If you ask ten different people what “being healthy” means to them, you’ll probably get ten different answers. For one person it’s having enough energy to keep up with their kids. For another it’s sleeping through the night without waking up wired. Someone managing a chronic illness might define health as good days outnumbering bad ones. Someone in recovery from an eating disorder might define it as not thinking about food for an entire afternoon.
None of these definitions are wrong! Health isn’t one fixed, objective thing that we can measure with a single number and call it a day. It’s personal. It shifts depending on what season of life you’re in, what your body has been through, what you value, and what kind of lifeyou actually want to live. We don’t all prioritize the same things, and we shouldn’t have to.
And yet, for decades, we’ve been handed one number and told that’s the whole story: weight. Step on a scale, get a verdict. As Alissa Rumsey writes in her piece Is Weight Really a Problem?, the link between weight and health outcomes that most of us grew up believing was gospel actually has a lot less science behind it than you’d think, and a lot more history tangled up in bias, profit, and control than most of us were ever taught.
So if weight isn’t the main story, what is?
There’s a framework that’s been used in public health for a long time but rarely makes it into the conversations we have about our own personal health: the social determinants of health.
Image from www.cdc.gov
The World Health Organization (WHO) defines social determinants of health as the conditions in which people are born, grow, live, work, and age, along with the access (or lack of access) people have to power, money, and resources.
In plain terms: where you live, what you earn, what kind of job you have, whether your neighborhood is safe, how much schooling you got, and what kind of discrimination you face on a daily basis allimpact health. AKA it’s often more than anything you’re doing at the dinner table or the gym.
WHO’s own research has found that these social and economic conditions can outweigh both genetics and access to health care when it comes to predicting health outcomes. That’s a pretty big claim, and it should make us pause every time we default to talking about health as a matter of individual choices. The Centers for Disease Control and initiatives like Healthy People 2020 have pointed to these same multiple determinants for years, yet they still rarely make it into everyday conversations about health.
So what’s actually on this list? A few of the big factors that could influence health:
The bigger the gap between rich and poor, the bigger the disparity in health status. When you can’t afford healthy food or buy food consistently, that affects health far more than any meal plan.
Lower education levels are tied to more stress, less confidence, and worse health overall.
Clean air, safe water, affordable housing, and walkable, safe neighborhoods. Pollution and unsafe living conditions are linked to certain diseases like asthma, and reliable transportation determines whether you can even reach a clinic or hospital.
People with more control over their work and schedule tend to fare far better, physically and mentally, than people without it.
Strong relationships and community ties are protective. Isolation is not.
Whether you can get health services when you need them, including preventive care and screening, and whether that care is respectful and competent.
Racism, weight stigma, homophobia, transphobia, ableism. All of it takes a physical toll, not just an emotional one, and all of it is a serious risk factor for poor health.
Some of this really is just the body you were born into. Your genes are one determinant, but far from the only one.
Notice what’s not driving this list: willpower. Personal behaviors like nutrition patterns and physical activity is part of the picture, but it’s one slice of a much bigger pie, and it’s often shaped by everything above it. You can’t out-exercise poverty. You can’t meal-prep your way out of chronic stress from racism or a broken healthcare system.
Here’s the thing about weight: it’s not a behavior. It’s an outcome, influenced by genetics, by access to food, by stress, by sleep, by all kinds of factors most of us have limited control over. Treating weight as if it’s a direct readout of how “good” or “disciplined” someone is misses almost everything that actually shapes a body.
This is part of what Alissa gets at in her piece. She traces how the cultural fixation on thinness predates any real scientific evidence connecting weight to health, and how some of the most commonly cited “facts” about weight (like BMI categories… EW) have more to do with industry influence than with actual research. Worth a read, 10/10 recommend!
If discrimination is a social determinant of health, then weight stigma belongs right there with it. Not weight itself. The stigma.
Being teased, dismissed, or blamed for your body size creates significant chronic stress, and chronic stress is one of the most well-documented pathways to health problems that we have.
Rumsey points to research showing this stress shows up regardless of how much someone actually weighs. It’s the experience of stigma that does the damage, not the number on the scale.
This shows up in healthcare settings constantly. People in larger bodies are more likely to delay or avoid going to the doctor’s office because they’re afraid of being lectured about their weight instead of being treated for whatever actually brought them in.
That avoidance means missed screenings, missed early diagnoses, and worse outcomes down the line. It’s not that people in fat bodies don’t care about their health. Don’t get it twisted. It’s that the healthcare system has often made it unsafe for them to seek care in the first place.
A few things.
First, it helps to widen the lens on what “progress” even looks like. Instead of the scale, you might pay attention to things like your energy levels, how you’re sleeping, whether you’re more attuned to hunger and fullness, how you’re coping with stress, or whether your relationship with food feels less consumed by rules and more grounded in trust. These markers reflect your health and well-being far better than a number ever could.
Second, it means looking at the bigger picture when you think about your own health, or anyone else’s. If someone is struggling, the first question doesn’t have to be “what are they eating” or “are they moving enough.” Watch out, your inner asshole is showing!
It might be:
These questions get closer to the truth more often than we’d like to admit. OR another great option is to remind yourself to MIND YOUR DAMN BUSINESS. Seriously, who gives a f*** what other people’s bodies look like? It’s not your job to police them, so Let. It. Go.
And third, it means giving yourself permission to define health on your own terms. Not the terms diet culture handed you, and not the terms a BMI chart handed you.
None of this means individual choices don’t matter at all. They do. But they’re one piece of a much bigger system, and they’ve been given way more credit (and way more blame) than they deserve. Weight was never the whole story. It’s barely even a chapter.
If you’re ready to think about your health in a way that actually reflects the FULL picture, including all the things that have been left out of the conversation for too long, we’d love to support you. Reach out here to learn more about how our team approaches care from a weight-inclusive lens.
Megan is a weight inclusive registered dietitian and Certified Intuitive Eating Counselor. She is the founder and director of A Soft Place to Land, a multidisciplinary group practice based in Lehigh Valley, Pennsylvania that specializes in eating disorders, chronic dieting, and body image care. She is fiercely on a mission to be a loud advocate for ethical care of every BODY. Megan’s goal is to provide a weight inclusive and trauma informed safe space with an emphasis on social justice, fat liberation, self-exploration, and compassion. When she’s not taking down the patriarchy, you can find her spending time with her dogs outside, gardening, and painting plant pots!
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