Reader Question – What are Weight-Related Health Conditions?

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Reader Marcella wrote:

“I keep seeing the term weight-related health conditions. Can you explain what this means?”

Thanks for asking Marcella!

If you don’t have time to read this whole thing, the very basic answer is that weight-related health conditions are simply health conditions that people of all sizes get, that get called “weight-related” when higher-weight people have them.

But let’s dig in a bit more:

The idea behind this term is that if higher-weight people are believed to be at “higher risk” for a health condition, then that health condition gets called “weight-related.” There are multiple problems with this definition, and the use of it becomes even more problematic.

First, the idea that higher-weight people are at “higher risk” for these conditions comes from research that is, at best, just shoddy and, at worst, manipulated by the weight loss industry. It happens when research shows that being higher weight and having a health condition occurs more often in higher weight people than thinner people. Then the people who are conducting the research (abandon anything resembling best practice,) and simply declare that the condition is “weight-related.”

If you’re thinking “wait, that’s exactly what they told me NOT to do on the first day of my first research methods class” you are absolutely right. You can’t blame a health condition on being higher-weight just because it might be more common in higher-weight people. (I mean, you can, I guess, but you shouldn’t call yourself a researcher or scientist or expert while doing it.) If we want to credibly call ourselves researchers, scientists, experts (or even successful graduates of Research Methods 101 classes) before we say that these conditions are “weight-related” we have to ask ourselves at least one question: What else happens more often to higher-weight people that could cause these health conditions to be more prevalent in this population?

I’m glad that you asked.

The problem with these supposed “weight-related conditions” is the complete failure to account for, control, or (typically) even mention other things that could cause this relationship (aka confounding variables.) Weight stigma, weight cycling, and healthcare inequalities are all correlated with health conditions that get called weight-related, which means that these conditions may actually be better explained as weight-stigma-related, weight-cycling-related, and/or healthcare-inequality-related conditions.

For example, the CDC lists “low quality of life” as a “weight-related” condition. But would higher-weight people experience a lower quality of life if they weren’t living in a world where they are constantly stigmatized and oppressed across every aspect of their lives? That’s the kind of question you would ask yourself if you were a competent researcher (or trying to get at least a C on your first assignment in  Research Methods 101). Instead, the CDC calls it “weight-related” and recommends no longer existing as a higher-weight person as the cure (aka weight loss.)

People who are well-meaning but currently mired in the weight = health paradigm buy into this and perpetuate it because it fits in with their core beliefs and they have no reason to question it.  If you were taught that being higher-weight is automatically “unhealthy” (by whatever definition one might be using,) then when someone tells you that a health condition is caused by being higher-weight and would be solved by losing weight, you would probably accept that without asking any questions.  It’s not scientific, but it is, sadly, incredibly common (and a mistake that I personally made a lot before I started digging into the research on my own 20-some years ago.)

The insidiousness happens in the weight loss industry. Let’s say you want to sell weight loss interventions, and you know that the best way to market weight loss interventions is by creating weight stigma and that the most common outcome of your weight loss interventions is weight cycling (losing weight and then regaining it.) You are funding the research, and/or you are on the weight loss industry payroll and you are conducting the research. It’s to your benefit to claim that being higher weight causes health issues, and it’s to the detriment of your bottom line to point out that the actual cause might be weight stigma (that you perpetuate) and/or weight cycling (that your interventions create.)

But it gets worse. When it comes to weight loss intervention, risk is typically predicated on size. Which is to say that as someone’s weight gets higher, the healthcare system views their life and quality of life as more risk-able. So, for example, a more dangerous weight loss drug or surgical procedure might only receive FDA approval for people with a BMI over 30. Which is to say, with a BMI under 30 you are still considered “too big” but not “so big” that the FDA is willing to risk your life or quality of life with this intervention.

 I did a deep dive into this with weight loss surgery and type 2 diabetes here.

But say you’re in the weight loss industry and you want the biggest market you can get. So, you suggest that if someone has a lower BMI but also has a “weight-related condition” then it’s reasonable for them to risk their life/quality of life with this dangerous (highly profitable) intervention. Then you keep churning out shoddy research claiming that as many conditions as you can possibly think of are “weight related.”

Just to point out again, these “weight-related” conditions don’t happen to all fat people and do happen to thin people, so being higher-weight can’t be a sure cause, and being lower-weight can’t be a sure preventative or cure (even if we had a method that had shown the ability to create significant, long-term weight loss in more than a tiny fraction of people which we don’t!)

To sum up, “weight-related conditions” is a made-up concept to describe health conditions that happen to people of all sizes, that get called “weight-related” when higher-weight people have them, and that are used to justify more risky weight loss interventions. Like the entire concept of “ob*sity/overw*ight” it has done nothing to support the health of higher-weight people but has been very successful at creating profit for those who sell weight loss and weight loss accessories.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.