Sick and tired of trying to shed a few kilos to reach your ‘ideal’ weight? A growing scientific movement claims you can be healthy at every size. Karissa Woolfe and Lucy Arthur report.
When you see a program promising to help you feel better and improve your health, chances are you would assume it was a weight-loss program, right?
Probably because you keep hearing about how undesirable it is to carry excess weight. With television shows, such as The Biggest Loser, countless books and websites offering to help you ‘shed the kilos, ‘get a flat belly’, ‘trim your thighs’ or ‘get a bikini body’, it’s easy to obsess about your number on the scales.
But when did our quest for health and wellbeing become so entangled with having a perfect figure or being a certain clothing size? Now there is a vocal band of health professionals arguing that promoting diets is unethical, and that you can be fit and healthy at every size.
Here’s what the experts and latest evidence says.
The problem with measuring body fat
The traditional way to judge if your weight is in the ‘normal’ range is to calculate your Body Mass Index (BMI). It’s a measure of body fatness based on your weight in relation to your height, with a BMI from 18.5 to 25 considered the healthy, ‘ideal’ range for adults. By this standard, just one in three Aussies have a healthy weight, according to research conducted by the Australian Bureau of Statistics.
But the problem with using BMI to define your ideal weight is that the formula doesn’t take into account your shape, body composition or ethnicity. People carrying more muscle, like athletes or those from Pacific Island backgrounds, such as Samoans, can appear lean, yet have a BMI in the overweight or obese range because muscle weighs more than fat.
Where we carry fat is also important. Tim Olds, Professor of Health Sciences at the University of South Australia explains. “Being fat in the wrong places [around the abdomen] is worse than being fat in the right places [hips and thighs],” he says. “In fact, thigh fat appears to be protective, and can lead to a healthier blood fat profile.”
We now know that how you store fat has different effects on your health also. Subcutaneous fat, the fat found just under the skin which we can see and feel, isn’t as bad for your health as visceral fat — which is stored deep inside the belly and wraps around organs like your liver. High amounts of visceral fat are associated with problems such as insulin resistance, which can lead to type 2 diabetes, heart disease and high blood pressure (hypertension).
Professor Olds suggests measuring your waist girth, having a skinfold thickness test, or getting a dual-energy X-ray absorptiometry (DEXA) scan will deliver a more accurate assessment of your health.
Does slim mean ‘healthy’?
Not if you’re TOFI (thin on the outside, fat on the inside). Researchers in Italy were the first to identify what they call ‘normal-weight obesity’.
These people have a BMI within the ‘healthy’ range, but a higher than normal ratio of visceral fat. They may also have insulin resistance (a precursor to type 2 diabetes), high cholesterol and high blood pressure — which are health conditions traditionally associated with a higher BMI.
Smoking, how much exercise you do (or don’t do!) and your family history of heart disease or type 2 diabetes, also strongly contribute to how healthy you are, regardless of your weight.
“If you are an ideal weight (BMI 23) but you smoke, you have the same risk of dying in the next year as someone who is obese (BMI 37),” warns Rod Jackson, Professor of Epidemiology at the University of Auckland. “Some people say they smoke to reduce their weight, but you are much better off not smoking.”
What’s more, evidence is emerging that fitness is a much better predictor of health and longevity than fatness. “In one study, men who were lean but unfit had almost twice the risk of dying compared to men who were overweight but fit,” says Professor Olds. “Remember, being lean and unfit is worse than being fat and fit.”
What is Health At Every Size?
In light of these findings, a new movement is gaining ground around the world. Health At Every Size (HAES) is a ‘peace movement’. It acknowledges that wellbeing and healthy lifestyle habits are more important to health than any number on the scale — and it embraces size diversity.
HAES is based on a scientifically tested program which found that accepting your size and quitting dieting, and focusing instead on establishing some everyday healthy habits can improve your health more effectively than dieting.
It was spearheaded by US researcher and author, Linda Bacon, who is committed to raising awareness regarding the scientific evidence that weight-loss regimes aren’t capable of delivering on their promises.
Professor Bacon, an expert in nutrition and psychology, describes how personal experiences prompted the research project and subsequent best-selling book.
“I used to have this idea that if only I were thinner, everything in life would be better for me,” says Professor Bacon. But diets and exercise made her miserable and she gained weight in the long run.
It’s for these reasons that Professor Bacon isn’t a fan of BMI, dieting or the focus on weight. She would like to see weight removed from the health equation and encourages learning about your own body needs as a basis to adopt healthy behaviours and mindful eating.
“We all have internal systems designed to keep us healthy — and at a healthy weight,” she says. “Eat when you feel hungry and stop when you’re full. By building trust in yourself, you can support your body in naturally finding its appropriate weight by listening to its signals of hunger, fullness and appetite.
“For example, if you eat a low-fibre diet, you may feel constipated and tired,” she says. Eating a diet rich in vegetables, legumes, fruits and whole grains will help you feel more energised and regular.
Professor Bacon prefers to focus on non-dieting approaches to improve health, and uses techniques such as mindful eating in her support groups. She also helps participants to work at creating a strong social support system of family and friends, and addresses the unhelpful eating behaviours and psychology that can impact on their wellbeing.
“Fulfilling your social, emotional and spiritual needs restores food to its rightful place as a source of nourishment and pleasure,” she says.
Ditch the fat shame (and find freedom!)
Health at Every Size is about learning to shift your focus from hating your body and fighting your weight, to starting to appreciate your self-worth and your body. Here are some of the key strategies that Professor Bacon and her followers say work for them:
Learning to embrace size diversity is key to happiness
Listen to your body: Eat when you’re hungry, stop when you’re full. Pause in the middle of a meal and ask yourself, what is my current fullness level?
Seek out satisfying foods and savour them slowly: Take the time to sit down when you eat, and eliminate distractions, such as phones and TVs.
Practise self-kindness by making healthy choices that make you feel good. This might mean filling your fridge and fruit bowl with fresh, colourful fruit and vegetables and seeking out high-quality produce.
Find active things you love — it might be yoga, or a walk at sunrise — and do them often. Forget militant exercise, just get active and recognise how good it makes you feel. Stop exercising simply to burn calories, do it because it makes you feel energised.
Make peace with food: Break the habit of thinking of foods as ‘good’ and ‘bad’. It’s just food. As soon as you tell yourself you can’t or shouldn’t have particular foods, you will only feel deprived and crave them more.
Nurture your relationship with yourself: We often spend so much of our time doing things for those around us that we can tend to forget about our own emotional needs. Say affirming things to yourself every day, or write down positive qualities that you like about yourself. And, if you’re feeling stressed or sad, think about non-food related activities that will make you feel good, and allow yourself the time to do them.
Reassess your goals: Set positive, health-focused goals rather than weight-loss related ones. For example, ‘I will eat a healthy breakfast before leaving the house every day this week’ or ‘I will try to go for a 15-minute walk after dinner three times this week’.
Go slow and be realistic: Improving your health doesn’t have to mean tossing out all of your favourite foods and vowing never to eat chocolate or white bread again. Adding one small, healthy habit to your day means you are making changes that are small, but positive. Over time, these small changes will become long-term habits that add up to a big difference to your overall health.
Respect your body: Health and vitality come in all shapes and sizes, so when faulty old thoughts creep in that make you feel bad about your shape or jean size, try to remind yourself that it’s more important to be the healthiest weight you can achieve and maintain, rather than being thin at any cost.
It’s time to focus on you
(By Brooke Longfield, Healthy Food Guide editor and dietitian)
Like Professor Bacon, you may have found that decades of dieting have failed to live up to their promises.
Dropping the pursuit of weight loss isn’t about giving up, it’s about moving on. It’s so ingrained in us that losing weight is the only way to improve our health, when there is research that tells us otherwise.
Most health indicators, such as blood pressure, cholesterol and insulin resistance, can be improved through changing health behaviours, i.e. moving more or eating more fruit and vegetables, regardless of whether weight is lost.
But, at the same time, we can’t overlook the strong evidence that losing just 5–10 per cent of your weight is all it takes to see major health benefits. This includes reducing your risk of developing type 2 diabetes and heart disease, not to mention reducing stress on joints.
What’s interesting about the HAES method is that while you’re focussing on getting healthier, there’s an accidental pay-off — you often do lose weight. And because you haven’t been through the normal diet cycle of feeling starved or deprived, this method seems to have the lasting benefits we all want.
When you make choices because they help you feel better, not because of their presumed effect on your weight, you’re more likely to maintain them.
So what can you do today to take a step towards a healthier, happier self. Perhaps it’s enjoying a leisurely walk in the fresh air, or signing up to that yoga class you’ve always wanted to start, but never had the confidence to join. Or, how about filling your fruit bowl with colourful fruit so there is always a healthy snack in full view when you walk through the kitchen.
And, next time you feel like chocolate, go ahead, have some! Allow yourself a sensible-sized portion and really appreciate it. Savour each mouthful slowly so it melts in your mouth before taking another bite.
An interesting thing happens when you stop trying to control your weight through willpower: your body starts doing the job for you — naturally, and much more effectively. So which new healthy habit are you going to start today?