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But What About Health? Weight-Neutrality & Health Series Part 1

Health at Every Size / by

It seems like we are constantly being bombarded with messages about our health, and what is best for our health. We get them from mainstream media and social media, health care providers, so-called ‘wellness gurus’, friends and family… heck, we can even get unsolicited health advice from strangers on the street or in the line at the coffee shop! 
 
In my work as a body liberation and health counselor, one of the most common things I hear when I talk about learning to trust our bodies without rules, lists or apps is…⁣
⁣
“BUT WHAT ABOUT HEALTH?”⁣
Despite what we see on a daily basis in mainstream media, there is a WIDE body of evidence showing us that health does NOT look a certain way. ⁣It is not a body size, shape, color or ability. ⁣Health is a process and often a privilege.⁣
 
Sure, there are health behaviors that can move the needle on health outcomes; I mean, I have MULTIPLE degrees and certifications all involved in the pursuit of health! But it’s important to understand there are other factors that are either completely out of our control or largely out of our control.⁣..It’s complicated.⁣ So where do we start?
 
I’m breaking it down in a series of articles over the next few weeks in order to try to bring some clarity around the concept of health (and weight). ⁣
 
In this first installation, we’ll explore:
  • The traditional definition of ‘health’
  • The concept of ‘social determinants of health’ 
  • What part ‘modifiable health behaviors’ play in our health outcomes

Let’s first understand the most commonly repeated definition of ‘health’ from the World Health Organization: “A state of complete physical, mental and social well-being.” (source: WHO Constitution, 1948). I mean… you see the problem, right?

So we are supposed to attain or try to attain a constant state of COMPLETE physical, mental and social well-being? Is that even possible? It certainly isn’t remotely realistic. Context is critical here.

Think about a person who has chronic migraines which are well-managed with medication. Or someone who deals with occasional knee pain and utilizes physical therapy and swimming to minimize the occurrence of the pain. Or someone diagnosed with an anxiety disorder who manages their condition with a combination of cognitive behavioral therapy and meditation. Are all these people unhealthy? 

Next, we need to understand how much of our individual health depends on the “Social Determinants of Health” (SDOH). Over the past 20 years, there has been an increased understanding the the conditions in the environments where people are born, live, learn, work, play, worship, and age affect a wide range of health, functioning, and quality-of-life outcomes and risks. 

When I was completing my degrees in Health Promotion and Education, and Public Health, the percentage of our individual health that depends on things we can’t change, like genetics, where we were born, the  economic circumstances into which we were born into and the level of education and health care we had access to  was thought to be around 60%-70% of our health outcomes. More recently, the National Academy of Medicine placed that number closer to 80%-90%. In addition, living in a marginalized body of any type (size, race, sex, or gender or physical/mental ability) further influences our health outcomes. 

What these statistics tell us is that the vast majority of our health is determined by things we can’t control and a much smaller percentage of our health depends on individual health behaviors. Often, our ability to engage in health-promoting behaviors depends on holding certain privileges like access to a wide variety of foods, a safe place to move our bodies, and economic privilege to afford these things- as well as things like dental care, mental health care, and medical care. 

It’s critically important to contextualize the factors that influence our health and our ability to engage in health-promoting behaviors because diet culture (which IS the culture we currently live in) is constantly feeding us misinformation, leading us to believe that the vast majority of our individual health is in our control. This cultural obsession with health and health behaviors can lead to disordered eating and/or exercise, disordered beliefs about body size. It can also contribute to further marginalization of bodies that don’t fit the ‘health ideal’ and can create internalized feelings of guilt and shame.

What I love about the Health at Every Size framework is that it takes into account social justice, social determinants of health, AND individual health behaviors. It does not make the pursuit of health a moral obligation, but rather seeks to support people across the health spectrum and advocates for systemic change in order to bring people in from the margins. As I continue in this series, I’ll be talking about health exclusively from the perspective of Health at Every Size. Therefore, the working definition of health I’ll use is the HAES definition:

“The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.”

ASDAH, 2022

Now that we have a working definition, and have contextualized health, we can delve into the dynamics of health. Next up…What are so-called “modifiable health-behaviors”?