Can you be Healthy at Every Size

This is a blog I have struggled with.

I started writing it the first week of July 2020. I struggle with it because I know people who struggle with Body Acceptance. I Know people who Body shame others. I know people with significant Body Dysmorphia and Eating disorders. 

One of my goals as a Functional Medicine Wellness Coach is to Empower People to Health. So I feel obligated to write this particular article. But also, obligated to be vulnerable with you and caring in what I write. There is a Movement called Health at Every Size, or HAES for short. It wants people to recognize that a person who is Morbidly Obese can be as healthy as a person of “Normal” size. (20-25% body fat in the pictures below).

 

Body Fat Percentages
20-25% is considered healthy for Females, 12-20% for Males

HAES challenges some of the key assumptions of traditional approaches to weight management. These include

  1. that adiposity poses significant morbidity and mortality risk,
  2. that weight loss will prolong life,
  3. that anyone who is determined can lose weight and keep it off through appropriate diet and exercise,
  4. that the pursuit of weight loss is a practical and positive goal,
  5. that the only way for people living with obesity to improve health is to lose weight, and
  6. that obesity-related costs place a large burden on the economic and health system, and this can be corrected by focused attention to obesity treatment and prevention

Principles of HAES:

  1. Intuitive eating
  2. Body acceptance
  3. Movement for health not weight loss or performance

So What does the research say?

HAES says that not every approach works the same on each individual and a 2015 Study in the American Journal of Public Health denounced HAES research stating that While the exact proportion of obese people who are metabolically healthy varies depending on what criteria are used to define both obesity and health, it is smaller than the proportion of obese people who are not metabolically healthy. As it is currently not possible to predict which people will remain metabolically healthy despite excessive weight gain, it may be dangerous to make blanket community statements that people can have health at every size. 

Interpreted: We are unsure who is really healthy and stays that way according to cardiac and lung function, Diabetes as well as Cholesterol levels. This also includes things like Sleep Apnea. 

Study published in the Journal of American Diet Association in 2005  Showed that persons of obese nature improved metabolic fitness in cardio, lipid profiles, social behavior, depression and self esteem. But Intuitive eating not without risks: Food is calorie dense and nutrition deficient, which allows for people who lack satiety gene to over eat, as they don’t feel full, Causes those with sweet tooth gene to eat more sugars which lead to further obesity and then other health concerns. Cost of Nutrient poor versus nutrient rich foods is significantly different and has a significant impact on Socio-economic habits and allowances. Then the environment which someone grows up in with genetic predisposition for obesity or thinness.

Body Acceptance:

On top of all of this, body acceptance is lacking world wide in the female population. The Number of women who berate themselves daily about weight, acne, size of hips or thighs is remarkable. It shows how we look at the world as a society and what society believes is attractive versus what’s healthy is out of balance. There is also research that has been published on the difference, particularly in women, on how providers see and treat women. It showed that if a woman was obese, no matter the reason for her visit, she was more likely to be lectured about weight ad diet. A woman who was put together with good clothing, hair, makeup was less likely to be taken seriously regarding pain. Also, a woman who was dressed in sweats, hair in a bun and no make-up was looked on as drug seeking if there was a complaint of pain. As providers of Healthcare it means that we need to be aware of the bias we come to the table with and try to think of the person in front of us. Try and connect more intimately with the complaint they have in front of us and try and treat equally, regardless of size. 

 

Here is some startling information: If you use the calculator found here:Calculate BMI and HERE: Calculate Body Fat You can get a sense of where you fall according to Normals. I have a BMI of 25.1, putting me at obese. My Body Fat with this crude calculation is 36.5%, placing me also in the obese category. 

Moving for health, Not Fitness

Movement for health is a great tipping point many have difficulty overcoming, Particularly in the Endurance category and Body Building Category. The ability to just go for a walk to walk and enjoy the outdoors is lost on many. The use of E-bikes has improved the number of persons in a specific socioeconomic class enjoying trains throughout the cities in the US recently. The other portion of this coin is Movement sometimes takes an inner motivation that people don’t possess and therefore need a significant amount of goals or push to get the exercise in. 

The Skeletal system:

Whether or not a person with excess weight develops metabolic diseases such as diabetes or cardiovascular disease, sooner or later the mechanical effects of excess weight and the resultant gait abnormalities, combined with systemic inflammation, are likely to take a toll. As one example, adults who are overweight have a 2.2-fold greater chance of developing knee osteoarthritis than those with a BMI under 25 kg/m2, and this increases to a 2.6-fold greater risk for adults with a BMI of 30 kg/m2 or more. Moreover, every increment in BMI contributes to escalating difficulties in performing activities of everyday life, such as walking, getting out of a chair and climbing stairs.

How do we know that inflammation happens overtime with obesity? Studies of adipose tissue show that they have their own homeostasis in relation to Hormone secretion and cytokine production. The Adipose or Fat tissue actually makes its own estrogen and Cytokines. In the current environment with COVID-19 showing a Cytokine storm as the leading cause of Intubation in ventilator use, we know that an Obese person is more likely to suffer this fate. Intubation comes with a host of problems later down the road such as poor lung function. Poor lung function leads to decreased ability for the Cardio-respiratory system to keep up with the body’s needs. 

In addition to this, Cytokines can actually cause destruction of small Blood vessels in the capillary beds.  

After this time, carrying excess weight may become ‘hard wired’ into the parts of the brain that regulate body weight, and it may be almost impossible to make any changes at all. In normal animals, exposure to an energy dense diet that is high in fat, or high in fat and sugar – similar to the default diet of modern societies – initially leads to physiological changes that would tend to counteract weight gain, as recently reviewed

The study by Sainsbury showed that animals originally will stop eating or eat lighter meals when exposed to high sugar and high fat diets in order to regulate body fat. This is done by the hypothalamus supporting release of Leptin. What happened over time though was that the animals became leptin resistant in a period of 9-12 months and then developed higher body fat and lost the ability to feel satiety. They never felt full, so kept over eating. 

Studies in 2006 and 2007 showed that Obese Rats that were continually fed the same diet developed a leptin resistance. In the 2007 study, Rats were able to “reset” Their Leptin resistance and become a healthier weight again with dietary changes. However, the 2006 study showed that the rats actually reached a “Set Point” that was higher than the original point at which the body thought it was healthy. This is why some people say things like “I have to starve myself to get below X and maintain it.” This is where the Genetics come into play. If you are predisposed to weight gain and have a difficult time taking it off, using Lipids circulating in your blood as energy or converting stored fat to energy, you may develop a higher “set point” This is the Definition of epigenetic. The effect the environment, including nutrition, has on the genes you were born with. The really dangerous part of that: IT leads to future generations of obesity due to the fact that the DNA is changed. 

The HAES movement says wait until it is convenient to do something about the weight. Epigenetics says you can not waste that time. By Age 50, it may be too late. If you have a family history of obesity and you want to see positive changes for your future generations, it should start prior to pregnancy and certainly through your lifetime and the child’s lifetime. That does not mean Body Shaming. It means education about healthy choices and responsibility. It will take 3 generations to DAMAGE the DNA and 5 generations to REVERSE the Damage.

 

 

Studies:

Vincent HK, Heywood K, Connelly J, Hurley RW: Obesity and weight loss in the treatment and prevention of osteoarthritis. PM & R. 2012, 4 (5 Suppl): S59-S67.

Blagojevic M, Jinks C, Jeffery A, Jordan KP: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis and cartilage / OARS. 2010, 18: 24-33. 10.1016/j.joca.2009.08.010.

Enriori PJ, Evans AE, Sinnayah P, Jobst EE, Tonelli-Lemos L, Billes SK, Glavas MM, Grayson BE, Perello M, Nillni EA, Grove KL, Cowley MA: Diet-induced obesity causes severe but reversible leptin resistance in arcuate melanocortin neurons. Cell Metab. 2007, 5: 181-194. 10.1016/j.cmet.2007.02.004.

MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO: Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. Am J Physiol Regul Integr Comp Physiol. 2006, 290: 1577-1588. 10.1152/ajpregu.00810.2005.

Milagro FI, Campion J, Garcia-Diaz DF, Goyenechea E, Paternain L, Martinez JA: High fat diet-induced obesity modifies the methylation pattern of leptin promoter in rats. J Physiol Biochem. 2009, 65: 1-9. 10.1007/BF03165964.

Zhang FF, Morabia A, Carroll J, Gonzalez K, Fulda K, Kaur M, Vishwanatha JK, Santella RM, Cardarelli R: Dietary patterns are associated with levels of global genomic DNA methylation in a cancer-free population. J Nutrition. 2011, 141: 1165-1171. 10.3945/jn.110.134536.

Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J: Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011, 365: 1597-1604. 10.1056/NEJMoa1105816.

Size acceptance and intuitive eating improve health for obese, female chronic dieters.

Bacon L, Stern JS, Van Loan MD, Keim NL, J Am Diet Assoc. 2005 Jun; 105(6):929-3

Am J Public Health. 2015 May; 105(5): e38–e42.

Published online 2015 May. doi: 10.2105/AJPH.2015.302552The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward, Tarra L. Penney, BSc, MA and Sara F. L. Kirk, PhD

Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P: Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutrition. 2010, 64: 1043-1051. 10.1038/ejcn.2010.114.

Sainsbury A: The Biology of Weight Control. A modern epidemic – expert perspectives on obesity and diabetes. Edited by: Baur L, Twigg S, Magnusson R. 2012, Sydney, Australia: Sydney University Press