What Gets Missed When Weight Takes the Spotlight

How Misconceptions About Obesity Put Our Health at Risk

As someone who deeply believes in body autonomy, which means the right for every person to make decisions about their own body, I know that some clients will choose to pursue weight loss. However, lately, I’ve noticed a hyperfocus on weight as the primary health metric from health providers and clients.

Whether it’s a book I’m reading or a podcast that I’m listening to, the misconceptions about weight’s connection to health, especially in the Black community, are deeply troubling. This became abundantly apparent to me after reading a 2020 study in which a 54-year-old was misdiagnosed with “monstrous obesity” when she had a cancerous 46kg mass in her abdomen. It was in the opinion of the authors (and mine) that the reason she was misdiagnosed was due to weight stigma.

Weight stigma refers to the mistreatment of individuals due to their weight or size.

In healthcare, weight stigma can contribute to patients going undiagnosed or being misdiagnosed. Even in my healthcare journey, before my diagnosis of rheumatoid arthritis and Sjögren’s syndrome, I went to my general practitioner to share some health concerns. She was convinced my problems were minor and that my actual focus should be on losing weight due to my high BMI. It wasn’t until after my diagnosis that I realized those health concerns that I shared were symptoms of RA and Sjögen’s, which I’d later get diagnosed with three years later.

That’s why we cannot ignore that our healthcare system's obsession with weight and specifically obesity is rooted in serious misconceptions about health’s connection to weight.

Myth 1: Health is Solely Determined By Weight

The belief that weight indicates health status ignores factors such as genetics, lifestyle, and socioeconomic status, which can significantly influence a person's health. Even though we’ve discussed this before, it’s always worth repeating that a person’s health cannot be solely determined by weight. In the 2020 study I mentioned, the patient was diagnosed without them performing a proper examination. Instead, she was referred to diet and nutrition professionals to lose weight, even though the weight she was gaining had nothing to do with her individual health choices.

As a health coach training to become a master health coach, this study has stuck with me for the past five years. After reading it in 2020, I realized how harmful misconceptions about weight can be for my clients' health. When we make assumptions about a patient's or client's health based on their weight, we can overlook serious medical issues.

Myth 2: Weight Loss is the Answer to All Health Concerns

The weight stigma that clients in larger bodies face can contribute to their health concerns being dismissed or minimized. In that same 2020 study, even though the patient went to her healthcare team about unexplained weight gain and pain in her abdomen, the only solution that they recommended to her was weight loss. It truly pains me inside because if they hadn’t dismissed her initial concerns, they could have diagnosed her a year (or more) sooner. Their determination to give her a specific diagnosis of obesity clouded their judgment.

This is a lesson that I and other health professionals can learn from when working with patients and clients. Our patients and clients know their bodies better than anyone else’s because they live in them day and night. If they come to us with concerns, we mustn’t dismiss or minimize them. Instead, the concerns they share may be the key information we need as a healthcare team to support them adequately.

Myth 3: Weight Is Solely the Result of Individual Choices

Believing that individual choices solely determine weight overlooks the fact that weight is not a behavior. In the 2020 study, the patient’s unexplained weight gain resulted from the growing mass in her abdomen, not her dietary choices. That means that no matter how strict she was in following the diet plan created by her healthcare team, the underlying issue that needed to be addressed was the tumor.

I want to stress this point because unintentional weight gain does not indicate that our patients or clients are doing something wrong. By continually pursuing a weight-centric approach to health, we start with a bias that can lead us to overlook the obvious. That can be dangerous, if not deadly, for our patients and clients.

That 2020 case study is a glaring example of what happens when weight is treated as an indicator of a person's health status. It isn’t for an amalgamation of reasons, some of which I’ve noted above. Ultimately, instead of focusing on weight, providers can choose to focus on factors that will move the needle on a person’s healthcare journey, such as:

1. We can ensure that we provide culturally relevant care that respects each individual's autonomy, culture, and traditions.

2. We can provide nutritional recommendations that recognize individuals' unique food access barriers.

3. We can acknowledge the impact of stress and give individuals the right tools to make informed health choices.

4. We can understand that chronic illness is not a moral failure, nor should it be used as a validation to deny any person care.

5. We can embrace community care to support individuals between doctor's visits and coaching sessions.

There are many ways to improve our health and well-being. I hope what I shared today gives you some new things to consider. Whether you’re a healthcare provider or not, understanding that Weight ≠ Health is essential. It’s not an opinion, but a fact that has unfortunately been misunderstood for far too long.

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