Health-first vs Weight-first

What if I told you that your weight has nothing to do with your health?

Would you roll your eyes and say: “As if Kate, we all know that if you’re overweight, you’re unhealthy.”

Would you be shocked and appalled and say: “I can’t believe this person calls herself a nutritionist, she’s spreading misinformation.”

Would you be curious to know more and say: “Can you explain this to me Kate?”

If you’re the third person, great. Read on. I will explain.

Firstly, I’d like to clarify that the statement I used above was ‘click-bate’. I used an over-simplified, black and white statement that was potentially shocking to get your attention. Don’t hate the player, hate the game. You’re reading this now. I’m happy.

The truth is, your weight is not as connected with your health as we once thought and certainly not in the way that our culture and society makes it out to be. It’s not that it’s not important, it’s just one part of you that can influence your health, and it’s not as influential as the other things. And when I say other things, I mean your health behaviours.

For many decades, this is how weight loss was evaluated in the science:

Group of people. -> They do specific things in order to lose weight (health behaviours). -> The scientists measure health outcomes (heart disease, diabetes, risk factors, longevity). Conclusions: weight loss leads to health outcomes.

But was it the weight loss that led to the health outcomes or was it the healthy behaviours?

If the people did the healthy behaviours consistently but didn’t lose weight, did they not reap the health benefits of their behaviours?

Here’s what really happens with most studies about weight loss:

There are multiple groups of people on a specific type of intervention like a special diet or lifestyle modification. These interventions are often different, to test which one is better, but they frequently include some kind of health behaviour like exercise, vegetables, high diet quality, avoiding large amounts of processed foods, etc.

In the study they measure multiple things. Weight changes is usually one of them. They also often measure metabolic markers of health and then, of course, they measure the outcomes they are testing for like reduced CVD risk or improved markers of diabetes.

If the study is measuring health outcomes, like risk factors for heart disease or prevalence for diabetes, it will report whether the participants improved aspects of their health. It will also report which interventions did it better, and whether their research supported a similar study or contradicted another.

When it comes to weight loss, in many studies, the average weight loss is small (2-6kg) which means that based on the spread of data, there would have been people who lost lots of weight at one extreme and people who lost no weight or even put in on at the other extreme (these people are then often excluded from the results). So even though specific interventions are pushed as being a successful way for ALL people to lose weight, when we look at the science, not all the participants get weight loss results. It’s not guaranteed.

Yet despite all this, we still conclude that weight loss = improved health outcomes.

Why am I telling you all this?

Separate to your desire to have a small body and our culture glorifying such a body, if you want weight loss because you want to improve your health, then I would highly recommend you stop trying to lose weight, and start focussing on improving your health behaviours. Why not focus on the thing you actually want?

And the truth is, some of the behaviours that support your long term health are the same things that you could focus on for weight loss, but because health is your goal and not weight loss, you don’t let your weight dictate whether you’re doing a good enough job of things AND you remove the temptation to achieve weight loss at all costs. Not all situations of weight loss are healthy, especially if you achieved it via unhealthy means.

For those who consistently focus on health and build habits and routines to support regular health behaviours, weight loss may be a side effect of these changes. However, you should not use weight loss as an indicator of success, it’s just a side effect that’s neither good or bad.

Weight loss is a nasty game that I don’t want to play anymore.

The use of weight loss as a measure of success is fraught with mind games, frustration and disappointment. It chips away at your self-esteem. It consumes your whole life. If it was so easy, wouldn’t we all have mastered it? But eating is not easy and it’s not simple. Eating is complex. It’s psychological, social, cultural and physical and there is no weight loss program, meal plan or philosophy that tells you what you should and shouldn’t eat that can help you unravel and unpack the relationship you have with food and how you interact with it day to day. In fact, weight loss diets have been shown to make this relationship with food worse, not better.

A health-first approach removes the pressure individuals feel to lose weight, especially if you’re one of the many people who started a diet early on in your life with your weight ‘always being a problem’. It can feel demoralising to have a health professional tell you to lose weight for your health, when you’ve been trying and failing to do so your whole life. And if you feel demoralised, you are disempowered and if you are disempowered your ability to make positive changes to your lifestyle, the ones required for health, but that you do because you want weight loss, is diminished.

I also want to point out that shame, in any shape or form, is not how we help people change. No matter how ‘well-intentioned’ we are. Weight stigma, judgement, demonising of foods, fear mongering and just making people in larger bodies or who eat is a certain way feel crap about themselves is not how we care for individuals who actually do want to practice self-care but feel too ashamed to do so.

A health-first approach focuses you more on how you feel and on seeing changes in the factors that matter. We can help someone reduce their cholesterol, improve their blood pressure, manage their blood sugar levels AND boost thier gut health with diet, all without a focus on weight loss. Nobody can guarantee weight loss, I certainly won’t if you work with me, but I can guarantee that if you choose to focus on your health, you will FEEL better, in your body and your mind and if you ask me, that’s all we really want.