A few months ago, I started down the road of questioning why I felt bad in my body despite having what was considered a healthy diet, weight, and general lifestyle. In the process I discovered that I had been dieting since before I was born because my mother was dieting while pregnant on the advice of her doctor. Mom, her mother, and my father all believed that less weight = good health and that having gained ‘too much’ weight meant one had let oneself go, thus a dire moral failure. They likely picked up these beliefs from the culture and from experts of the time. I picked up these beliefs automatically, had them reflected and reinforced by television and people all around me. There is nothing unique about my experience of this compared to others my age except that I happen to have documentation of my mother’s dieting in her letters. Of course, like most women my age, I started dieting in high school after having grown up with many dietary restrictions and rules around food. I learned to fear food and to fear weight gain and, until recently, I didn’t even know it.
I found myself always uncomfortably hungry, weak, and cold – uncomfortable in my body despite being at ‘ideal’ body weight and BMI. I felt this way, I discovered, because I was keeping myself in a constant state of food deprivation. (I wrote about discovering this in my April 2023 post “Why am I always hungry?) and because I had always been dieting, even before I was born. I just couldn’t continue to do that to myself once I knew. And so, I began the process of eating and experiencing the predictable rebound weight gain. What was the healthy thing to do? My only paradigm was dieting and food restrictions. Looking for answers for my dilemma, I started reading and searching. As I wrote previously, I was shocked and mortified to learn that thin obsession has deep roots in racism as I wrote about previously.
I am currently on a journey working with intuitive eating, but it is too soon for me to share whether I think it is a sound practice or not, but you can find further information about that in the footnotes[1] and see for yourself.
As I’ve explored my dilemma about what to do if I’m not dieting, I’ve found an incredibly complex area of exploration. Health, weight, body image distortions, all intermix with gender stereotypes, marketing and media, science and populations studies, racism, oppression, and othering. I’d like to share some things that I’ve learned with you but will break this down over a few posts because of its complexity. Today I’m going to explore what health and healthy mean.
Health does not equal weight.
Like much of the messaging we get from our culture, I had come to equate weight with health. Thin equals healthy, fat equals unhealthy. Ideal body weight = good! Above idea body weight = bad. However, health is more complex than weight or body size, and body size alone doesn’t inform us much about health, regardless of what we’ve been told[2]. People of all sizes can experience good health[3].
For years, my unconscious personal definition of health has been “achieving and maintaining near ideal body weight/BMI, while eating as healthy of a vegan diet as possible.” I could add some other things, like exercise (I dislike gyms), sleep, stress management, but really, I have been totally focused on food and weight for addressing my health. I’m calling it a cultural mental illness that I am now working to recover from.
Since I now have enough information to convince me that dieting and weight cycling are not in fact healthy, I must answer the question “What does being healthy mean?” The fact that I lack a sane working definition of this is particularly embarrassing considering that my career was in ‘health care’!
So, my quest took a detour from looking to understand weight and body image distortion, to find a better definition for health and healthy that the ‘unhealthy’ one I was using.
What is health?
In its simplest definition, health is the absence of disease, illness, or injury. But this is not a satisfying definition, but it is the default version I learned in medicine. Doctors are trained to diagnose illness, diseases, or injuries and prescribe treatments. We screen for risk factors for poor health, usually without ever defining good health clearly. In pediatrics, I did work on ‘health promotion’ which was mostly about injury prevention - seat belts, bike helmets, avoiding cigarette and poison exposure, avoiding drowning, gunshots, vehicle accidents. I measured and plotted heights, weights and head circumferences on growth charts looking for balanced growth over time. If growth was unbalanced, we would screen for diseases that cause growth to go awry. Then, we did not recommend diets to children who were ‘overweight’, rather talking about healthy eating and giving out American Academy of Pediatric guideline handouts, probably to little effect. These prevention strategies were all aimed at avoiding the most common things known to kill and maim children or to place them at risk for chronic diseases. These strategies involved teaching, took a lot of time and were poorly reimbursed by insurers who paid the bills. Thus, the more teaching I did, the more time I spent with children and their parents, the less I was paid. I did it anyway and was perpetually annoyed at the unfairness of it all. I believed I was helping children be healthier and I was on one level if I helped them avoid death or severe injury, but I was able to do little about the real experience of living in good health. That was beyond my sphere of influence within conventional medicine, and I didn’t really have a good working definition of healthy for myself.
The working life of a physician in my time (which ended in 2009) was profoundly unhealthy for the doctors - with poor food, rushed eating, lots of sleep deprivation, high levels of stress. I even smoked through medical school and residency and drank too much beer in the few moments I was off in the early days of practice. The system was not set up for physician health. We were supposed to sacrifice ourselves for our patients’ health. I knew at the time this was nuts and bad for my health, but I was focused on surviving for a better day.
I share this to say that I knew I was not experiencing health myself and I was not helping children and families be truly healthy. I knew that health was more than the absence of disease, but I didn’t have a definition that worked in the situation I was in. Additionally, I personally carried along the thin obsession for myself that I was born into. And I do this to help you understand why interactions with the healthcare system are not very satisfying.
Now that I am living differently, I need a good working definition of health and healthy.
Webster’s Dictionary gives several definitions of health.
• The condition of being in sound body, mind, or spirit especially freedom from physical pain or disease.
• The general condition of the body as in poor health, good health, inquiring into someone’s health.
• A condition of thriving for someone or something, equivalent to well-being. Examples would be protecting the health of the planet.
• A general condition or state, as in economic health.
• Of course, ‘good health’ is used as a toast before drinking in many cultures[4].
I like the idea of being sound in mind, body, and spirit. Let’s get another opinion. The World Health Organization (WHO) definition from its constitution is interesting.
“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.[5]”
This definition has been criticized for being too ambiguous, too absolutist, too difficult to measure. If applied to the individual, it’s kind of like ideal body weight. Who can have complete physical, mental, and social well-being[6]? Nonetheless, for a global policy making organization working at the level of populations, having aspirational definitions probably serves us all well. Imagine if the WHO thought the absence of pain and disease was good enough. I’m glad for their lofty, if ambiguous, definition.
Does this help us towards a working definition of health? For me, I think so. At least this removes weight and diet. I like the loftiness of the WHO definition, but it also tempts me towards perfectionistic thinking, so I think I’ll work health as being sound of mind, body, and spirit. More practically health can be defined as the state one finds oneself in that can then be characterized further…good health, robust health, poor health, mediocre health, excellent mental health, etc. Well-being is how one experiences one’s health…how it feels inside. Being healthy, then, can be described as being in a positive state of health such as good health or robust health. To confuse things, the word healthy is also used to describe things that are thought to help with having good health or better health…as in healthy food, healthy exercise, healthy sleep. So many uses for the same words.
How do you define health for yourself?
Health is about more than food and weight.
Health and being healthy turns out to be complex. Individual health includes physical health, mental health, and emotional health, but there are many other facets as well. Things like social health, cultural health, spiritual health, financial health, occupational health, and environmental health all profoundly affect one’s quality of life[7]. Here in America, we are taught to be highly individualistic and that includes health. If we are in poor health, it must be something we are doing wrong we are told. It’s our fault. However, we don’t really have all that much control or influence over most of these things even though politicians, corporations, and other cultural powers try to tell us otherwise.
That brings us to the ‘social determinants of health’. According to the CDC,
“Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems”[8].
This gets us into the realm of population level (collective) health and is a big source of confusion for most of us. What is best for the whole, or populations (like the people of a country or continent or ethnic group), does not always translate to what is best for any given individual, and yet, when working for the greater good of better health for all, population level health is where that happens. These social determinants of health are the larger systems in which we find ourselves, such as our state, our work, where we can afford to live, whether we are endangered because of environmental toxins, climate change, racial or ethnic or body size biases, and determines what kinds of systemic support is available when we have problems. We have a tiny amount of influence in these systems, such as our one vote, our ability to protest, lobby elected officials, but most of us don’t have much impact. These are huge systems that affect each of our lives. And these systems largely determine our health. They can and do change, but usually slowly and with great collective effort.
So, what do we have control or influence over? What we eat, were we live, how we move, how we manage our stress, whether we have friends and community, how we manage our inner and outer immediate environments, whether we engage in growth – these are a few things we influence. However, our control is more limited that we generally think. Few people can just pick up and move if the environment turns out to be toxic. Not everyone has access to fresh food, or food that contains minimal contaminants. None of us can escape plastics, no matter how we might try. I’m sure you can think of lots of other examples where you are someone else might have limited ability to control these things that have important effects on health. Of course, we have no control over the biology we get when we are born.
What next?
I’m not trying to encourage victim thinking here. What I’m encouraging is some realism. We can only influence and control what we can, and we need to let the rest go. We will all have some health issues. They probably won’t be because of something we did or didn’t do. We will all eventually die. Happiness, enjoyment, satisfaction are also important to health and these are all impaired by chronic dieting. In fact, happy people live longer[9].
Nest week, I’ll dive into some other things I’ve learned on this journey trying to sort out health, weight, body image and gender distortions. Here are some possibilities.
Our biology, genetics, and ancestry have profound affects on our health.
We have less control over our body size than our cultural environment leads us to believe.
Ideal and recommended weight/body sizes are less clear than I thought.
Body image, gender stereotyping, racism, and misogyny are interrelated.
Hating fat harms people of all body sizes, but particularly people in large bodies and people with eating disorders.
There are many different approaches to re-envisioning body size stigma and redefining health..
Until then, I’m going to continue redirecting my understanding of health to be more holistic. Practically, I’m working on learning to feel my body signals of hunger and fullness, since I never learned that. Most importantly, I will consciously continue treating this body I’m in kindly and with gratitude.
I hope you will also enjoy being in your body just the way it is.
[1] The definitive book is Intuitive Eating. A revolutionary Anti-Diet Approach. Fourth Edition. By Evelyn Tribole and Elyse Resch who are both are dieticians, and their recommendations are well studied and documented. When I saw the first recommendation, which is to reject diet mentality I realized I couldn’t do that without help. I started working with a dietician trained in this stuff. The website is here. The list of certified intuitive eating councilors is here.
[2] Here are some resources to check out – Intuitive eating, Burnt Toast by Virginia Sole-Smith on Substack, Maintenance Phasepodcast (recommended by my dietician). I’ll have a lot more to share when we explore the connection of weight to health, probably in my next post.
[3] There is an entire movement called Health at Every Size that is working to destigmatize people in larger bodies, including addressing accusations of bad health and reframing health to include people in all sizes and shapes of bodies.
[4]You can find the definition of health at Webster Merriam online here.
[5] This comes from the constitution of WHO. Find the link here. See page -1- of Basic Documents 49th edition 2020.
[6] Well-being also deserves some definition. In brief, I understand it to be a positive state experienced by individuals (and societies) that is affected by social, economic, and other conditions. See the World Health Organization discussion here. See the Center for Disease Control discussion here. And for completion, here is what the National Health Service of the United Kingdom has to say.
[7] Chat GPT reminded me of some of this information when posed with the question “What is health?”
[8] Direct quote from the CDC’s website first paragraph here. For another way of say this see Health People 2023 here. For another perspective check out WHO’s take here. And for yet a different view, the Pan American Health Organization has information here.
[9] Find an interesting study about happiness and longevity here.
Being a person who, like yourself, would describe themselves as living in constant deprivation around food, I can so relate to what you have shared here. And I so appreciate your tackling the overview issue of what health even is. I so appreciate the depth of your research around this subject and all the references at the end of the article. I am going to look into "intuitive eating".. that sounds like a breath of fresh air as a possibility. I will be excited to hear how that approach is working for you in respect to your sense of well being and general health. Just DECONSTRUCTING all the attitudes and beliefs around health and weight that we have been force fed in our culture, is important to cultivate as a focus for our mindfullness around food. Thank you for your assiduous research and bringing this important consideration into further coherent focus.... that is, showing us another angle on the hologram of weight and health!! You and your writing is such a gift! Thank you!! ariel spilsbury