Can you be Healthy at Every Size?
by Molly Gries, PT, DPT
Have you ever been given this advice? “If you lose 10 pounds, your knees will not hurt as much,” or “Before you begin a running program, you need to lose weight.” Wait, what?? Is this true? Is a number on a scale the sole determinant of your health or a true limiting factor on being active? While science suggests there is no such thing as “healthy obese,”1 think of it this way: It is not that your weight does not matter. It is just that it is not the only thing that matters. The goal of a healthy weight is living a life that balances the amount of energy you input (eating) to the energy you expend (exercise).2
What is Health at Every Size?
The Health at Every Size movement (HAES) promotes acceptance and appreciation of one’s body, even if you’re overweight. It encourages overweight people to shift their focus from losing weight to other healthy habits, such as eating healthy foods and getting more physical activity and exercise.
Weight is Just a Number
The number on the scale does not tell the whole story about your health. Measures of weight are not highly correlated to health.3,4,5 Body mass Index (BMI) measures a ratio between your height and weight. The number on the scale and BMI do not consider body composition. A very muscular person may have a BMI that is considered overweight or obese. On the flip side of the coin, someone with a low BMI may still have a high amount of visceral fat—the so-called “skinny-fat” phenomenon—which increases disease risk. It is worth pointing out that the conventional criteria for healthy body weight are based primarily on Caucasian body types and may not be appropriate for all races and ethnicities.6 In a culture that values thinness and lean bodies, it is easy to think you can only be healthy at a lower weight. This is simply not true. In fact, research shows that being thin is not a safeguard to disease or painful conditions. 4,7
Let’s Focus on Something We Can Change
Being healthy is a choice driven by habit. You can truly be healthy at any size and people are healthy at every size. Your body can still heal, and you can have less pain without losing 10 pounds. You can start a new activity and hobby without being a certain weight. Treating your body with respect and appreciation must come first and optimizing your health habits does just that.
Your body weight is affected by many variables, including genetics, nutrition, and physical activity. While we cannot change genetics, we can change our habits. One goal should be to eat enough calories to sustain you while eating a well-rounded diet that is rich in fruits, vegetables, lean proteins, and low in high-processed food. Another goal is to engage in some form of physical activity daily to average at least 150 minutes a week of moderate-intensity aerobic activity. And don’t forget about getting adequate sleep (8 hours a night on average) and staying hydrated (about 8 glasses of water a day). Optimizing health habits affects your pain experience and ability to function in your daily activities and roles in life far more than a set number on a scale.5
How does your bodyweight affect your pain complaint?
When evaluating injury or persistent pain, it is important to determine underlying root causes. Often, sedentary activities or doing repetitive activities with little to no variety contributes to sensations of pain more than how much you weigh or what the scale says. Most sensations of pain start to feel better when walking or moving versus sitting still. Though often blamed for the onset or persistence of pain, specifically prescribed exercise and physical activity has been shown to relieve pain.7 Your weight did not change because you walked around the block, but your experience of pain may have lessened. This shows that your bodyweight may not be correlated to your experience of pain. However, it can be daunting to start a new activity and difficult to figure out the first steps. This is where your Doctor of Physical Therapy can help. Physical therapists educate and guide you in starting an exercise program aimed at reducing pain through education and training in optimal loading and movement patterns and working collaboratively with you to create baseline fitness to achieve your movement and fitness related goals. This can be as simple as a guiding you through a progressive walking program with optimal loading patterns, and progress to a more complex and comprehensive program that includes strength training, aerobic activity, stretching, mindful meditation, and tips on nutrition and sleep hygiene. A Doctor of Physical Therapy specializes in movement and pain science and can help you confidently and safely reach your fitness goals.
Being as healthy as you can be at your current size may also be a bridge to being healthy at a healthier size in the future.
In a society that is biased against being overweight, HAES philosophy offers a valuable and needed perspective. It is not that your weight does not matter. It is just that it is not the only thing that matters—in terms of your health, but also in terms of your value and rights as a human being.
If you’re overweight, losing weight would probably decrease your risk of various diseases, especially if you go about it in a sane and sustainable way, but following HAES philosophy, the focus should be on optimal health versus weight. Find activities that bring you joy and that you will follow consistently. Eat food that makes you feel good and that you enjoy. Starting a new exercise or activity does not mean you have to be perfectly pain-free and good at it right away. It is better to start with small steps and ask for help from a trainer, coach, or your physical therapist. Most importantly, being healthy is about feeling good about yourself. You can truly be healthy at every size.8
“Everybody can do amazing things, regardless of the number on a scale.
Take a moment and appreciate all that you can accomplish.”
- Kramer CK, Zinman B, Retnakaran R. Are Metabolically Healthy Overweight and Obesity Benign Conditions?: A Systematic Review and Meta-analysis. Ann Intern Med. 2013;159(11):758–769.
- Worsfold, K. A., & Sheffield, J. K. (2021). Practitioner eating disorder detection: The influence of health mindset, thin-ideal internalization, orthorexia and gender role. Early intervention in psychiatry, 15(2), 296–305. https://doi.org/10.1111/eip.12940
- Body Mass Index: Considerations for Practioners. cdc.gov. (n.d.). https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf.
- Dias Neto, D., Mourinho Baptista, T., Marques, C., & Sousa Ferreira, A. (2020). The role of weight perceptions and their impact on health and well-being: A multiple mediation model. Clinical obesity, 10(4), e12362. https://doi.org/10.1111/cob.12362
- S. Department of Health and Human Services. (n.d.). Maintain a Healthy Weight. National Heart Lung and Blood Institute.
- Ethnic Differences in BMI and Disease Risk. Harvard TH Chan School of Public Health, Harvard University. https://www.hsph.harvard.edu/obesity-prevention-source/ethnic-differences-in-bmi-and-disease-risk/
- Louw, A. (2013). Why do I hurt?: a patient book about the neuroscience of pain. Orthopedic Physical Therapy Products.
- Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health, 105(5), e38–e42. https://doi.org/10.2105/AJPH.2015.302552
