Being overweight won’t necessarily make you unhealthy, but feeling bad about it will

Weight image and health
Weight image and health
Image: Jasu Hu for Quartz
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For years, doctors have warned that being overweight or obese puts people at higher risk for heart disease, diabetes, stroke, and a host of other illnesses. Now a growing body of research suggests that how you feel about your weight can influence your physical and psychological health much more than the actual number on the scale.

Weight dissatisfaction, which has risen dramatically over the last decade or so, has been linked to higher blood pressure and glucose levels, a greater risk of metabolic disease, higher body-mass indexes (BMIs), more disordered eating, lower self-esteem, and what one study described as “generally diminished quality of life.” In fact, says Christine E. Blake, a professor at the Arnold School of Public Health at the University of South Carolina, even relatively short-lived weight dissatisfaction predicts higher levels of type 2 diabetes many years later.

One possible explanation of the phenomenon is that people who are overweight or obese are naturally more dissatisfied with their bodies, and it’s the weight rather than the dissatisfaction that leads to health problems. Not so, says Blake, whose 2013 study compared women in the same BMI categories as well as across the weight spectrum. She found that “normal”-weight women who were unhappy with their weight had higher blood pressure and fasting glucose levels than “normal”-weight women who were fine with their bodies. The same held true for people across every BMI category.

Another possible explanation, one borne out by the research, is that people who feel good about their bodies take better care of them. Dianne Neumark-Sztainer, a professor of epidemiology at the University of Minnesota, has repeatedly found that adolescent girls who are unhappy with their weight get less physical activity, have higher levels of disordered eating, gain more weight, and generally do a worse job with self-care than girls who like their bodies. Which makes sense, especially in light of other research showing that exercising improves body image even when people’s weight and body shape stay exactly the same.

“Weight dissatisfaction may actually discourage people from engaging in healthy behaviors,” says Blake. “They might be less likely to respond to programs that encourage health, saying, ‘Ah, forget it.’”

Given that many doctors and health-care experts believe that making people feel worse about their bodies can motivate them to lose weight and get healthier, this research matters. A few years ago, for instance, bioethicist Daniel Callahan made headlines by suggesting that more stigma aimed at fat people would curb the “obesity epidemic”—an idea that has since been soundly disproved.

But the more researchers look at the complex interactions between weight and health, the clearer it becomes that more stigma leads inevitably to more self-loathing, as people internalize the message that their bodies are “wrong” if they’re not thin and toned. A better approach, says Blake, is to remind doctors that focusing on weight creates stress and increases people’s risk of disease, and to point them instead toward body acceptance and how that can help improve health and quality of life.