Updated: Mar 6
A case study on how much healthier you can get when you stop focusing on weight loss.
Nicole was in tears.
This was two years ago, during my first Zoom call with a woman who would go on to become my client of 15 months.
Nicole was stuck in a cycle of dieting and binge eating, and had recently gained back all the weight she had lost the previous year during another round of Whole30. She was almost back to her highest lifetime weight, and was terrified of returning to that milestone.
“Heart disease runs in my family,” she was saying. “I need to be healthy for my kids. But I can’t keep doing this.”
Nicole was one of a long line of clients who felt at the crossroads between wanting to be healthy but finding herself in a spiral of disordered eating the more she tried to lose weight.
“What if you don’t have to lose weight to be healthy?” I asked her.
Nicole laughed. “I know I have fatphobia,” she explained. “But I have a hard time believing you can be fat and healthy.”
I hear this kind of thing from followers and clients on a weekly basis. And why should it be different? We are raised to believe that the thinner you are, the healthier you are, and vice versa. We have studies and medical professionals backing that up, alongside media imagery that teaches us to associate small bodies with things like nutrition, exercise, financial privilege, happiness, and “success.”
Fat bodies mostly just serve to be the “before” imagery, the comic relief, the butt of the joke. Fat bodies hardly ever stand alone – they are portrayed in context of their fatness, a caricature of themselves. We do not see Peloton commercials or happy housewives cleaning impeccably decorated farmhouse homes in bodies above a size four, maybe six.
Deconstructing fatphobia, which has been hard-wired into our mental imagery, is not an overnight process. And disentangling the concept of health from the concept of weight is a part of that.
Nicole was open to this process, but skeptical. She really just wanted to “eat normally.” We agreed to allow health goals to unfold over time.
Over the next six months, we focused on things like eating without shame, attuning to hunger and fullness, removing “good” and “bad” labels from food. And as often happens with “food work,” we also started looking at things like self-talk, identity, communication and boundaries in relationships, feelings of purpose, creativity, and emotional regulation.
We shifted Nicole’s social media feed to include fitness influencers in larger bodies, plus-size fashion brands, and accounts who spoke neutrally about weight and food. I sent her books like Jes Baker’s Things No One Will Tell Fat Girls and she started listening to the Maintenance Phase podcast by Aubrey Gordon and Michael Hobbes. She became a fan of Meg Boggs, an athlete who lives in a fat body – I remember Nicole sending me an Instagram post of Megs lifting a set of heavy weights and jumping onto a box with the “mind-blown” emoji.
“I’ve never seen anyone in a body like this able to do these things,” she commented. “It’s weird and cool.”
Nicole gained weight. Her mood went up and down. Some weeks she showed up to calls feeling empowered and free; she couldn’t believe how much easier it felt to walk away from the dinner table or to have Halloween candy in her house without binging on it. Other weeks she felt low, depressed, and wanted to run away from the process. The physical discomfort in her body was an incessant reminder that she was “too big.”
We made room for all of this, the highs and the lows. We practiced the art of “staying with oneself” instead of spiraling into hopelessness and self-abandonment. We nurtured self-talk that felt supportive and compassionate instead of critical and negative.
I noticed Nicole texting me less through the week, able to get herself through days where she had previously left me multiple messages a day seeking help and validation.
A few months later, Nicole had an appointment with her cardiologist. She was terrified.
“My doctor doesn’t understand all this weight-neutral fatphobia stuff,” she told me. “He’s going to tell me to lose weight and exercise. I’m dreading this.”
I reminded Nicole that she could look for another doctor, but for this visit she chose to keep the appointment. The following week, Nicole said that her cholesterol numbers had gone up but that her blood pressure was, for the first time in memory, in the normal range. Her bloodwork numbers were also normal, including her thyroid, which had previously been in the higher range.
“He still told me to lose weight and exercise,” she said.
I asked her how she would rate her health now, nine months into a process that she feared would corrupt it.
She didn’t hesitate much.
“I feel so much better, mentally. The most significant thing is that I’m not binge eating anymore, and that alone is a health benefit. I’m still not eating the way I want to be eating but I feel much better about the choices I make and that I don’t feel that stress around food constantly. That’s number one.
“I also feel calmer because I’m actually able to think things through in my personal life instead of getting angry so fast. I don’t sound like a tyrant anymore. I’m communicating with [my husband] and our marriage feels stronger.
“I think I have more energy. I’m reaching goals about keeping my house clean and I don’t mind tidying up at night because my head is clear and I’m not beating myself up about food. I go out more and even though I’ve gained weight, I’m not always comparing myself to my friends because I feel happier.
“But don’t get me wrong. I’m uncomfortable in my body and I don’t like the way I look. I still want to move more. It’s hard to climb the stairs after I do laundry. That doesn’t feel good, and it doesn’t feel healthy.”
Because Nicole’s eating patterns and self-talk had stabilized so much, I asked her if she’d like to start working on Gentle Nutrition and movement some more. She said yes, and we began the slow, steady work of incorporating more produce into her routine. I partnered her up with a weight-neutral fitness coach who emphasized the importance of rest, pleasure, and joy in the pursuit of movement and cardiovascular goals.
The work was slow, and like the rest of Nicole’s progress, with ups and downs. Peaks and valleys. Nicole integrated more fruits and vegetables into her choices at home and when eating out in a way that felt comfortable to her. She also initiated a movement routine that increased her strength and endurance so that she was eventually able to climb the basement stairs with less fatigue.
“It’s funny,” she said later. “I assumed I would have to lose weight first in order to start eating vegetables and exercising. That’s always the way I pictured it. As if I didn’t deserve to take care of my body unless it looked a certain way, or to make that the point.”
That statement is often at the root of weight and health conflicts.
Because we have such strong associations between body size and health goals, our brains don’t understand the juxtaposition of health goals for health’s sake, and can’t comprehend the availability of it’s pursuit in a body that doesn’t reflect what it’s “supposed” to.
Health is a reflection of our behaviors, not our weight.
In a larger body, we can still experience the benefits of movement and exercise, varied nutrition, regular hydration, and solid sleep routines. These are the physical health behaviors associated with good health, and behaviors are not a privilege of only thin bodies.
I spoke to Nicole again in preparation for this article, just over two years after we met and nine months after we stopped working together.
Her health update was this:
“My eating is more stable than it has ever been in my life. I don’t really think about it anymore because it has become normal for me to eat what I eat, including daily fruits and vegetables. I still have sweets but don’t binge on them.”
Nicole also reports that her cardiologist is happy with her bloodwork and blood pressure, and has put her on a statin for cholesterol (which she states is more likely due to familial history than nutrition.) She exercises somewhat regularly with Pilates and walking her dogs, and “yes, I feel stronger than I did in the beginning” even though her weight has remained the same.
“I’m happier,” she confirms.
And what might our lives be like, I wonder, if we factored that into our health goals?