Recently, I found myself in the middle of some internet drama after posting videos about weight and disease. A physician stitched one of my clips, and suddenly my DMs were flooded.
Instead of battling it out in 60-second soundbites, I wanted to use this space for something better: nuance.
Because when we talk about body size and health, nuance matters.
Let’s start here: I am a thin, white, able-bodied, cisgender woman. I hold a tremendous amount of privilege. And even with that privilege, I receive hate for speaking up about weight stigma and weight-inclusive care. My colleagues in larger bodies or marginalized identities experience exponentially more harassment for saying the exact same things.
So I will continue to use my voice. And I will continue to advocate for fat bodies.
Now let’s get into the science….
If you haven’t read it yet, I highly recommend the book Body Respect by Lindo Bacon and Lucy Aphramor. They discuss this very topic and the research behind it.
Here is the core concept:
Yes, certain diseases are more commonly found in people in larger bodies.
But that does not mean body fat causes those diseases.
Much of the evidence people point to is epidemiologic research. Epidemiology tracks patterns across groups over time. It shows associations. It does not prove causation.
To make this clearer, consider an example often used in research discussions: bald men have higher rates of cardiovascular disease than men with full heads of hair. That does not mean baldness causes heart disease. The likely explanation is a confounding variable, such as higher testosterone levels, which are associated with both hair loss and cardiovascular risk.
The key word here is confounder.
A confounder is a variable that influences both the supposed cause and the outcome, making it look like one causes the other.
So when we see correlations between higher weight and certain diseases, we must ask: what else could be influencing both?
Let’s take a closer look at three major confounders:
1. Fitness Level
One of the biggest myths in health culture is that you can look at someone and determine their fitness level.
Research from the Cooper Institute has shown that thin but unfit individuals have at least double the death rate of their higher-weight counterparts who are aerobically fit. Across body size categories, cardiorespiratory fitness is a stronger predictor of mortality than weight.
Fitness appears protective. Body size alone does not tell us much.
And yet, people in larger bodies are routinely assumed to be inactive or unhealthy. Many of my clients have described strangers at the gym congratulating them simply for showing up, as if their presence is surprising.
That assumption is rooted in weight bias, not science.
2. Weight Stigma and Discrimination
It is tough to live in a higher-weight body in our culture.
Weight discrimination is pervasive. Research has shown that experiences of weight stigma are associated with increased stress, higher cortisol levels, and poorer health outcomes. Chronic stress is a known risk factor for many diseases, including cardiovascular disease and diabetes.
One study of more than 170,000 adults found that the gap between someone’s actual weight and their perceived ideal weight was a stronger predictor of mental and physical health than BMI itself. In other words, body dissatisfaction can be more harmful than body size.
When someone in a larger body goes to the doctor and every concern is attributed to weight, that is not neutral. That is harmful. It delays diagnosis, reduces trust in healthcare providers, and increases stress.
If we ignore weight stigma as a variable, we are missing a huge piece of the health puzzle.
3. Dieting and Weight Cycling
Diet culture tells us that weight loss improves health.
The research is more complicated.
Calorie restriction increases inflammation. Repeated cycles of weight loss and regain, known as weight cycling, are associated with increased inflammation and higher risk markers for heart disease and diabetes.
Inflammation itself is a risk factor for many chronic diseases.
So when we see an association between higher weight and disease, we have to ask: are we looking at the effects of adiposity alone, or are we looking at the long-term impact of chronic dieting, restriction, and weight cycling?
In a culture where intentional weight loss is relentlessly promoted, that distinction matters.
The Bigger Picture
Blaming fatness for disease without considering fitness, stigma, and weight cycling is like blaming yellow teeth for lung cancer without acknowledging smoking.
Yes, disease patterns exist. But patterns do not automatically reveal cause.
And when we reduce complex health outcomes to “your body size is the problem,” we oversimplify the science and harm the very people we claim to be helping.
This does not mean you are not allowed to care about your health.
You are allowed to want to feel physically, mentally, and emotionally well. You are allowed to engage in movement, nourishment, and self-care because they feel good and supportive.
But shame is not a sustainable motivator.
Your body is not a moral failure. Your size is not a character flaw. And health is far more complex than a number on a scale.
When we release the belief that our body is the problem, we create space to engage in health-promoting behaviors from a place of respect rather than punishment.
That is the foundation of intuitive eating. That is weight-inclusive care.
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If this conversation resonated with you, especially if you have spent years blaming your body for illness or feeling ashamed of your size, you deserve support that is unbiased and inclusive.
At Find Food Freedom, our team of registered dietitians and certified intuitive eating counselors provide weight-inclusive care for eating disorders, body image healing, PCOS, diabetes, autoimmune conditions, prenatal and postpartum nutrition, sports nutrition, and more.
Explore different ways that you can work with us.
You do not have to navigate this alone.
