Health vs. Weight: Do they always correlate?

I guess I like to talk about weight more so than health because there are more misconceptions surrounding it and I’m more about dispelling bad advice than giving good advice. The wrong advice can lead you very quickly into a hole, whereas good advice is very difficult to vet. Besides, the basics of good advice are more easily summarized: eat plenty of nourishing nutrient dense foods, get adequate sleep, minimize your stress, don’t diet, and don’t stress the small stuff. Oftentimes, offering good advice is more about clearing our heads of all the junk. Nutritionism suffers from too many concepts, not too few.

Diana Schwarzbein has a saying: “You need to be healthy to lose weight, not lose weight to be healthy”. I’m sure I’ve repeated it on this blog in the past, but I’m not going to check right now. The main point I want to get across is that the direction your weight is going doesn’t always correlate with the direction you health is going.

I know I’ve brought up Health at Every Size in a previous post, and from there we know that adopting healthy lifestyle practices is enough to ensure good health whether weight comes off or not. We also know that calorie restriction (whether by reducing food intake or increasing exercise) is not an effective long-term means of improvement in health or weight. Yet, there is an intuitive part of us that says weight and health should correlate. Is that cultural conditioning? Above a certain point, probably not.

The concept I really want to go after here is that you have to lose weight to be healthy, or that if what you are gaining weight, you must be doing something wrong. This brings us into discussion of the starvation response of the body. The best study on this is almost certainly Ancel Keys semi-starvation study.

Ancel Keys performed a controlled experiment, where the caloric intake of 32 healthy young men was cut in half for a period of 24 weeks. The men suffered a wide array of negative side effects. And yes, they all experienced weight loss, but what I’m concerned about here is the hormonal changes in the body that are a response to famine.

All men, after the 24 week period was over, gained fat above and beyond their original starting point, despite not having weight or health problems before the experiment began. Moreover, the fat gain occurred before lean body mass was restored and consisted primarily of visceral (or ‘belly’) fat. This gain in visceral fat did not even begin to reverse itself until 33 weeks of eating to appetite.

I consider this a clear famine response of the body. The body needs sufficient nutrients and calories, adequate sleep, and low stress and it should be able to sort itself out. Many of us start out with what is a small weight problem and immediately start dieting. It doesn’t matter if it’s calorie restriction, fat restriction, or carbohydrate restriction. They are all forms of deprivation. Currently, I am unaware of a way for somebody in a dieted state to not go through the fat gain phase while bringing their body out of the famine response. The fat may not be permanent though, as the men in Ancel Key’s study eventually lost a lot of their rebound fat by not dieting and continuing to obey appetite.

But think about this for a moment. How many people in our society are dieting? How many people automatically assume that health is all about body weight and getting fit? The answer is a lot. And the result is that there are a lot of people actively attempting to ignore their bodies’ queues in an effort to lose weight. That’s a lot of people in a state of partial deprivation.

Now consider that every one of these people have placed their bodies at least partially into the famine response state. Consider that every one of them is suffering a lot of side effects. Consider that almost none of them will be able to carry this on indefinitely. And finally, consider that when the rebound occurs, virtually none of them will be willing to wait out the 40 to 50 weeks it would take to confirm rebound fat gain is reversing. Pretty soon a person in this position falls into guilt and self-loathing, and restarts the diet long before the body has had the opportunity to heal. This is how yo-yo dieting works, and it is a societal problem, not a personal one.

Cut Calories to Gain Fat
Good overview of Ancel Key's study.

Ancel Keys and the Biology of Human Starvation
More extensive overview with a lot of quotes pulled out of the study. Definitely worth reading if you want to know possible side effects of dieting, why it is not healthy, and why it is not maintainable.

Animal Obesity
Obesity Paradox
A couple interesting blog posts that point out how obesity isn't always about the number of calories.