There are a lot of people who connect with the body positivity movement but wonder what to do if they’ve been told they have to lose weight for health reasons. If that’s you, read this article for some things to think about in deciding how to care for your body.

There are many different reasons why someone might want to lose weight. Most people assume aesthetics is the main motivation for people who are dieting. In my experience, while it is a major one, it is often much more complex than a “shallow” desire to be thinner. We live in a deeply fatphobic culture that puts pressure on humans to try and shrink their bodies from a lot of different angles.

In my practice, I work with quite a few clients who have mostly worked past their desire to look thinner. They are often in happy, long-term relationships, have solid friendships, and have fulfilling careers and/or family lives. They know from experience that society’s message that you have to be thin to be happy is not accurate. They know that changing their appearance would not change their life, and they are well informed on diet culture, intuitive eating, and body positivity.

And yet, sometimes, they struggle with the desire to lose weight. Almost always, it is due to health concerns. They have been told to lose weight by their doctor or struggling with a health condition they think may be due to or exacerbated by their body size.

The purpose of this post is not to say whether you should or shouldn’t try to lose weight. We’re big believers in bodily autonomy over here! It’s impossible to know your own unique situation, health history, and relationship with food, and even if I did, it’s still not up to me. That said, I do believe everyone has a right to information in making decisions about their health. If you’re wondering if you should lose weight for health reasons, I hope this blog post gives you some things to consider in making a well-informed decision.

Is your weight negatively impacting your health?

In mainstream medicine, weight is often treated as synonymous with health. For people who have a BMI in the “overweight” or “obese” categories, the recommendation to lose weight is thrown out at almost every doctor’s visit, even for things as clearly non-weight related as a broken bone or the flu. It makes sense that most people would assume they need to lose weight for health.

In reality, the relationship between weight and health is far from given. For starters, using BMI to characterize one’s fatness is highly flawed, so any research examining BMI and health is also poor. That said, the research on BMI and health paints a different picture. In the best-designed study looking at the relationship between BMI and mortality, the category with the lowest rate of mortality was “overweight,” and grade 1 “obesity” (BMI 30-35) was equal to the “normal” weight category. Multiple studies have found the “underweight” category to be the most significant health risk, yet people whose BMI falls in that category rarely get a “weight talk” from their doctor. I’ve had many, many clients who were severely emaciated and underweight, whose anorexia was not diagnosed by their doctor, despite being the rare case of someone who looks like the stereotypical image of someone with an eating disorder.

That said, there is a correlation between higher weights and specific health conditions, like type 2 diabetes and heart disease. However, there is quite a bit of research that suggests much of this statistical increase in morbidity and mortality is due to the health effects of weight cycling (i.e., yo-yo dieting), the stress of stigma and oppression, poor health care, and health care avoidance, an understandable reaction when every time you go to your doctor, you’re shamed for your weight. No health condition affects only people with larger bodies, so to blame a health condition on weight is, at best, overly simplistic.

Is your health condition being exacerbated by your weight? Sure, that’s within the realm of possibility. Would your health improve if there was a magic wand that could instantly take pounds off your body? Maybe. Maybe not. However, such a wand does not exist, and weight loss requires behaviors, medications, or surgery that may have side effects, which brings me to my next point…

What is the health impact of dieting/weight loss?

Weight loss doesn’t happen in a vacuum. One has to create a caloric deficit through diet or exercise, take weight loss medications, or have bariatric surgery. These things come with their health risks. Even if we knew that weight loss would improve health (and we don’t), it’s hard to weigh that (no pun intended) against the possible, or perhaps likely, health risks of dieting.

Restricting calories, limiting intake, and eliminating foods/food groups may lead to weight loss. Usually, that weight loss is temporary. It also may lead to nutrient deficiencies, fatigue, disruptions to gut microflora, digestive issues like diarrhea or constipation, loss of muscle mass, lowered bone density, gallbladder disease, hormonal problems (especially with sex hormones), decreased immune function, fluctuations in blood sugar, dehydration, and headaches. From a psychological standpoint, dieting can lead to or exacerbate anxiety and depression and cause moodiness (we all know hunger!). Dieting can impact your social life and can lead to social isolation. Weight loss can also trigger a life-threatening eating disorder for people who are at risk, and except for people who have a family history, we don’t have a good way of knowing who is at stake.