The Weight Factor: Facts, Fictions, and Fallout

"I avoided going to all doctors for two years because I was so embarrassed about being overweight when I had to get undressed. I even skipped mammograms." —S.P.

Did you know it's getting worse? In 2021, the National Center for Health Statistics reported that more than 70 percent of adolescents said they had been bullied about their weight in the past year, and a 2019 survey found that 56 percent of adults also reported that they had been body-bullied, usually by friends or family.¹

And "weight shaming" extends to those who are underweight as well as those who are overweight.

"I'd never tell someone they are too heavy. So why do people think it's OK to tell me that I'm too skinny or that they hate me because I can eat desserts?" —M.H.

Unfortunately, we often internalize the comments others make to us about our bodies and start to say the same things to ourselves. We tell ourselves that we're unhealthy and that it's our fault for being heavy or thin, but the truth about body weight is often very different.

• Fiction: If you are above a certain body mass index (BMI), you are probably unhealthy. Research suggests that a high BMI or excess weight alone does not determine overall health. Metabolic health is also an important factor, as is your abdominal adipose tissue/circumference.²
• Fiction: If you are below a certain BMI, you are probably very healthy. This is not necessarily true, either. You may be at a lower risk of diabetes and high blood pressure. Still, many studies find that being underweight can be associated with other health risks like osteoporosis, decreased muscle strength, hypothermia, lowered immunity, and fertility problems.³
• Fiction: People in larger bodies usually lack willpower or discipline. Since body size usually results from a combination of social, genetic, and environmental factors, explaining obesity as representing a lack of willpower is an oversimplification of a complex process. If it were simple, the diet industry, which is part of the $135-billion weight-loss industry, would not still be growing. It grows because diets rarely lead to sustainable weight loss. The problem is not a lack of willpower but the metabolic, hormonal, and even cognitive changes triggered by weight loss and drive rebounding.⁴
• Fiction: People in smaller bodies usually have an eating disorder. Actually, there is such a thing as naturally slim. Twin studies have shown that inheritance can play as much as 40 percent of a role in body weight differences, and a gene study of 10,000 subjects, including more than 1,500 thin adults with no eating disorder, finds that the thin group had a lower genetic risk score for obesity. The researchers concluded that since your genes can give a faster metabolism or smaller appetite, thinness, like obesity, is a heritable trait.⁵

Weighing In on Fertility

These body-size fictions do not only affect self-esteem, mood, body image, and quality of life. I know from my patients that body size can also impact fertility journeys—and not just medically.

"Every time I tried to discuss our problem conceiving, my family doctor would tell me to lose weight and then come back. Finally, I went to a fertility specialist, and she tested my husband, and the problem was his." —K.K.

"My infertility was called 'unexplained' for over a year until my therapist helped me gain weight without feeling out of control. I only gained 8 pounds, but I finally became pregnant when I did." —P. Z.

There are, of course, very real physiological fertility factors that can be associated with body size.

• If someone has a BMI of 30 or higher, fertility may be impacted by hormonal imbalances, disrupted menstrual cycles, and ovulatory dysfunction due to elevated levels of androgen.
• If someone has a BMI under 18.5, fertility may be impacted by low levels of estrogen and other suppressed hormones.

But these are general statistics about weight and may not be the answer to a particular individual's fertility problem. To determine the degree to which a low or high body weight may be causing or contributing to someone's fertility problem, medical exams and appropriate tests are needed.

Unfortunately, says Victoria Ozadovsky, a postpartum certified doula and a patient care advocate at Progyny, because the impact of weight on fertility can be overestimated, some patients with larger bodies find that access to those exams and tests are not available to them, and they are not getting the comprehensive care they need.

While the effects on fertility of being overweight can be overestimated, the effects of being underweight can be underestimated. When that happens, low body weight patients may not get the guidance they need to increase their weight as part of fertility treatment.

Ozadovsky encourages patients to advocate for themselves if they encounter weight discrimination or medically unsound barriers to their health care. Second opinions can be a first-rate idea.

What to Do When the Target Is You

1. Practice positive self-talk and replace self-criticism with self-acceptance. Putting yourself down is a habit, and it can be broken.
2. If weight loss or weight gain is your plan, try to focus on incorporating forms of movement that feel doable and on incorporating nutrient-dense foods. In other words, focus on giving yourself something rather than denying yourself something.
3. Cut back on social media time if posts, ads, and influencers make you feel bad about yourself. Spend your time with people who make you feel good and return the favor.
4. If you are not reaching out for what you need from the medical community because you are looking at yourself through their eyes and feeling self-conscious or ashamed, switch your focus. Look at healthcare team members through your eyes and see if they measure up as compassionate and competent. Most healthcare professionals are aware of weight stigmas and often have been victims themselves.
5. If friends and family are truly concerned about your weight but expressing it hurtfully, try labeling the statement (not them): "That's harsh," for example. Then let them know you appreciate their concern but "I'm on advice overload right now" or, my favorite, "I already consulted my doctor, and you'll be happy to know that I'm healthy."

Body Image Essential Reads

Does the "Mid-Size" Fashion Label Hurt Your Body Image?

The Risks of Promoting Wegovy and Ozempic for Weight Loss

Janet Choi, chief medical officer of Progyny, reminds patients: "Weight and, more importantly, how it fits into your overall health—whether to promote fertility, health, pregnancy, longevity—should never be other people's business but your own (and your doctor's)."

Finally, remind yourself, as we all know but often forget, that human bodies come in all shapes and sizes. And beyond our bodies, there is also our mind and our heart. If you need help with your body, mind, or heart, reach out for medical support for your body, mental health support for your mind, and group support for your heart. Groups will not only reassure you that your experience with weight stigma is common, but it will also give you an opportunity to talk with those who really understand, gather tips and suggestions, hear yourself out loud, increase your sense of belonging, and, best of all, help others.

To find a therapist, visit the Psychology Today Therapy Directory.