I know all too well the dangers of a culture obsessed with thinness. That doesn't mean there is no such thing as a healthy weight.

Are we now instead promoting yet another unhealthy ideal?

I’ve been underweight, I’ve been overweight, and I’ve been a healthy weight. As an anorexic teenager, I didn’t get my period until I was 19. This was pretty standard and considered desirable in elite gymnastics, which is the world I grew up in.

I hated myself and believed I was grotesquely obese despite having a body fat percentage of 2%. I took obscene amounts of laxatives to purge any food taken in at all, and I spent all my waking hours counting the calories I’d both eaten and burned.

I read the novel “The Best Little Girl in the World”, about an anorexic young girl’s destructive obsession with being thin, as a how-to guide, not a cautionary tale.

As a gymnast, I knew a young woman, Christy Heinrich, who ultimately died at 22 years old from anorexia. We both grew up in gymnastics, a culture that was rife with fat shaming and constant weigh-ins.

It was difficult not to be torn asunder by the culture of weight obsession, and I almost was.

Tragically, Heinrich was not able to overcome the damage. Her weight dwindled to 47 pounds before her death, which was ultimately caused by multiple organ failure.

I know all too well the dangers of a culture obsessed with thinness. This is personal for me.

After leaving gymnastics, I gained 70 pounds over the course of 2 short years. I went from a diet of 400 calories a day, to compulsive overeating and bingeing.  As a result, I couldn’t walk 2 miles without getting tired and my joints, damaged from years as a gymnast, ached to the point of making it hard to walk at times.

If you don’t believe me that I was fat, I’ll give you the details. I went from being a 99-pound gymnast on a starvation diet, to weighing 175 pounds at just 5’3”. That’s a body mass index of 31, which qualifies as obese. You can say that’s just a construct created by a thin-obsessed culture, but I wasn’t healthy. And I wasn’t happy.

I also went from being flat-chested to being painfully large-chested. I ended up getting a breast reduction at the age of 21 because of the extreme discomfort in my back and shoulders. This surgery made it difficult to breastfeed later in life, when I became a mother. And I can’t help but wonder, if I’d lost some weight, would the surgery have been entirely unnecessary?

The plastic surgeon never raised the issue. The procedure was sold to me as a solution to my problems. I was happy with the result at the time, and still largely am to this day, but I wish the doctor had sat me down and said: “Why don’t you try to lose 20 pounds first and then see how you feel?”

It makes me sad not to have pursued that path as an option, one that would have required more effort on my part, but one that would have resulted in no adverse impacts. I would have avoided invasive surgery and had a much easier time nursing as a mom.

But that’s not what the doctor was selling. So that’s not what happened. She was all too happy to just take my money. But the fact is, a quick fix is rarely a long-term solution, and always comes with unintended consequences.  

In the 1990s, fashion brands like Calvin Klein furthered a dangerously unhealthy body ideal, with ads like this one featuring Kate Moss.

It’s hard to say whether they were reflecting the culture or creating it, but it certainly didn’t help with the accelerating incidence of eating disorders amongst teenaged girls.

This gaunt look was known as “heroin chic” at the time. Great. An aspirational look that emulates IV drug-users is never going to be a good thing.

By the 2000s, the “look” had changed, best represented by Victoria’s Secret. Thin was still in. But this time with incomprehensibly large boobs atop incomprehensibly thin bodies. The aspirational look no longer involved illegal drugs, but did involve silicone implants and going under the knife. Also not good.

And now, in the 2020s, the standard has shifted once again. Magazine covers and advertising from some of the largest brands in the world feature overweight women, celebrating “healthy at any size!”

I’ll admit, in some ways it’s a refreshing change, reflective of the way more women look in the real world. The body positivity movement has been very useful and successful in calling attention to the dangers of a culture that was obsessed with unrealistic standards of thinness.

But I wonder, is this healthier?

Of late, this movement has shifted from body acceptance to celebrating physical un-health. I’m healthy just because I’m me, no matter what I weigh!

Is this just another quick fix? One that makes us feel good in the moment, but is not a long-term solution and comes with unintended consequences.

Being obese is not a recipe for good health, despite what the body positivity movement now claims. Being overweight comes with costs. According to the CDC , the health impacts of being overweight can include heart disease, stroke, high blood pressure, Type 2 diabetes, osteoarthritis and many others, including a greatly increased risk of premature death.

As Bill Maher recently asked: “Have you ever seen a fat 90-year old?” No. I haven’t.

While I am grateful for the spirit of inclusiveness and self-acceptance that the body positivity movement has driven, I can’t help but think that there must be a way to balance and include both self-acceptance and physical health. A view that says: “We are all of value, no matter what we weigh. But there is, in fact, such a thing as a healthy weight and a healthy lifestyle.”

But that is unacceptable to say these days. Now thin-shaming is all the rage. In 2021, when pop star Adele revealed that she had lost 100 pounds, she was attacked. She was viewed by some as a traitor to the body positivity movement.

As a beautiful, accomplished woman who had been overweight, Adele was a hero to many. But in her own words: “You don’t need to be overweight to be body positive.” And she wanted to get healthier, so she lost 100 pounds. She lost all that weight the hard way, through a healthy diet and exercise.

Weight and good health are connected. To lose sight of this because of a new ideology of “radical self-acceptance,” furthered by a harm reduction approach to Public Health (which has also led to a movement to celebrate safe drug use) is to do so at our peril.

Dr. Shveta Raju, Board Certified in Internal Medicine and a primary care physician in Georgia, told me:

“If there is any condition that is worsened by being overweight – joint problems, metabolic disorders – it’s a dereliction of my duty as a physician not to raise it. I’m able to do this in my practice because there is a high degree of trust with my patients. But Public Health is failing in this area. They aren’t providing the resources that incorporate our evolving understanding of health and nutrition to empower people on how to be healthy. Our high obesity rates nationwide the last several decades reflect this.”

Just over 1/3 of Americans are obese - defined by the World Health Organization (WHO) as having a Body Mass Index over 30 - and another 1/3 are overweight. Given the preponderance of obesity in America today, it has been called a healthcare epidemic by the WHO.

And yet, given the politics in America surrounding this issue these days, one is attacked as being fat-phobic and bigoted to even speak of it. When I publicly raised the fact that being overweight is linked to poor Covid outcomes, I was relentlessly vilified as a fat-phobe.

When doctors do not address the real health impacts for patients who are overweight or underweight, they are abdicating their responsibilities. Medical professionals failing their overweight patients appear to be unduly influenced by the politics of the day.

Presumably, these doctors know better, but fear speaking up because they will be labeled bigots. This, combined with Public Health’s harm reduction approach to just about everything (except Covid), means some doctors are utterly neglecting their patients’ healthcare needs.

But I somehow have a feeling that when Big Pharma creates a pill that can be sold to magically melt the fat away overnight, Public Health will sound the alarm and will forcefully change their guidance to physicians.

When there is something to sell, money will trump ideology. The quick fix will win again. Long term impacts will not be taken into consideration.

And of course, when that happens, all the fashion brands will go right back to pushing the unhealthy, excessively thin ideal.