HEALTHY AT EVERY SIZE - FACT OR FICTION?

I was asked to give my thoughts on this subject so here they are.

Our bodies and minds are resilient. We can be healthy at different weights and shapes within reason. Contrary to what most people believe about the body mass index (BMI) it is actually the most accurate predictor of health according to current research (1).

It's also important to distinguish health from fitness, since a generally healthy individual may or may not have a six pack or be able to run a half marathon or squat 300Lb. Although fitness compliments health you don't need to be a gym buff or be crazy lean to be healthy. You just need to maintain a reasonable amount of activity in your day to day life and have a reasonably balanced diet. Within this scope you can be healthy and have a range of possible shapes and sizes.

However, from my understanding of the "health at every size" movement it's promoting the false idea that being overweight or underweight is healthy (or at least not detrimental to health). My BMI is 37 and I weigh 280Lb at 6ft tall. This means I am clinically obese. At this bodyweight I struggle to put on my shoes not because of a lack of flexibility but because my thighs push up against my stomach when I bend down. If I do not drink 6L of water a day and eat heaps of food I risk potentially serious injury during training. I have developed sleep apnea because of my weight, and although it has become manageable I still have chronic breathing issues that prevent me from sleeping uninterrupted. Sleep apnea is serious and in some cases can even be fatal and it's prevalent amongst obese individuals (2).

I can not go on long hikes as I used to because it is incredibly hard on my knees, hips and back. I need to see two therapists weekly to keep me healthy and prevent injury. I have routine physicals and have my blood tested every three month to check my cholesterol, blood pressure and an array of other tests to ensure I can manage my health effectively.

The reality is I'm not obese. At 20% body fat I'm well within the "healthy range" and as a powerlifter I have a lot of muscle and by no means look out of shape. But it's inarguable that I would be much healthier and my life would be significantly easier if I lost weight. In fact I would almost certainly be happier.

From a physiological standpoint numerous comorbidities, such as cardiovascular disease (CVD), obstructive sleep apnoea, type 2 diabetes, different types of cancer and osteoarthritis, particularly in subjects with central adiposity. It has been established that 4 million deaths worldwide can be attributed to overweight and obesity, and more than two-thirds of these deaths are due to CVD (3). This is extremely well documented and I have never seen a single credible source that suggests obesity has no negative impact on health.

From a sociological standpoint, being overweight seems to be an impedance to finding a partner. Appearance weighs heavily in a males selection of a female partner. Not simply appearance, but symmetry and proportion specifically because it's a physiological marker of health and reproductive potential (4). This holds true cross culturally, but conversely since a significant factor influencing female mate selection is based on status and formidability, it's probably not helpful to be overweight as a man.

This is not entirely due to appearance either but has more to do with their status in comparison to other males who do in fact compete for dominant positions in a social hierarchy (5). A 2017 study found "The rated strength of a male body accounts for a full 70% of the variance in attractiveness. Additional variance (up to 80%) can be explained by adding the premium women put on height and subtracting the penalty put on additional body mass unrelated to physical strength" (ie. fat mass). This also stems from cues of formidability and protracted aggression which lends itself to being a better provider (6).

There is also a strong relationship between body and self esteem . If you are in good health and in good physical shape you are more likely to have better mood, higher self esteem and more confidence (7).

If you move too far in one direction or the other on the weight spectrum it's almost certain you will encounter significant health issues. Illness is a terrible thing that will slowly chip away at your ability to sustain a positive outlook and have a fulfilling life.

The focus of this article is directed primarily toward the overweight/obese demographic because the "healthy at every size" movement is being pushed specifically to support being overweight/obese. I have seen many articles, videos and other content presenting what I can only describe as falsified research in support of this movement. However I haven't seen a parallel support of or push toward promoting overly skinny individuals, which is why I'm not addressing it in this article. But make no mistake, being too skinny can absolutely be unhealthy.

To summarize, I don't think anything I'm writing here is news to most people. Don't get too fat or too skinny because it's not healthy. Don't get too fat or skinny because it may negatively impact your mood, self esteem and mindset. Don't get too fat or skinny or it can create an unnecessary barrier to finding a partner.

I know currently it's taboo to talk about these subjects. But I think it's important to pass on accurate information especially considering how many people obesity affects. I think a big barrier to overcome is the idea that discussing this openly is seen as "fat shaming".

Some people will fat shame and those people are just being dicks. But it's also true that there are significant risks to being overweight, and talking about it has nothing to do with fat shaming. It's something we need to talk about, especially in the health and fitness industry, we need to provide more education so that people are equipped to make better decisions. You should feel good in your own skin, but that doesn't mean you can't improve. I'm a confident person. I'm proud of how far I've come in the sport of powerlifting and with my current physique. But I can also say that as I write this I'm still very far away from the physique I want and the level of competition I'm capable of reaching. You can be comfortable in your own skin and still strive to lead a healthy lifestyle. It's not a binary situation where if you're overweight you must learn to love yourself and stay overweight or you're shallow (yes I've heard this response before). You can feel good about yourself while also striving to become the best version of yourself.

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REFERENCES:

1. Angelantonio, Emanuele Di, Shilpa N. Bhupathiraju, David Wormser, Pei Gao, Stephen Kaptoge, Amy Berrington De Gonzalez, Benjamin J. Cairns, Rachel Huxley, Chandra L. Jackson, Grace Joshy, Sarah Lewington, Joann E. Manson, Neil Murphy, Alpa V. Patel, Jonathan M. Samet, Mark Woodward, Wei Zheng, Maigen Zhou, Narinder Bansal, Aurelio Barricarte, Brian Carter, James R. Cerhan, Rory Collins, George Davey Smith, Xianghua Fang, Oscar H. Franco, Jane Green, Jim Halsey, Janet S. Hildebrand, Keum Ji Jung, Rosemary J. Korda, Dale F. Mclerran, Steven C. Moore, Linda M. Okeeffe, Ellie Paige, Anna Ramond, Gillian K. Reeves, Betsy Rolland, Carlotta Sacerdote, Naveed Sattar, Eleni Sofianopoulou, June Stevens, Michael Thun, Hirotsugu Ueshima, Ling Yang, Young Duk Yun, Peter Willeit, Emily Banks, Valerie Beral, Zhengming Chen, Susan M. Gapstur, Marc J. Gunter, Patricia Hartge, Sun Ha Jee, Tai-Hing Lam, Richard Peto, John D. Potter, Walter C. Willett, Simon G. Thompson, John Danesh, and Frank B. Hu. "Body-mass Index and All-cause Mortality: Individual-participant-data Meta-analysis of 239 Prospective Studies in Four Continents." The Lancet388, no. 10046 (2016): 776-86. doi:10.1016/s0140-6736(16)30175-1.

2. Vgontzas, Alexandros N. "Sleep Apnea and Sleep Disruption in Obese Patients." Archives of Internal Medicine 154, no. 15 (1994): 1705. doi:10.1001/archinte.1994.00420150073007.

3. González-Muniesa, Pedro, Miguel-Angel Mártinez-González, Frank B. Hu, Jean-Pierre Després, Yuji Matsuzawa, Ruth J. F. Loos, Luis A. Moreno, George A. Bray, and J. Alfredo Martinez. "Obesity." Nature Reviews Disease Primers 3, no. 1 (2017). doi:10.1038/nrdp.2017.34.

4. Saad, Gad, and Tripat Gill. "The Framing Effect When Evaluating Prospective Mates: An Adaptationist Perspective." Evolution and Human Behavior 35, no. 3 (2014): 184-92. doi:10.1016/j.evolhumbehav.2014.01.002.

5. Sell, Aaron, Aaron W. Lukazsweski, and Michael Townsley. "Cues of Upper Body Strength Account for Most of the Variance in Mens Bodily Attractiveness." Proceedings of the Royal Society B: Biological Sciences 284, no. 1869 (2017): 20171819. doi:10.1098/rspb.2017.1819.

6. Sell, Aaron, Aaron W. Lukazsweski, and Michael Townsley. "Cues of Upper Body Strength Account for Most of the Variance in Mens Bodily Attractiveness." Proceedings of the Royal Society B: Biological Sciences 284, no. 1869 (2017): 20171819. doi:10.1098/rspb.2017.1819.

7. Szabó, M. Kékes. "The Relationship Between Body Image and Self-esteem." European Psychiatry 30 (2015): 1354. doi:10.1016/s0924-9338(15)32029-0.