The murky waters of weight status: can you be healthy and overweight?
In July 2012, I wrote a guest post at the Whole 9 blog titled: “How Perfect is the Perfect Body?” The answer, fairly definitively, was “that depends.”
This is because a stereotypically ideal body does not in fact indicate anything definitive about the individual’s health. It is entirely possible to be a lithe, shiny machine of a human being, but still have some sort of internal metabolic disaster. It is also possible to be overweight and to have a healthy internal environment.
There are three primary phenomena that make this possible: first, many health markers other than weight status are crucial for lifelong health. Secondly, the conditions for women are a bit complex: having more fat can be healthier (within normal ranges), and fat loss can be less easy because of hormonal set-points. And finally, a person’s health status can never be truly understood without the context of her history.
Other crucial markers of health
Many studies show that fitness is a better indicator for health than both BMI and body fat percentage. This is true both within and across body fat ranges—indicating that someone who is overweight but athletic might be healthier than someone thin and not athletic.
This study shows that low fitness is one of the strongest predictors of mortality within all BMI categories. And this study shows that, relative to fitness level, both BMI and body fat percentage were not a predictor of mortality for men with diabetes at all.
We often conflate the perfect body with perfect health, but that is a flawed concept. The truth is that a fit body provides merely the assumption that an individual has good physical health. What is her fasting insulin? His C-reactive protein? Her triglycerides? These three markers are perhaps the most important indicators of health, with a wide variety of metabolic indicators, hormones, and micro-nutrient levels all playing important roles. These are the first things we should think of when we want to evaluate physical health—not appearance.
Body composition is not the only influence on blood markers. Crucial influences include nutritional status, gut health, personal history, eating patterns, fitness level, sun exposure, alcohol consumption, sleep status, and stress.
The final (and perhaps most important) influence on health is stress. Many studies show that stress, like fitness level, is more importantthan body fat percentage in promoting health and longevity. For example, some studies show that implementing Healthy At Every Size practices, which means ignoring weight regulation in favor of intuitive eating and living, significantly decreases mortality in overweight adults, and promotes better lab results, health behaviors, and self-esteem than weight loss treatment.
Stress up-regulates adrenal function—and chronically elevated cortisol levels cause a vast array of health problems, including reduced sleep quality, impaired immune function, infertility and hormone dysregulation, and a higher risk for metabolic derangement and virtually all diseases of civilization.
Finally, neuroticism, defined by emotional sensitivity and negative emotions which include low self-esteem, is one of the greatest health risks and predictors of mortality of all. When we look at centenarians time and time again we find that their shared characteristics are having simple, loving, gently-exercising, stress-free, or passionate, lives. We can argue back and forth all day long about whether high fat or high carbohydrate diets make for longer lives, and whether fat is uniquely protective for the elder (it is), but the one commonality among all long-lived souls is existential peace.
A woman’s body and fat: how development and puberty shape adult fertility and health
It’s fairly well-known that women require more body fat than men. “Female fat” appears primarily around the buttocks, hips, and thighs and is significantly associated with a woman’s well being. Aside from protecting women against starvation more strongly than men, as well as assuring that a woman will have enough energy and nutrients to carry offspring, this fat is also largely responsible for partitioning DHA (the “good” omega 3) fat to a woman’s offspring. Children born of mothers with more of this DHA-heavy fat tend to be smarter than those without (PDF).
The most fertile woman is not the thinnest or the most buff woman. Instead, the most fertile woman is above 22 percent body fat. Many studies even argue that women between BMIs of 25-29—often considered by our culture as “overweight”—fare better in longevity and long term health (PDF) than lower weight women. Below the healthy range of > 20 percent body fat women often begin experiencing cravings, anxiety, depression, insomnia, loss of libido, brittle hair and nails, hypothyrodism and infertility.
Yet what is less well known is the fact that a woman’s weight status in her early years in part shapes the range of body fatness at which she can be fertile in her later years. As a woman develops throughout childhood and puberty, her reproductive system (as well as her metabolic system) becomes accustomed to a certain level of body fat. This system is primarily driven by the two hormones leptin and estrogen, which are secreted by fat cells.
Being “hooked on” these levels, if estrogen and leptin drop too low, a woman’s reproductive signalling can run off track. This is true for women who become supremely thin, though it may also be the case for women who are overweight and then slim down. I am not sure where the dividing lines are for women– nor could I ever be sure, seeing as they vary by each individual– but it remains a fact that some women become unbalanced when they lose whatever their pituitary gland considers to be too much weight. Some women also find that weight loss becomes supremely difficult at a certain point, and losing more weight at that point would significantly sacrifice their psychological wellness with respect to food.
All women should of course strive for positive, normal-weight, self-loving and nourishing weight loss. But they should not punish themselves in order to achieve this goal. There may be a reason the body is not losing weight so quickly. The female hormonal environment requires nourishment and safeguarding above all things. And protecting that is what leads to the best health, fitness, and body weight for each woman.
Context is king
Each human being is constructed out of two things: a genetic blueprint and environmental triggers. Unfortunately for us in today’s world, both of those factors can be easily and powerfully deranged.
The vast majority of children in America today are raised on processed, sugary, toxin-filled foods. This puts these people at an immediate disadvantage. No matter what sort of genes they are born with, the ways in which they treat themselves (and so often at no fault of their own) can permanently damage their health.
Consumption of trans fats, for example, has been linked to a long-term reduction in the ability to burn fat.
And seriously restricting calories has been shown to permanently increase the number of fat cells and the rate of fat storage in dieters.
Even worse, however, is the fact that consuming toxins does not only damage our personal metabolisms, but also the genetic blueprints that we hand down to our offspring. For this reason, the genes with which people are being born today now pose even more difficult genetic obstacles than may have ever existed naturally.
We also don’t know much about the shape of these genetic changes or the impact our histories have on our current health. Can we really become rail thin after having been obese? Will this be optimally healthy for us? Is this only achievable after having starved and restricted ourselves so harshly that our psychological health is in serious peril?
Do women have a harder time moving past hormonal set points than men? And is that even necessary for optimal health?
The bottom line
None of us can be understood outside of our contexts. What genes were we born with? What were we fed when we were children? How much did we weight when we started our periods? Was there a lot of BPA in our diets? How much metabolic damage has been done to us throughout our lives?
Meeting Stacy of this lovely blog has taught me much about the health and power of women and men who might still be considered overweight. Stacy prioritizes putting good food in her body above all, and she has lost more than a hundred pounds naturally as her hormones re-aligned themselves and settled into a more optimal place. She is healthy. She is fertile. And she is strong. She’s an inspiration to all of us, to be proud and embodied within the contexts of our own stories.
This journey is about health, and about nourishment. When we’re doing absolutely everything we can to be nourishing, and we feel good, and we are relaxed, and have good blood markers for health, and we are not beating ourselves up for not living up to ideals and norms, then we are living exactly as we should be within the context of our own stories. This is something that means we are living magnificently, and of which we should be fiercely proud.
Stefani Ruper is the author of the recently released PCOS Unlocked: The Manual, as well as the voice behind the Paleo for Women blog and the Live. Love. Eat. podcast. Through these endeavors, Stefani advocates holistic health and wellness. This manifests in discussions of physiological health issues such as PCOS, fertility, and menopause on the blog, as well as discussions of psychological health issues such as body image, disordered eating, and self-love in as many places as possible. Stefani holds degrees in biogeochemistry from Dartmouth College and in philosophy from Boston University.
If you are as moved as I am by this post, please use the share-a-holic buttons below to share it with those people in your life that need to hear, prioritizing health is what really matters. I’m honored to have inspired or taught Stefani anything on this topic, since it was she who gave that insight to me. – Stacy