At the start of every new year, we’re inundated with mixed messages about diets, nutrition, and health. Every health enthusiast or influencer claims their method is the best, and they can help you get to where you’ve always wanted to be. Year after year, it’s the same thing. And it’s gotten old.
For decades, the world has desperately needed to change the conversation surrounding health and body size. The messaging is confusing at best and damaging at worst. Weight bias is prevalent everywhere we turn; it’s such a norm that it isn’t even recognized as a problem by most of our culture.
Instead of focusing on a variety of health and well-being factors, many medical professionals and others use BMI or other weight-related statistics as a key indicator of health. Fitness gurus use shaming tactics to “motivate” followers, leading them down a slippery slope that too often leads to unhealthy habits of yo-yo dieting, low-self esteem, or other harmful results.
Fortunately, the Health at Every Size (HAES) movement has emerged with a fresh, healthy outlook on size and shape that’s compassionate, weight inclusive, and considerate of the many human differences individuals experience. We can’t control everything that happens in our current social climate, but we can shift gears as much as possible; we can provide a better way to talk about size and hope that more people will continue to join in.
What is Health at Every Size? We’ll dive into that, but first, we’ll discuss a few reasons why it’s long overdue.
What is BMI?
For decades, BMI (body mass index) has been used as one of the main indicators of a person’s health. It’s a measurement that compares body weight and height and is widely used by health professionals today to classify individuals. It’s led to increased insurance premiums for people who land on the higher end of the spectrum and has no doubt misidentified healthy people as having a weight problem.
Here’s the truth: a person’s health is not accurately determined with a simple equation, yet so many professionals use it to indicate something’s amiss. And along with being inaccurate at what it’s trying to do, an overemphasis on BMI can cause a weight stigma, leading to even more health issues that go ignored far too often.
About 200 years ago, a Belgian astronomer and mathematician named Adolphe Quetelet created the Body Mass Index to measure a population, not individuals. Quetelet assessed middle-aged French and Scottish men, paying no heed to body mass, muscle, or bone size.
In the 1970s, a group of researchers searched through existing methods of obtaining body measurements to find which was best. They wanted a measurement simple enough to gather information quickly at doctor’s visits. They chose the BMI measurement, even though it was rudimentary and only partially accurate at determining weight classifications. (1)
Why BMI is BS
Not only has BMI led to too many stressful trips to the doctor, agony over life insurance policy rates, and increased health insurance premiums, but it’s also not an adequate measure of body composition. It may be a decent place to start as a general measurement, but BMI is simply the result of a math equation; it can’t differentiate the many factors contributing to health.
Many people who have large muscle mass are considered overweight by the BMI measurement. Ethnicity, age, and gender are also essential metrics but are not included in the BMI equation.
In fact, this study found that populations above the age of 65 are at increased mortality risk with a BMI lower than 23.0 (although 23.0 is considered to be in the “normal” range). Those who were categorized as “overweight” with a BMI range of 27.0-27.9 were found to be at the lowest mortality risk.
The researchers stated, “Because of multiple factors such as physiologic changes associated with aging, chronic disease, polypharmacy, and psychosocial changes, older adults have an increased risk of undernutrition, which is associated both with increased mortality and morbidity. Undernutrition often goes unrecognized because nutrition assessment is limited to one measure of BMI or weight.” (2)
This is proof that BMI is not accurate at gauging health for all ages, genders, ethnicities, etc, and that there should be more consideration into what is actually healthy for these various groups.
Psychological scientists A. Janet Tomiyama, Ph.D. and Jeffrey M. Hunger, M.A. study health and wanted to highlight the drawbacks of BMI to prove to policymakers “how many healthy people would be adversely affected” if this was the only metric used to determine health.
They examined the health markers from The National Health and Nutrition Examination Survey (NHANES), which samples the BMI and health of a group of Americans every two years. Tomiyama and Hunger came up with their own definition of “healthy” based on various metrics, including blood sugar, blood pressure, and cholesterol measurements. They set out to see how many healthy participants were deemed unhealthy by their employers because of their BMI range.
Here’s what they found: “After crunching the numbers, the results were stunning. BMI did not map onto the real markers of health. Some 34.4 million of the 70 million-plus Americans categorized as “overweight” by BMI were perfectly healthy. That’s 47 percent! The chances of BMI being a good predictor were not much better than flipping a coin. And 29 percent of Americans rated “obese” under BMI were healthy as well.”
Tomiyama and Hunger also found that 21 million individuals who fell in the “normal” BMI category were, in reality, unhealthy according to these additional metrics. (3)
And remember, when BMI was created, the population measured was specific and non-inclusive. Sabrina Strings, author of Fearing the Black Body, said in an interview for HuffPost, “It is racist, and also sexist, to use mostly white men within your study population and then try to extrapolate that and create norms and expectations for women and people of color…They have not been included in the initial clinical analyses, and therefore their actual health outcomes cannot be determined by these findings.”
This sums it up perfectly: “In short, the way BMI is being used is unscientific because of its origins and the homogenous population it was created from.” (4)
The facts speak for themselves: BMI clearly cannot be a single measurement of health as it has been for decades.
Besides being an imperfect and inaccurate metric of individuals, BMI also perpetuates the problematic weight stigma that’s so prevalent in our culture.
Why Weight Stigma Harms Health
Weight stigma is discrimination, bias, or stereotyping of a person based on their weight. This phrase may be new to you because the damaging rhetoric surrounding weight is commonplace in our culture. From ads on TV to comments from “well-meaning” family members, it’s everywhere.
Weight stigma hasn’t been widely viewed as an issue, but it’s a real problem that can lead to the following:
- Depression
- Eating disorders
- Poor body image
- Higher levels of cortisol (the stress hormone)
- Increased risk of cardiovascular disease and diabetes (5)
Clearly, it’s time to change the way we talk about weight. Weight stigma does a lot more damage than any possible good.
In our current culture, weight stigma likely won’t go away anytime soon, but the good news is there are people who are trying to change things for the better. Health at Every Size is a movement that’s trying to alter how we view and discuss weight.
What is Health at Every Size?
Maybe you’ve heard about it on social media, but you’re still wondering, “What is Health at Every Size?” Health at Every Size (HAES) is a weight-inclusive peace movement that focuses on increasing healthy behaviors in a respectful and compassionate community. HAES follows three basic components: respect, critical awareness, and compassionate self-care. Doesn’t that sound like a better way to discuss health and size than the way we’re used to?
What does Health at Every Size mean?
Health at Every Size is a set of principles and a movement that recognizes healthy behaviors and overall well-being as more important than weight. It also acknowledges that various life circumstances affect health more than society and many professionals recognize. HAES rejects the ever-present weight bias and celebrates all sizes and human differences.
Health at Every Size is about helping individuals find health in the way that is best for THEM. It’s about so much more than reaching an arbitrary number on the scale or a specific BMI range. It’s about considering all the factors that contribute to an individual’s health and accepting an individual despite their shape or size.
What are the Health at Every Size principles?
According to The Association for Size Diversity and Health (ASDAH), HAES focuses on the following principles:
1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes while rejecting the idealizing or pathologizing of specific weights.
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma and support environments that address these inequities.
4. Eating for Well-Being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement to the degree that they choose. (6)
The HAES model is about finding what health means for you, not trying to reach society’s version of health. It’s about finding movement that you actually enjoy doing. Eating is about nourishing yourself with food that satisfies you, not what you’ve heard from the latest influencer will be best to achieve the elusive perfect body. It’s about trusting and listening to yourself and your body.
Those in the HAES community believe everyone should be treated with respect and given the same healthcare access regardless of size or BMI. It’s acknowledging that a person’s worth goes far beyond their shape.
Does Health at Every Size mean everyone is healthy?
One misconception among those unfamiliar with HAES principles is that health at every size means that everyone is healthy at any size. This isn’t what Health at Every Size is about; instead, it’s about pursuing health at any size in the way that an individual chooses.
You also can’t look at a person’s weight and determine whether or not they are healthy. HAES rejects the idea that weight can be a sole indicator of health.
Who started the Health at Every Size Movement?
HAES has recently received attention in the media, but the principles aren’t as new as many think. The movement began to form in the 1970s due to activists against weight bias, but the official HAES principles were created in 2003 by the Association of Size Diversity and Health (ASDAH). Dr. Lindo Bacon wrote Health at Every Size in 2008, introducing the HAES movement to a broader audience. The HAES community continues to expand as more people commit to spreading the word about this improved method of thought. (6)
What are Better Indicators of Health than BMI?
So if Health at Every Size rejects weight as an indicator of health, what is a better way to determine health?
HAES proposes that doctors, insurance companies, and other professionals should consider political, social, and cultural factors related to a person’s health. A person’s access to medical resources, their economic situation, and other life situations impact their health and should be considered along with other health indicators.
Health professionals can also get a more complete understanding of an individual’s health if they consider lifestyle factors, blood pressure, blood cholesterol, and blood sugar, along with BMI. (7)
In the research mentioned above, the National Health and Nutrition Examination Survey determines health with questions about diet, demographics, socioeconomics, and more. These are certainly more relevant factors for considering a person’s health than just BMI and would be helpful for other professionals to use. (8)
Ready to Shift Your Mindset?
Your journey is a personal one. What works for your sister or your best friend or that girl from high school you follow on Instagram may not work for you. If you’re ready for a weight-inclusive approach to nourishing your body and soul, I’d love to work with you.
As a Registered Dietitian, I’ve helped hundreds of clients become experts on their own bodies. I can help you establish lifestyle changes that focus on creating more balanced and enjoyable eating patterns. I’ll share simple tips for planning ahead and teach you how to fuel your body and listen to it by honoring your health and cravings.
Together we’ll work toward helping you feel your best in the body you have now.
Schedule a free 15-minute call to get started!
References:
- Your Fat Friend, “The Bizarre and Racist History of the BMI”, Medium, https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb
- Jane E Winter, Robert J MacInnis, Naiyana Wattanapenpaiboon, Caryl A Nowson, “BMI and all-cause mortality in older adults: a meta-analysis,” The American Journal of Clinical Nutrition, https://academic.oup.com/ajcn/article/99/4/875/4637868
- A. Janet Tomiyama, Ph.D. and Jeffrey M. Hunger, M.A., “the HAES® files: Body Mass Index Is Not a Good Measure of Your Health,” Health At Every Size® Blog, https://healthateverysizeblog.org/2016/04/14/the-haes-files-body-mass-index-is-not-a-good-measure-of-your-health/
- Christine Byrne, “The BMI Is Racist And Useless. Here’s How To Measure Health Instead.” Huff Post, https://www.huffpost.com/entry/bmi-scale-racist-health_l_5f15a8a8c5b6d14c336a43b0
- “Weight Stigma,” National Eating Disorders Association (NEDA), https://www.nationaleatingdisorders.org/weight-stigma
- “The Health at Every Size® (HAES®) Approach,” Association for Size Diversity and Health (ASDAH), https://asdah.org/health-at-every-size-haes-approach/
- Karen Coulman, Sarah Sauchelli Toran, “Body mass index may not be the best indicator of our health – how can we improve it?”, The Conversation, https://theconversation.com/body-mass-index-may-not-be-the-best-indicator-of-our-health-how-can-we-improve-it-143155
- “About the National Health and Nutrition Examination Survey,” National Health and Nutrition Examination Survey (NHANES), https://www.cdc.gov/nchs/nhanes/about_nhanes.htm
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