As an OB/GYN, I see patients at every phase of their reproductive journey. Women who are prenatal, postpartum, trying to conceive (or not), perimenopausal and menopausal walk into my office daily. Weight concerns come up almost every single time. My patients wonder how weight impacts fertility, whether birth control will change their bodies, how to lose weight, gain it or maintain it. Their queries are valid, but sometimes it seems like numbers on a scale are top of mind.
This isn’t a surprise. Our culture focuses on dieting and weight loss so much that we can mistake these factors for overall good health. These myths—that weight is a primary sign of health—are baked into our medical system, too. But even with all of the concerns my patients express about weight-loss goals, I don’t make it a focus in my practice, and I’m here to tell you why.
Weight Is a Factor, But Not the Only One
Before I get into it, let’s get one thing straight: The American College of Obstetrics and Gynecology (ACOG) and other associations have weight-focused recommendations that help doctors guide patients. This isn’t a bad thing. However, many medical guidelines are based on body mass index (BMI), a measurement tool—approved by the World Health Organization and National Institutes of Health—that uses your weight and height to assess whether you’re under-, over- or at a normal weight.
Unfortunately, this somewhat flawed calculator tells an incomplete story. People come in different shapes, weights and sizes. There’s no universal “healthy body.” So, overemphasizing these BMI-based rules can get us into trouble.
Another critical point to consider: Most health care providers haven’t received adequate nutrition or fitness education unless they’re a dietitian or physical therapist. We might know how to make sense of BMI, but most providers weren’t taught how to effectively counsel people on better nutrition and physical activity. This is why I tend not to fixate on weight-loss goals when talking about good health.
Better Indicators of Good Health
Instead of assigning weight-loss goals, I get curious. I ask my patients about their sleeping habits and mental health. I might ask how often they exercise, get fresh air and eat leafy, green vegetables. Believe it or not, lifestyle factors have an incredibly profound impact on the number that pops up on the scale. These daily life choices may be a better indicator of health.
Traditionally, medical providers are taught to view health through binaries: illness or a lack thereof. But that mental health isn’t inclusive. It doesn’t account for the spectrum of experiences we all have. It’s essentially a one-size-fits-all approach to well-being. The Health at Every Size (HAES) movement, which informs my work as a doctor, maintains that factors like weight, size and BMI aren’t stand-ins for good health.
HAES goes a step further and says that good health is available to all people regardless of their specific condition or ability level. Can weight give us information? Absolutely. However, relying too heavily on weight and emphasizing an “ideal size” can cause us to overlook treatable conditions that significantly impact our lives. It also makes those who don’t fit that body type feel unwelcome in traditional health and fitness spaces.
For instance, polycystic ovary syndrome (PCOS) is a common hormonal condition where your menstrual period is either infrequent, prolonged or you experience excess levels of the male hormone, androgen. On top of that, your ovaries may fail to regularly release eggs. This disorder generally affects women during their reproductive years. Lots of factors, including genetics and inflammation, can contribute to risk, but doctors tend to zero in on weight.
Recently, I started to wonder if there was evidence that the condition has a greater impact on people with larger bodies. I got busy researching, combing through tons of articles and academic databases to try and figure out the answer. Do you know what I found? Many researchers believe that PCOS may make people more likely to gain weight and make it harder to take it off. Still, doctors recommend weight loss as if it’s so easy to attain and sustain. I’m not saying doctors shouldn’t advise patients to lose weight, but it’s not some magic cure-all. Not all of the patient’s medical issues will be resolved with weight loss.
Case in point: When we hone in on weight loss, we may miss an opportunity to explore other factors that might be causing people discomfort. PCOS is just one example of how patients lose out when doctors are laser-focused on weight. Other examples? Telling pregnant or postpartum women that they need to drop a few pounds can add pressure and cause women to approach weight loss in unhealthy ways, such as exercising before they’re ready or forgoing nutrition in the name of calorie counting.
Providers Need To Do Better, But Here’s How You Can Stay Empowered
Ultimately, my medical community and I need to work together to divest from a culture that equates weight with physical health. Make no mistake: Linking healthfulness to thinness overlooks skinnier people who may have unhealthy habits or disordered eating behaviors. No one benefits from a health care system that focuses too closely on weight.
So, while you can’t change the system, there are a few things you can do. You can talk to your provider openly about any discomfort you might be feeling. You can always refuse to be weighed at an OB/GYN exam if you feel uncomfortable. If you encounter a doctor who emphasizes weight or makes you uncomfortable, please know that you’re allowed to find another provider.
If you’re looking to revamp your fitness and health routine, lean into healthy habits that bring you joy rather than making weight loss your main motivator. Experiment with exercises you’re excited about. Try new instructors and workouts that interest you. Seek out supportive fitness communities that make movement fun. (Average Peloton Moms, Black Girl Magic or PeLatinos, anyone?) Instead of calorie counting and abstaining from your favorite food, try introducing new dishes and ingredients. Peruse your local farmer’s market and pick up a fruit or vegetable you’ve never tasted. It might sound simple, but when making lifestyle changes that we enjoy, the numbers on the scale tend to sort themselves out.
Heather Irobunda, MD is a board-certified obstetrician-gynecologist practicing at NYC Health and Hospitals and a paid consultant of the Peloton Health and Wellness Advisory Council. She is invested in sharing her learnings with her online community to improve access to reliable, relatable healthcare information for women. Follow her on Instagram and Tiktok.
This content is for informational and educational purposes only and does not constitute individualized advice. It is not intended to replace professional medical evaluation, diagnosis, or treatment. Seek the advice of your physician for questions you may have regarding your health or a medical condition. If you are having a medical emergency, call your physician or 911 immediately.