those thoughts for a period, Norman explains, but our bodies are sophisticated and will find ways to keep or gain the weight it needs. That’s why people struggle with restrictive diets and find themselves yo-yoing.
“The more you diet, the more your body fears that it will be starved again,” she says. “Losing weight gets harder and you have to do more extreme things. Focus on feeding your body regularly and well-rounded meals.”
Norman also emphasizes that filling, nutritious diets need to fit your lifestyle. Eat what you can afford, have access to and can fit into your schedule — you don’t need to spend all your money and time on Sunday meal-prepping “super food” lunches.
2. Start habits young
According to NEDA, more than half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking, vomiting or laxatives.
Seeing the impact that unhealthy relationships with food and body image can have from a young age is major reason why Norman’s team at Mary Bridge Children’s has changed their program to focus on the feeding relationship.
From a young age, her team encourages the approach that parents are responsible for what, when and where, while the child is responsible for how much and whether they will eat.
Norman says it all comes down to trust and providing, not restricting. Children learn to trust they will receive regular meals with at least one thing on the table they like and a pleasant, nondemanding experience with new foods. In response, parents can trust their child to eat what they need, while slowly learning to try new things.
It is just as important to watch our language regarding weight and body image around children, she adds. Don’t praise weight loss, and try using terms like “living in a larger body” rather than “overweight.”
3. Give yourself grace and support
If you want to set a goal around health for the New Year — whether that’s weight or any other aspect — talk with your primary care physician first, Dr. Eisen says. MultiCare provides many resources for improving one’s life in all aspects.
And of course, give yourself grace. Health journeys are not linear, he says. There will be days of progress and days of setback, but taking it one day at a time will create a pattern for success.
“Our society works against us because it is one filled with opportunities for instant gratification,” Dr. Eisen explains. “Long-term wellness and mental health are a process, not something that happens overnight.”
Resources
One way to combat weight stigma and promote body positivity and whole-body approaches to well-being is by talking about it in healthy, inclusive and honest ways. Our team has put together a list of websites, podcasts and blogs for great resources on the topic.
Body positivity, healthy at every size and intuitive eating
- Food Heaven
- Mom Genes the podcast
- Karen Koenig
- Maya Feller Nutrition
- Marisa Moore
- Heather Caplan – Real Talk podcast
Body positivity and social justice
Food psyche
Parenting: Feeding
