The Weight Debate: Does It Really Reflect Health?

Step on the scale. See the number. Feel the wave of shame. Sound familiar? We’re conditioned to equate a lower number with being healthier, happier, and more attractive. But what if that’s not the whole story? Can you define health without mentioning weight?

Weighing ourselves wasn’t even a thing until the early 1900s. The bathroom scale didn’t go mainstream until the 1920s, first as a novelty before sneaking into every household. As thinness became the gold standard, stepping on the scale turned into a daily ritual, one tied to self-worth and health.

Let’s dig into the history, the science, and the impact of weight stigma to find out why that number on the scale might not mean what we’ve been told. (Yes, this one will be controversial, so buckle up.)

But First: Disclaimer!

Let’s face it: weight science is complex. We’re here to unpack the nuance, not to decide whether weight loss should be part of your wellness journey. Our job is to break down the research so YOU can choose the best approach for your whole-body health.

How Weight Became the “Problem”

Why BMI Falls Short

If you’ve heard that BMI isn’t a great measure of health, you’re right. The BMI, originally called the Quetelet Index (QI), was created in 1832 by a Belgian statistician. His goal? To categorize populations, not assess individual health. He used data exclusively from white European men.

Enter the insurance industry. In the 1950s, life insurance companies noticed that people with higher-weight had slightly higher mortality rates (which later research contradicts, more on this later). They used this data to create weight tables, which then shaped medical standards.

Then in 1972, physiologist and researcher Ancel Keys popularized BMI by linking it to health outcomes in studies. In 1997, the World Health Organization recognized obesity as a global epidemic. The weight-health connection had been cemented in public perception.

How BMI Was Manipulated for Profit

In 1998, the National Institute of Health lowered the “overweight” BMI category from 27 for women and 28 for men to 25. Why? The change was based on a report funded by pharmaceutical companies selling weight-loss drugs. The more people who qualify as overweight, the more profits to be made.

And get this: the decision to classify “obesity” as a disease in 2013 went against the recommendation of the American Medical Association’s (AMA) committee.

While BMI isn’t the most accurate metric, let’s face it, it serves a purpose. It’s actually the main reason our practice can accept insurance. It’s deeply embedded in healthcare, influencing assessments, treatment eligibility, and yes, insurance coverage.

Beyond BMI: The AMA Recognizes Its Shortcomings

Here’s some good news: tides are shifting. In June 2023, the AMA updated its stance on BMI, acknowledging its limitations in accurately assessing an individual's health. BMI overlooks key differences in:

Race and ethnic groups
Sex and gender
Age groups
Body composition

A 2025 Lancet publication addresses the controversy by:

Acknowledging that BMI is imperfect because it doesn't consider fat amount or where it's stored in the body.
Introducing two categories of obesity:
- Clinical obesity: When extra fat affects how organs function or impacts daily activities, like walking up the stairs.
- Preclinical obesity: When there’s excess fat, but it hasn’t caused health problems yet, though the risk is higher.

TL;DR: Health is a lot more complicated than a simple height-to-weight ratio.

Rethinking Weight and Health

The “Obesity Paradox”

We’re told higher weight means worse health outcomes. But the data tells a more complicated story. Enter the obesity paradox: people in the “overweight” or even “obese” BMI categories sometimes have better survival rates than those in the so-called “normal” range.

An article reporting on a sample size of 2.88 million (from 97 studies!) provided estimates of mortality risks (i.e., likelihood of death) associated with different weight categories. What did they find?
- People classified as “overweight” had a lower risk of death than those in the “normal” BMI range. The authors say this could be because they see doctors sooner and have extra energy reserves to handle illness.
- Individuals in the “obese” category (BMI 30-34.9) had the same risk of death as those in the “normal” range. However, higher grades of obesity (BMI >35) were associated with higher all-cause mortality.
Some of the highest mortality rates are actually in the “underweight” category. Malnutrition is a major problem in elderly populations; it can worsen immunity, recovery, fall risk, cognitive functioning, and quality of life. And remember: illness often leads to weight loss.
About a third of people labeled as “obese” are actually metabolically healthy (defined by blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data), while nearly a third of those in the “normal” BMI range fall into the “unhealthy” category.
People with “obese” BMIs who have conditions like type 2 diabetes, high blood pressure, cardiovascular disease, and chronic kidney disease tend to live longer than their thinner counterparts with the same conditions.

Let’s be clear: nutrition research is complicated, especially when we look at epidemiological studies (which track health trends in large groups of people).

We’re not saying that every body size is healthy. But we do believe it’s possible to be healthy at a wider range of sizes than recognized.

The Impact of Weight Stigma

We live in a society where thinness is seen as superior, and larger bodies are labeled as “lazy” and “unhealthy.” But this simply isn’t true. Many people in larger bodies work out consistently, follow diets to a tee, and are still told they’re not doing enough.

Dieting creates a deprivation mindset. The mind is rewired to view food as “off limits” and the enemy. This leads to feelings of drain, frustration, and dysregulation. It’s exhausting.

Providers often dismiss concerns from higher-weight patients with a blanket recommendation to “lose weight.” This weight stigma leads to real harm:

Avoidance of healthcare – Many people in larger bodies skip doctors visits to avoid judgment. We see this all the time. And can you blame them? Their care is sub-par.
Increased stress – Weight bias is linked to lipid dysregulation, impaired glucose metabolism, and inflammation. This is measured through something called the “allostatic load," which is the build-up of stress on various bodily systems (like the cardiovascular, metabolic, and nervous systems), which is linked to chronic diseases and early death.
Disordered eating – Constant pressure to lose weight can lead to harmful food and exercise behaviors, such as binging or restriction. This is serious: eating disorders have the second-highest mortality rate of any psychiatric disorder.

If weight stigma in medical settings resonates with you, ask your provider “How would you treat this condition in someone living in a smaller body?” Treat the condition, not the body size.

PS: Weight stigma extends beyond medical settings. From job discrimination to media portrayals, people in larger bodies face bias, exclusion, and harmful stereotypes. Want to check your bias? Try this Harvard weight bias test.

So, What Does Define Health?

Instead of focusing on weight, consider:

Movement – Movement boosts heart health, mood, and longevity.

Nutrition – Eating well isn’t about dieting; it’s about fueling your body with nutrients that support energy, immunity, and longevity. Self promotion moment: here is where we’d love to support you!

Mental health – Stress, sleep, and emotional well-being matter for whole-body health.

Holistic healthcare is good healthcare. It sounds cliché, but how you feel matters most. And it feels good to move, to nourish your body, and to feed your soul with what lights you up. What doesn’t feel good? Stepping on the scale.

FAQs

But isn’t fat bad?

Excess fat (especially visceral fat that wraps around your organs) promotes inflammation. But key point: you can be “thin” and still have excess visceral fat. And yes, excess weight can put strain on your joints (just as too little weight is a risk factor for fractures).

And have you heard of brown fat? This metabolically active fat, abundant in infants, burns energy by breaking down blood sugar and fats. Researchers are exploring its potential for new obesity and diabetes treatments.

We're not here to “pick sides” on weight loss. What we are saying is weight is one of many data points, and it’s often given more weight (ha, no pun intended) than it deserves.

Just telling someone to “lose weight” can backfire. It feeds weight stigma, ignores underlying biology, and misses the chance to address metabolic health with smarter, behavioral changes.

At Dietitian Driven, we focus on metabolic health. While there’s a lot of talk about being 'overfat,' the truth is many of us are 'undermuscled.' This is important to acknowledge: low muscle mass may actually pose a bigger health risk than high fat mass.

How do I track progress without a number on the scale?

That’s for you to decide! Sure, weight can be one piece of the picture, but consider these other metrics:

Strength and performance: Keep track of how much weight you're lifting, how many reps you can do, or how your endurance improves.
Energy Levels: Consider if you’re feeling more energized throughout the day.
Body Composition: If numbers motivate you, consider muscle mass measurements (like through a DEXA scan or skinfold test).
Lab Values: How are your blood sugars? Cholesterol? Vitamins and minerals? These objective measures give insight into your health.

Really ask yourself, how do you define health? Your definition of health matters.

The Bottom Line

Weight is just one data point, and it does not define your health. The real “problem” isn’t body size; it’s the stigma attached to it. Health is about sustainable, supportive habits, not numbers on a scale.

This is a controversial topic. At the end of the day, we support patient autonomy. At Dietitian Driven, we practice with a weight-inclusive lens and support your goals.

A gentle reminder: we aren’t born hating our bodies. That’s something we’re taught. And it’s something we absolutely can unlearn.