We Must Stop Using Weight As A Proxy For Health
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The use of weight as a proxy for health is ubiquitous. We see it in the use of the deeply flawed BMI, and BMI-based denials of care. We see it in the categories that were made up to pathologize higher weight bodies (including “ob*se”* and “overw*ight, and their stigmatizing “person first” versions). It needs to stop for a number of reasons, but before I get into it I just want to say, as always, that health is an amorphous, multifactorial concept and is not an obligation, a barometer of worthiness, or entirely within our control.
The issues with weight as a proxy for health:
It perpetuates stigma
Healthism is wrong on it’s own and it doesn’t make fatphobia a better look. Still, in a society rife with weight stigma and healthism, the persistent belief that thin is healthy and fat is unhealthy exacerbates the stigma that fat people experience. This does those most harm to those at the highest weights, and those with multiple marginalized identities, including and especially people of color, because weight stigma is rooted in, and inextricable from, racism and anti-Blackness.*
It’s inaccurate
Weight is a poor proxy for health, especially on an individual basis. Two people of the exact same weight (or BMI) can have very different health statuses. Two people with very different weights (or BMIs) can have the same health status.
It obscures the harm done to fat people
We know that weight stigma, weight cycling, and healthcare inequalities are correlated with the same health issues to which being higher weight is correlated. When we use weight as a proxy for health, we gloss over all of the things that are done to fat people that can harm them, and simply blame their bodies for the negative impacts of those harms.
It props up the failed weight-loss paradigm
The idea that weight is a proxy for health drives the assumption that weight loss makes people healthier. Even if we ignore the fact that the vast majority of weight loss attempts fail, there is still the issue that the vast majority of research on weight loss doesn’t even track health outcomes. Prescribing weight loss to increase health relies on the assumption that being thinner is healthier than being fatter, thus weight loss will increase health. Research does not support this, including the common refrain that 5-10% weight loss creates “clinically meaningful health benefits.” Further, it leads to fat people being prescribed weight loss to prevent/treat health issues that thin people get, often instead of the interventions that are prescribed to those thin people.
It promotes subpar healthcare
When healthcare practitioners use weight as a proxy for health, they often end up practicing stereotypes instead of medicine. This leads to everything from recommendations based in stereotypes, to BMI-based denials of care, to continued recommendations of weight loss despite the complete lack of an evidence-basis, including using weight and weight loss to gatekeep healthcare.
It even harms thin people
When weight is used as a proxy for health, it can mislead thin people into believing that they don’t need things like early detection screenings - that their weight is all they need to know. When there is a belief that some healthcare issues are “fat people problems” it can mean that thin people don’t get diagnostics and that issues can be missed.
The good news is that we don’t need weight to be a proxy for health, we can use the same measurements (for things like metabolic health) in people of all sizes. We can move to a weight-neutral health paradigm which will provide more benefits with fewer risks for everyone.
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More Research
For a full bank of research, check out 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 Harrisons Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.