I just finished talking with a new/old client. I saw him years ago when his doctor warned him of signs that pointed to higher risk of diabetes. He came to see me once. Today he is diagnosed with diabetes, hypertension and elevated cholesterol.

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“George” is a high flyer. A busy businessman who figured that knowledge is the same as behavior. Two years ago he met me for one session. We discussed a plan and what he needed to do. I remember discussing a follow up session with him. He was convinced he just needed time to make the changes we had discussed. No follow up necessary.

Fast forward two years. He is now diagnosed with type II diabetes and recently was given metformin for his elevated blood sugar along with a statin for cholesterol and an ace inhibitor for high blood pressure. Every drug is giving him typical side effects. He is angry and frustrated, mostly because he is not overweight. What is the deal?

OVERWEIGHT IS OVERBLOWN

Medical and public health authorities continue to bang the drum deriding people for weighing too much. Overweight and obesity are defined as the cause of all sorts of disease states: diabetes, cardiovascular disease, hypertension and more. Why do intelligent people continue to perpetrate this myth?

We now understand that behavior coupled with certain metabolic processes contributes to disease. Excess weight is the result of this dynamic, maybe even more than the cause. Pretending that the metabolic mess of metabolic syndrome, diabetes, cardiovascular and other disease only occurs in the overweight and obese is a lie.

Body size is a poor surrogate for health. It is sloppy and presumptuous science to assume that as long as your body weight is within designated norms, all is well. There are more and more individuals who are “metabolically obese” despite a desirable BMI, number on the scale, or size of clothing. It is not honest to pretend weight is the definitive factor.

HEALTH AT EVERY SIZE

Body size bias is not news. Linda Bacon is a prominant voice promoting “Health at Every Size”.Most of the criticism of the current bias in “weightism” focuses on increasing risk for anorexia, chronic dieting and a full spectrum of eating disorders. These risks are real, but fail to address the fuller scope of the problem.

Today George is a victim of “weightism” as well. He is struggling with multiple metabolic challenges that he has effectively minimized over the years–primarily because he knew he was not overweight. My guess is that George figured that as long as his weight was low enough, he must be doing something right. Not necessarily.

THE PROCESS IS EVERYTHING

When we are preoccupied by weight, it is easy to pretend. As long as you are not overweight, there are no risks. In this medical model the focus is on weight, an outcome. There is little or no attention given to the process. It is time to step up our game.

When it comes to reducing risk and complications of disease, the process is everything. Every health care practitioner, every public health authority and every insurance underwriter needs to shift gears. Focusing on the outcome allows more and more Georges to miss the boat. We need to focus on the process.

We need to hone in on behavior: what we eat, how much we move, how long and how well we sleep, how often we rest, relax and restore. When we pay attention to our behavior, the outcome will take care of itself.

We need to push for health at every size.

Bonnie Modugno, MS, RD