Your Weight is Not Your Health — Stop Confusing the Two

An overwhelming majority of individuals I know want to start a new diet or exercise routine because they want to lose weight. I hear this from everyone I interact with on a regular basis: people I train, family, friends, work acquaintances, and people on social media. Being an exercise physiologist who studies the effects of exercise on human health and aging, I get asked questions about what the best routine is for losing weight or how to become healthier. Very often I hear the words “health” and “weight loss” in close grammatical proximity. That is to say most people associate losing weight with improved health. This is partly because the science surrounding weight and health has been twisted and manipulated into something its not, and also partly because of the social stigma surrounding body fat and body image. The message from society is that being overweight is bad for you, and that obese people aren’t as attractive as thin people. The whole concept is overly simplistic and wrong on many levels. Let’s try to unpack it.

First of all, the terminology itself is a misnomer. When people say they want to lose weight, they almost always mean fat. They want to lose fat. When I have these conversations with people, I try to help them identify the misnomer, because losing “weight” includes skeletal muscle and other lean tissue. Losing lean tissue is actually bad for our health, particularly as we get older because lean tissue loss results in functional declines like reduced independence and increased risk of developing life-threatening diseases. Second, weight isn’t even a good measure of health. In fact, by itself, it’s a terrible measure of health from a physiological perspective. I’ll explain why.

The study that is currently being conducted in my lab is using an 8-week aerobic exercise routine to help improve participants aerobic fitness and endurance. The majority of people (whether explicitly or implicitly communicated) have expressed that they want to lose weight. This is one of the main reasons they want to enroll in the study because they think that starting an exercise routine will help them lose weight. To be clear, weight loss is not at all the reason we are conducting the study, nor is it even one of our primary outcome measures. We do measure body fat percentage, waist circumference, and body weight, but this is mostly because they are easy and quick measurements that can help paint a picture about the effects of exercise. What’s interesting is the majority of the people who complete the study either do not change weight between pre and post measurements, or they actually gain a couple pounds. But when we measure their body fat percentage and waist circumference they have decreased, sometimes by a substantial margin. This indicates that they have gained lean tissue (muscle, bone, etc.) and lost fat. The result is approximately the same reading on the scale!

This is an incredibly important concept for people to understand — it is entirely possible for someone to lose fat but gain muscle and therefore remain the same weight. The major takeaway here is that people can get physically healthier without losing weight.

Just for comparison’s sake, if we had only measured the individuals body weight, not the body fat or waist circumference, the participants would think nothing has changed. This is in fact what many of them have pointed out when we measure their weight the second time. Its easy for me to notice the undertone of discouragement. The worked so hard but didn’t lose any weight. How is that possible? I then have a discussion with them, trying to explain to them that they have traded the bad weight for good weight.

These negative feelings surrounding their weight and body image are not uncommon. Practically everyone I talk to is currently, or has been frustrated by the lack of results. This may even cause some to stop exercising all together. This is one reason why I think it is bad for us to focus on using exercise to “lose weight”. It clearly doesn’t work like that.

The problem is everyone has access to a scale, very few people have access to a device that measures body fat percentage. This combined with the fact that very few people outside of the exercise physiology field know that exercise by itself is not a good weight loss tool. As a result, people become discouraged and fed up with exercise because it didn’t change their weight.

The first step in changing this view about exercise and weight loss is to educate people that exercise by itself is not a good weight loss tool. A person’s weight might not change or might actually increase as a result of an exercise routine. That’s okay. There are all kinds of health benefits that occur as a result of regular exercise whether or not you lose weight. Just think to yourself, you are trading fat mass for lean mass. Hopefully reframing it in this way will help people realize that exercising is not about losing weight, it’s about using it to trade bad weight for good weight, this leads to improved physiological function.

Second, people need to understand that even though they are trading fat mass for lean mass when they start an exercise routine, they likely won’t notice a huge difference in how they look. The people in my study are very surprised when I tell them they have reduced their waist circumference (which is measuring the amount of visceral fat or fat that surrounds our internal organs) and body fat percentage. They are surprised because they don’t see those results in the mirror. Again, this is okay. These are subtle changes that take a long time to really change how you look. And in most cases, you probably won’t see any differences just using your eyes. The before and after pictures of people losing hundreds of pounds are the exception, not the rule.

So why then is everyone obsessed with weight and fat loss? Along with the misconceptions about exercise as being a good weight loss tool, societal norms and body image drive many of the issues surrounding body weight and body fatness. Don’t get me wrong, there are major health benefits from losing excessive amounts of fat. But despite the physiological data that show health benefits that are incurred with losing fat, I fear the whole endeavor of trying to use exercise to lose weight is misguided, and societal norms about body fatness and fat shaming are not helpful. The social stigma promotes the use of exercise as a form of punishment, or to compensate for a cheat meal. This puts exercise in a negative light. People begin associating exercise with negative emotions, which is really bad for long term participation and adherence.

The reason I use the word misguided is simply because I think this is a framing issue. It’s okay to want to lose fat and gain lean mass. But this is not the thing you should focus on. First, as I have already illustrated weight loss and how you look in the mirror are not good metrics for fat loss. Generally speaking, how you look does not provide a good indication of how healthy you are. Your health is not your weight, it’s not even your body fatness. You can be healthy at a heavier weight.

Bottom line, we as a society should work towards dissociating how we look and our weight with our health. These are not the same.

There are three tests that virtually everyone can do to measure your physical health that are much better than using a scale or measuring body fat. Those are:

How many pushups can you do in two minutes?

How many body weight squats can you do in four minutes?

How fast can you run a mile?

Each of these tests require minimal equipment (stop watch or timer, and some athletic shoes), no gym membership required. They test upper and lower body strength and endurance and cardio-respiratory fitness. These tests are simple, but they have tremendous predictive power as far as your physical health, much more so than how you look and your body fat percentage. So, if you want to know how healthy you are and if you are progressing in your exercise routine, test yourself on these three measurements routinely (every month or two). If you are improving from one test session to the next you will know that the exercise routine is working, and you are getting healthier. I guarantee you will be improving with each of these measurements if you exercise regularly and do a variety of workouts (strength and endurance) with a high enough intensity.

The reason it is better for people to focus on how exercise improves what they can do, rather than how they look has to do with the probability of success. It is not a guarantee that you will ever look the way you want, even if you are exercising regularly and eating healthy. By uncoupling how we look with our physical health and reframing our mindset to focus on improving what we can physically do we create a more positive psychological environment. The thrill of knowing you are improving based on objective measurements of physical performance provides encouragement and positive feelings of accomplishment and improved self-esteem. It is highly unlikely that focusing on how you look or how much weight you have lost will create positive feelings and improve self-esteem. Focusing on improving performance is what health and wellness professionals should be encouraging, not the weight on the scale or the person in the mirror.

The caveat here is that to continue to improve physical performance, and therefore health, we have to progress with our workout dosage. We have to continue to push ourselves in our workouts to try to do more, because this is how our body adapts. Trying to jog just a little bit faster this week than you did last week or lift a little bit more this week than you did last week is what allows us to continue to improve. If we focus on taking small steps to progress through our workout routine we will improve, it is just a matter of time. Ironically, if we do this, we are more likely to look and feel the way we want. The weight will no longer be an issue, and the fat that you wanted to lose is slowly but steadily starting to come off. It just takes time, and a lot of work.

Framing how we think about exercise, and other health behaviors is a large part of the psychological battle we face. Let’s face it together. And let’s not make it harder on ourselves by creating a societal pressure or supporting social norms that undermine the benefits of healthy behaviors.

So, how should we frame our mindset around exercise and health?

First, own your body. Accepting that you are where you are is part of the battle. Try not to judge yourself, it is what it is. This is, as I see it, the central theme of the “fat but fit” movement, and people accepting their bodies as they are. This is great. I am in full support of this movement. But I would like to add to it. Let’s not stop there. Let’s now engage in healthy behaviors with a different goal in mind: focus on improving performance.

Second, eat foods that are healthy, but you should enjoy them too. Don’t count calories or try to starve yourself. Don’t restrict what you can eat, if you want a cookie, eat the goddamn cookie, and don’t feel bad about it. Focus on getting a wide variety of real foods from lots of different food groups. Diets that vilify certain food groups (Carbs or Fats) are unnecessary and lack any scientific evidence to support that they are better than a healthy diet with all nutrients included. Diets generally do not work. People stick to them for a while but when they realize they aren’t hitting their weight loss goals they become demoralized. Now, not only did you miss your goals, but you have added this unnecessary psychological stress of poor body image, feelings of failure, and probably bouts of depression and anxiety. Don’t sacrifice your mental health for a diet you think will make you happy. It won’t.

Third, don’t exercise or diet as a form of punishment. These are framing your psychological mindset in a negative way. This almost never results in the outcomes we want. On the flip side if you frame your health behaviors in a way that makes them positive you are much more likely to succeed. Increasing your running pace gradually over the course of several months until you can run an 8-minute mile. Increase the weight on the bar until you can squat 150 pounds ten times. These things have objective external measurements that are tied to internal effort and commitment. When you frame things in this way you have a much higher likelihood of success because you can measure the progress in real time. And it feels really good to set a goal, put in the work, and see it come to fruition.

What happens when we stop improving?

Everyone always has a plateau at some point. How we respond to a plateau is again about how we frame it. Do you see it as an ultimate failure of effort or discipline? Or is it just a window of time that you have to push through? The plateau should not be viewed as a setback or a negative. It is not reflective of your efforts. The key is that knowing you will get through it if you just keep working at it. Keep chipping away slowly. Results will come if you are patient and focus on the process. Knowing and accepting that there will be lows along the way is part of the challenge. Responding with negative self-talk or overreacting only diminishes our ability to deal with it and move past it. Be nice to yourself and to others. For the most part we are all trying our best in life, we should acknowledge that in ourselves and in others.

A large part of the battle we face with our health is psychological. This has become more and more apparent to me the longer I work with and train people in these research studies. Understanding the underlying physiology is important, but it isn’t the whole picture. Our mindset dictates how we feel about ourselves and influences our physical health. Let’s give ourselves the best chance for success by framing the good behaviors positively.

Your health isn’t your weight, or your fatness, let’s stop associating the former with the latter.