The Plus Size Dilemma

The annual Sports Illustrated Swimsuit Edition hit newsstands with the usual fanfare, with headlines highlighting its first-ever “plus size” model. At six-foot-two and size 12, Robyn Lawley looks healthy, curvy… and a lot like the women typically featured in SI.

Lawley doesn’t eagerly adopt the plus size label, the media certainly does—reminding all of us that size 12 is big, though the average American woman wears at least that. We know that labels and magazine covers are hardly a healthy way to gauge our own health and weight, but sometimes it’s hard to know where else to look.

Trainers tell us not to worry about the number on the scale, since muscle weighs more than fat. News reports cast doubt on the body mass index (BMI) as a measure. Clothing sizes are “just a number,” varying from brand to brand and fluctuating over time. Plus, our bodies naturally change and look different as we grow, give birth, and age. So what do we do? Try to pinch an inch? Scrutinize our cellulite? Ignore the 15 pounds that have crept up on us over the past couple years?

Carrying too much weight, as study after study shows, can contribute to a range of illnesses and even lead to early death. However, too often our attempts at living a healthy lifestyle go overboard, leading us to police what we eat and criticize our bodies. As a family physician, recognizing the reasons for weight gain and effective interventions for weight loss are crucial for how I treat my patients—especially as the number of overweight and obese Americans continues to grow.

As a Christian and someone who has been overweight since my childbearing years, I confront many of the same questions my patients do as they look at the scale and in the mirror:

• Am I being a good steward of the body God has given me?
• Am I jeopardizing my long-term health and my ability to serve my patients, my community, my family as God intends me to?
• Am I treating my body in a way that honors it and my Creator?

Even medical literature debates over how we designate a person clinically "overweight" enough to put their lives and health at risk. BMI, set as a federal standard in 1998, is still how medical professionals and insurance companies calculate health risk due to weight. Using height and weight ratios, it isn’t perfect (it mislabels as overweight some individuals who are fit and muscular), but it remains the best tool we have for simple calculation.

Based on BMI alone, two out of three adult Americans are now considered overweight or obese, a statistic that has doubled in the last 40 years. These stats indicate that beyond growing to "plus size," we’re carrying far more pounds than we have in the past. Although some “overweight” individuals may feel and look healthy now, the long-range studies suggest that may not last.

Health authorities agree obesity, defined as a BMI over 30, poses numerous hazards to our health, including:

• a higher risk of certain cancers due to the estrogen secreted by higher number of fat cells
• hypertension from the increased circulatory load in a heavier individual
• cardiovascular complications from coronary artery disease and heart enlargement
• metabolic syndrome and diabetes from the body’s cells no longer responding to insulin normally
• joint degeneration from extra weight bearing with more hip and knee replacements

There is still controversy and conflicting studies about where on a rising BMI graph does weight gain “tip the balance” resulting in increased illness and premature death.

Some studies suggest a higher risk of early mortality for those with a BMI over 25 (considered "overweight") or below 19 (considered "underweight"). However, these studies are criticized because individuals with serious disease and who smoke tobacco tend to have lower BMIs as their health deteriorates, making higher BMIs appear healthier when they may not be.

A recent Centers for Disease Control study determined being "a little overweight" is a protective factor compared to normal or low BMI, but was subsequently criticized by a Harvard panel of experts as misleading.

Although true obesity is an epidemic unlike anything we’ve seen before, the concern about weight has infected most Americans to the point where food has become a battleground with far too many needless casualties. Some become so obsessed with their weight and body image that they will adopt extreme measures to try to prevent weight gain, whether it is highly restrictive eating patterns, purging after eating with vomiting or laxatives, or excessive exercise. Individuals who are in a daily war with food and the weight scale become so self-absorbed in their determination, they lose connection with other people and aspects of their lives.

As a doctor who regularly sees a spectrum of individuals from the dangerously anorexic to the morbidly obese, I seek to help patients make peace with their bodies rather than dread coming to clinic and possibly being weighed. Like most doctors, I emphasize the goal of physical and emotional wellness and strength. This includes a look at coping skills, relationship with food, and physical activity.

Rather than pointing out the obvious when the overweight or underweight patient faces the dreaded number on the scales with embarrassment, guilt or shame, I ask if they feel the time is right to start work on feeling stronger and more fit. What we know can help improve overall health outcomes is very straightforward – even committing to one change can make a difference in overall wellbeing:

• Consuming at least eight glasses of water daily
• Avoiding soda and other "empty calorie" drinks
• Not snacking after dinner
• Tracking food consumption and activity
• Adding more vegetables and fruits, rather taking away foods
• Identifying alternatives to eating to deal with stress
• Participating in 20 minutes of aerobic activity daily

Weight change becomes a side benefit of the plan to be consistent in adopting behaviors to simply feel better and more in control of what we eat and how we exercise. Rather than reacting to a number on a chart or scale, or the arbitrary label of "plus size," we can choose to work toward behavioral changes that honor our bodies, as Christians and image bearers.

Dr. Emily Polis Gibson is a wife, mother, farmer, and family physician living in northwest Washington state. She blogs at Barnstorming, and her writing has appeared on KevinMD.com and Salon.