Thin Is Not The Same As Healthy

If you’re on a diet right now, you’re not alone. Everyone from your mom to your pediatrician to Oprah will tell you that the key to a long, happy, healthy life is getting your weight “under control.” From all sides, the message is clear: Weight loss is critical to health, and diets will help you get there.

The trouble is that it’s just not true.

There is widespread evidence that diets – restricting calories with the goal of weight loss – don’t work. It’s not that everything you’ve ever learned about the importance of eating nutrient-rich foods and getting regular exercise is wrong. Those things will absolutely make you healthier. What they won’t do is make you thin.

The vast majority of diets do not lead to sustained weight loss. What they do lead to is rampant preoccupation with food and weight, a toxic cultural thin ideal, body dissatisfaction, disordered eating, and for 10% of our population, life-threatening eating disorders.

Last week, Weight Watchers announced a program to provide free memberships to 10 million teens. The eating disorder community took to social media to urge Weight Watchers to reconsider, sharing personal stories of the damage that dieting has inflicted. It was powerful. But the problem is bigger than Weight Watchers, or even teen dieting.

The problem is thinking of weight as an indicator of health. As a group of scientists, therapists, diet survivors, and concerned citizens, we’re #donewithdieting. Here’s why.

Project HEAL is the largest nonprofit in the U.S. delivering prevention, treatment financing, and recovery support for people suffering from eating disorders.

Weight is a bad stand-in for health.

Weight is a bad stand-in for health.

Common wisdom says that obesity is associated with health risks, but the story isn’t that simple. Studies on dieting rarely control for factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status. When they do? Increased risk of disease all but disappears.

While there is increased mortality at both very low and very high weights, there is a wide range of healthy weights. People who are “overweight” or “moderately obese” live at least as long as “normal” weight people, and often longer. In fact, some studies have shown that obese people with type 2 diabetes, hypertension, cardiovascular disease, and chronic kidney disease may have greater longevity than thinner people with these conditions.

Diets don’t work.

Diets don't work.

Most people think that if you just commit to regular diet and exercise, you can have a body that is healthy and trim. But while what we eat and how we move certainly has some impact on what we weigh, they are by no means the biggest factor determining what our bodies look like. That factor is genetics. The genes we got from generations of ancestors determine not just the color of our eyes, but the shape and size of our bodies.

What this means is that every body has a unique healthy weight, and a complex system of metabolic and hormonal forces work to keep us at that weight by doing things like creating urgent and unwavering cravings for potato chips when we fight it. When we diet, our metabolism slows down to stop weight loss.

We may see some weight loss initially, but it doesn’t last. Long-term studies show that the majority of individuals on diets regain one-third to two-thirds of the weight within one year, virtually all within five years, and often end up weighing more than when they began.

In fact, dieting often does harm.

In fact, dieting often does harm.

The stories of contestants on The Biggest Loser are the most clear example of a more universal experience. Because diets don’t work, more often they result in an endless cycle of gaining and losing weight, which in turn increases inflammation and risk for many obesity-associated diseases, including hypertension, insulin resistance, and dyslipidemia. Weight cycling can account for all of the excess mortality associated with obesity in studies like the Framingham Heart Study and the National Health and Nutrition Examination Survey. It may well be that the association between weight and health risk is better attributed to dieting than to weight itself.

There is a common aphorism in the Health At Every Size community: "If shame were effective motivation, there wouldn't be many fat people." Adults who face weight-shaming report overeating, avoiding exercise, and avoiding medical care. Family weight teasing predicts overweight status, binge-eating, and extreme weight-control behaviors; adolescent girls who were teased about their weight were at twice the risk of being overweight five years later.

Dieting is also the most important predictor of developing an eating disorder. Eating disorders are prevalent in people of all body shapes and sizes, but people in higher weight bodies often don’t get help because they don’t fit the mold of what an eating disorder is “supposed” to look like. When a person isn’t technically underweight, society and the medical establishment can end up praising serious mental illness as an effort to get healthy.

If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741.

Focusing on real health outcomes will make us healthier and happier.

Focusing on real health outcomes will make us healthier and happier.

When we shift the focus from weight management to health outcomes that matter, the results are striking. Evidence from six randomized controlled trials indicated that a Health At Every Size approach is associated with improvements in physiological measures (e.g. blood pressure, blood lipids), health behaviors (e.g. physical activity, eating disorder pathology), and psychosocial outcomes (e.g, mood, self-esteem, body image). When we focus on health, our bodies settle at their healthiest weight – which looks different for everyone.

Together we can change the way we understand health.

Together we can change the way we understand health.

Research shows what makes us healthier, and it’s not dieting. But strong research alone doesn’t make change. To end the dieting epidemic, we need to show the damage it has done to our parents and our siblings, to the athletes and actors we respect — to the overwhelming majority of Americans. Which is why we’re asking anyone impacted by destructive dieting to stand up and speak out.

Being #donewithdieting is about naming the ways that dieting has harmed our mental and physical health. It’s about refusing to support companies that make their money from selling us products that do not work long term, and then selling them to us again. It’s about not just telling the world that 90% of American women dislike their bodies, but showing the world what that looks like with stories from the women all around us.

We’re #donewithdieting because the research tells us that it’s ineffective and dangerous. Why are you?

This letter is signed by...

This letter is signed by...

Kristina Saffran, CEO and cofounder of Project HEAL

Liana Rosenman, president and cofounder of Project HEAL

Neville Golden, MD, chief of the Division of Adolescent Medicine at Stanford

Rebecka Peebles, MD, assistant professor in The Craig Dalsimer Division of Adolescent Medicine at the Perelman School of Medicine at The University of Pennsylvania, and co-director of The Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia

Jennifer L. Gaudiani, MD, CEDS, FAED, founder and CEO of the Gaudiani Clinic, an outpatient medical clinic that is dedicated to treating people of all shapes and sizes with eating disorders and disordered eating.

James Lock, MD, James Lock, MD, PhD, director of the Eating Disorder Program at the Stanford University School of Medicine

Carolyn Becker, PhD, ABPP, FAED, professor, Trinity University, co-director, Body Project Collaborative, past president of the Academy for Eating Disorders

Linda Bacon, PhD, associate nutritionist, University of California, Davis, and author of Health at Every Size and Body Respect

Melainie Rogers, MS, RDN, CDN, CEDRD-S, founder and CEO of BALANCE eating disorder treatment center

Jennifer Siebel Newsom, founder and CEO, The Representation Project

Brian Beitler, former EVP and CMO of Lane Bryant, co-creator of the 67% Project

Amanda Crew, actress

Emme, supermodel

Jen McQuale, director and producer, Straight Curve

Joan Barnes, founder of Gymboree, Author of Play it Forward

Camila Mendes, actress

Jodi Guber Brufsky, founder and CEO of Beyond Yoga

Pamela Harrington, executive director, Bring Change to Mind

Elissa Myers, executive director, Academy for Eating Disorders

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