No, You Can't Be 'Healthy At Every Size'

By Aadam | April 30, 2018

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The Ancient Greeks believed in something called kalokagathia: a person who was physically beautiful was associated with being ethically good and conversely, a person who was physically ugly was associated with being ethically bad.
Of course, this sounds totally absurd today but this idea of associating ‘beauty’ with character still permeates our culture, even if subconsciously. 1 It’s the reason we tend to think good looking people are more intelligent (even if they aren’t), are paid more (the Beauty Premium), and why we trust what celebrities say (even if it’s totally batshit fucking crazy).
It’s also why we’re quick to discriminate against someone based on their weight. 2 Absurd I know, but fat stigmatisation is a very real thing that many people struggle with on a daily basis.
And this is where movements like HAES (Health At Every Size) got it right: We shouldn’t judge people based on their weight; fat shaming isn’t only not cool, but doesn’t work; 3 scales don’t measure your worth as a human being; losing weight isn’t as easy as ‘calories in/calories’ out and for some, it can be a Sisyphean task. I can get behind and fully support all of that (and have done on multiple occasions).

What I refuse to support is the notion that you can be ‘healthy at every size’–because you can’t.

This was put to rest with the publication of a study last year that found:

Out of the 3.5 million participants, who were initially free from cardiovascular disease, about 15% were classified as metabolically healthy obese. During an average follow-up period of five years, of the people who were initially metabolically healthy obese, about 6% developed diabetes, 12% had abnormal blood fats and 11% developed high blood pressure.
Compared with normal weight people with no metabolic abnormalities, people who were metabolically healthy obese had a 50% increased risk of coronary heart disease, a 7% increased risk of stroke and a double risk of heart failure. These results couldn’t be explained by age, sex, smoking or socioeconomic status as we took these factors into account in our calculations.

(Also see this and this.)
So yes, you might be ‘metabolically healthy obese’ but you have an increased risk of disease compared to non-obese individuals.
Oh, and the idea that obese and overweight people live longer?

Some have hypothesized that excess fat stores are beneficial for counteracting episodes of catabolic stress. If so, people with low muscle mass should benefit most from the energy reserves provided by excess adiposity. However, the risk of death associated with low muscle mass was not reduced by greater body fat as represented by higher BMI, but rather increased. Thus, our data are not consistent with a survival advantage related to overweight or obesity.” (Emphasis mine.)

Researchers concluding: 4

After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range.

Meaning: Once you take muscle mass out of the equation–body fat alone does not increase longevity.
But, this nonchalant attitude toward the health risks that come with being overweight isn’t the only problem with movements like HAES.


As people, we all believe certain things. We then like to hang around other people who also believe the same things. It makes us feel safe and wanted.
This is your tribe.
For the most part, tribes are fairly harmless, like that Pokemon fan club you started in school.
But, there are other kinds of tribes that form around an idea that’s emotionally charged. It’s these kinds of tribes that can become dangerous and destructive because it isn’t just an idea anymore, it’s become a part of that person’s identity–it’s literally them. And if someone doesn’t agree with the idea, they’re not disagreeing with the idea, they’re disagreeing with the person. This isn’t a disagreement, it’s an attack. Sorry, did you say I was wrong? OFF WITH THE HEATHENS HEAD. And when something is seen as a personal attack, all rationality goes out the window. It doesn’t matter how much information there is to the contrary–they don’t want to hear it and will defend their beliefs to the end. 5
This is the other, more concerning, problem with movements like HAES–proponents have adopted a tribe-like mentality towards anyone who disagrees or says anything remotely contradictory to what they want to believe.
An example of this was seen a few weeks ago when Cancer Research UK launched a campaign to create awareness about the fact that obesity is the second preventable cause of cancer after smoking. 6 This resulted in a bunch of people on the internet getting super angry and accusing Cancer Research UK of ‘fat shaming’–even suggesting petitioning to have the ad removed.
No, really, these people were ‘offended’ because an organisation that is working hard to eradicate a heinous disease from the face of the earth was raising awareness about the link between cancer and obesity.
Do you not see how ridiculously absurd that sounds?
For one, the campaign (pictured below) is completely depersonalized.

It’s not singling out or pointing fingers at any one person or group. It doesn’t say, “Fat people get cancer,” or “Being fat will give you cancer”–It’s just bringing awareness to an unfortunate, research-backed, fact: Obesity–a medical term–is a cause of cancer.
It’s no different than saying “HIV kills.” Does this mean that everyone who has HIV is a bad person? Of course it doesn’t. Just reading that sentence feels silly.
Was the CRUK campaign clickbaity? Sure. Does that automatically make it wrong or invalid? No. It’s a campaign, and for it to do its job it needs to catch attention and clickbait headlines work perfectly for that. 7
Ok, so there may not be a direct link between obesity and cancer (not yet, anyway) and cancer is definitely a complex, multifactorial disease that we still don’t fully understand. 8 But, obesity is correlated with a number of the leading causes of death–and while correlation may not mean causation, the evidence is strong enough to make the argument that obesity is dangerous, and yes, can even kill.
For example, coronary heart disease (CHD) is the number one cause of death in the world, killing 8.76 million people in 2015. Stroke is the second leading cause of death in the world, killing 6.24 million people in 2015. Even diabetes, a disease that’s rapidly increasing, killed 1.6 million people in 2015. 9 And obesity increases your risk factor for all three. 10

Which is why the tribal nature of movements like HAES is worrying.

Obesity rates are increasing rapidly worldwide.


And only projected to continue increasing. 11


Childhood obesity is on the rise, too–in some countries overtaking the rate of adult obesity. 12
In 2015, excess body weight accounted for about 4 million deaths worldwide. 13
A high body weight (and body fat levels) can increase your risk factor for a range of chronic diseases, including diabetes, cardiovascular disease, chronic kidney disease, and even some cancers. 14 Reduce the quality of your life. 15 And cause premature death. 16
My point: obesity is a serious problem that carries serious health risks and is only projected to get worse. It’s also a problem that we can work on solving but that’s not going to happen if every time the issue is raised people get offended, attack and disparage discussion.


In the 1920s, cigarettes were advertised as a weight loss aid. Take a look at some of the adverts for yourself:


“Reach for a Lucky instead of a sweet.” If your reaction was The fuck? You’re not alone. Seeing these adverts today is mind-blowingly bizarre because we’re fully aware of the health dangers of smoking; they’re irrefutable. But the only reason we’re aware of the health dangers is thanks to research and concomitant public health campaigns warning everyone just how bad smoking is.
Cancer Research UK calculated the number of adult cigarette smokers in Great Britain dropped nearly 20% from an estimated 10.2 million in 2007 to 8.3 million in 2016 since the smoking ban was introduced a decade ago. 17 According to the American Cancer Society, since 1991, the cancer death rate in America has dropped by 26%. 18 That means 2.4 million lives have been saved from cancer thanks to campaigns like this.
This is why discussion is so important. We’re only now starting to understand how dangerous obesity is and with obesity rates projected to continue rising, the more awareness that can be raised, the more people can be helped and saved.
I’m in full agreement that alongside the health dangers of obesity, more awareness needs to be raised about the complexities of obesity. Obesity is a physiological, psychological, sociological, and environmental phenomenon (amongst several other things). 19
So no,  it’s not as simple as ‘you eat too much, you’re lazy.’ Just like depression isn’t simply a case of ‘stop being sad’ or alcohol addiction a case of ‘stop drinking so much.’ 20
By raising awareness of the fact that obesity is not a simple math equation (calories in = calories out) the general public can begin to understand and have empathy toward people struggling with their weight. Hopefully, this will mean disassociating disease (obesity) from the person and more people can open up about their struggles and seek help without feeling stigmatised or that they’re somehow a bad person.
Food companies also need to be held accountable. It’s terribly egregious for food companies to make claims like, ‘Enjoy our foods in moderation’ while engineering extremely tasty, hyper-palatable, foods that are designed to be eaten in anything BUT moderation. 21
Maybe, like with cigarettes, we need to force food companies to open up about the dangers of their products? Maybe we need to stop with the perfunctory attitude toward junk food and help people understand that while food isn’t inherently ‘good’ or ‘bad’, some foods do have more of a potential to be bad, especially in those who are susceptible? Maybe there needs to be a stronger push for nutrition and healthy eating education in schools?
I don’t know because I don’t have the answers. What I do know is that burying our heads in the proverbial sand and not talking about these issues because we might hurt feelings definitely isn’t it. 22

Your genetics are not your destiny

I’m also not pandering to these people–yes, obesity is a complex issue but your body and health is still your responsibility and if you want to change it’s a choice you, and only you, can make.
Yes, there may be some things you can’t control (like your genetics or food companies advertising their foods), but there are a lot more things you can control.
For example: you can work on your mindset toward your health and fitness; you can educate yourself on food and good nutrition; you can seek professional help (doctors, therapists, personal training); you can decide what you eat and don’t eat; you can decide who you hang around with and who you don’t hang around with; you can decide to do activities and exercises you enjoy; you can decide to set up your home food environment so it’s more conducive to your goals. And ultimately, you can decide to cut the bullshit and work on improving your health, fitness, and body composition. 23
I’m not saying any of these things are easy, but they’re not impossible either. 24


I’m seeing a growing trend among HAES proponents (and others like it) taking photos of their overweight bodies and posting them to the ‘Gram in protest of ‘unrealistic body standards.’ 25 And not realising the irony: by trying to normalise a body state that increases health risks and reduces both the quantity and quality of your life they’re doing just as much damage, if not more, than the people they accuse of creating unrealistic body standards. 26
Some of these accounts have millions of followers–some, I’d posit, who are relatively young and impressionable. This is not the sort of message we want to be giving to people let alone young children, at a time when obesity rates are skyrocketing.
And if we’re going to blame Instagram fitness models for promoting unrealistic body standards, then we also need to acknowledge some of the positive effects. For example, more people are becoming health conscious. The 2015 Nielsen Global Health & Wellness Survey polled 30,000 online respondents in 60 countries to identify how consumers feel about their body image and the steps they’re taking to get healthier. Interestingly, the majority are trying to change their diet and exercise versus resorting to pills and supplements.

According to the same survey, more people are also reducing their consumption of ‘chocolate and sugary sweets’, while ‘expanding their diets with more natural, fresh foods.’
And I don’t think it’s controversial nor far-fetched to say that a large part of this is due to the rise of physical culture in the mainstream.
Speaking of the rise of physical culture: more people, especially women, are starting to lift weights and realising the importance of building muscle and strength and eating adequately to fuel their bodies instead of starving themselves. This, ironically, is thanks to other people posting their body transformations and showcasing what’s possible.
We’re quick to point the finger at social media for society’s ills, but here’s the thing–social media is just a tool. And like any tool, it’s how you use it that matters. You have a choice in who you follow and what you tell the algorithm you want to see. If someone (or something) is making you feel bad about yourself–stop following them.
It’s also important to note that despite how vehemently some people accuse fitness models and the media of promoting dissatisfaction with our bodies, the research isn’t definitive and, like with most things, it’s not as simple as placing the blame on only one possible factor. For example, this meta-analysis of more than 200 studies examining the effects of thin or muscular media ideals on men and women found ‘little evidence for media effects in males. Effects were minimal for most females as well although some evidence suggested that women with preexisting body dissatisfaction may be primed by media ideals.’
The key word here is pre-existing. If someone is susceptible to these images, then sure, there’s a possibility that this type of content could negatively impact them but that doesn’t mean everyone will experience the same (negative) effects. Just like not everyone who drinks becomes an alcoholic or everyone who diets develops an eating disorder or everyone who has sex becomes a sex addict. 27

Blaming social media as a whole is also unfair on those who are using it as a force for good.

There are a number of women, for example, who are making positive use of social media by–and as much as I hate this word–empowering other women through strength training, good nutrition, and showing that you can work towards a healthier, stronger, and fitter version of yourself while also showing yourself compassion.
More people are coming forward and opening up about how they manipulate lighting and strike certain poses to make them appear more leaner and muscular than they really are.
More ‘fit’ women are opening up about the fact that despite being in great shape, they too have cellulite and that it has no bearing them as a person.
None of this would have been possible a few years ago when fitness information was dispensed through major publications who had an agenda: sell more magazines no matter what.
And so what if someone wants to *GASP* *SHOCK* *HORROR* change their body because they’re unhappy with the way they look? While health is obviously important, unless you have a health concern, it just isn’t as exciting or motivating. For a lot of people, changing their appearance is a stronger motivator to change their diet and exercise habits than improving their health. 28 If you’re a healthy individual–i.e. you have no health concerns–me telling you to deep throat kale five times per day because you’ll ‘live longer’ is less enticing (if at all) than me telling you to eat better and exercise because you’ll look better, fit into your favourite jeans again, and probably have more sex.
This isn’t only about vanity, either. As people we like to see tangible results for our hard work. And seeing our bodies change provides positive feedback that tells us what we’re doing is working, which increases a person’s motivation to stick to the plan.
The two (health and appearance) shouldn’t be seen as mutually exclusive–if someone’s motivation to change is because they want to look better and this leads them to eat better, exercise, and maintain a healthy level of body fat, they’re concomitantly going to improve their health.
It’s cool to throw two fingers up at the establishment that’s tried to dictate what you should and shouldn’t look like for years. It’s cool to say, “Fuck you, I’m going to look however the fuck I want to look.”
But it’s not cool to spread misinformation. It’s not cool to try and normalise a body state that increases a person’s risk of disease. And It’s not cool to try to prevent discussion that could help save lives.
Because the research is clear: you’re at more risk of a myriad of diseases and health risks if you’re carrying excess body fat. Conversely, even a modest amount of weight loss can greatly decrease the same risks. 29
I think Health At Every Size needs an addendum: You can be healthy at every size that doesn’t increase your risk of disease and mortality. You can be healthy at every size that doesn’t reduce the quality and quantity of your life.
But, no, you can’t be healthy at every size just because that’s what you’ve decided. That’s not how it works.