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Metabolic versus Cosmetic Fitness

by Dana Sturtevant, MS, RD

We currently live in a culture that believes health comes in only one body size: thin. People (including physicians and other health care providers) make all kinds of assumptions about a person’s health just by looking at them (or calculating their BMI). Lucy Aphramor, co-author of the book Body Respect with Lindo Bacon, says: “I know a lot more about someone’s health from their zip code than their BMI.”

You see, our potential for health is influenced both by things within our control (the choices we make) and, more importantly, by things outside of our control (environment, genetics, and social determinants of health like socioeconomic status, race, oppression, stigma, etc).

When it comes the United States’ idea of health, people seem to be more preoccupied with meeting the culture’s narrow definition of beauty, than in doing things that actually support health and well-being. There is a BIG difference between looking fit and actually being fit; between looking healthy and actually being healthy. And research has actually shown, time and time again, that fitness and fatness can coexist.

One of my biggest pet peeves, as a dietitian, is when I overhear someone at a party say to a smaller-bodied individual: “You are so lucky you can eat whatever you want,” as if thin bodies don’t benefit from good nutrition, and larger bodied individuals must be so careful.

Another example of weight/size bias is Michelle Obama’s campaign to “end childhood obesity.” Instead of making her campaign about improving the health and well-being of ALL children (because let’s face it, they are all eating the same crappy food we serve in school cafeterias and many are living sedentary lifestyles), she decided to stigmatize fat kids and make the campaign about them.  Imagine being the fat kid in school that keeps getting the message that they shouldn’t exist or that they need to become different in order to belong.

Equating weight with health isn’t helping anybody. Instead, it is increasing the prevalence of weight discrimination (and weight bias affects all of us, regardless of our size) and promotes dieting, disordered eating, compulsive over-exercising, orthorexia, shame, and more.

The truth is you are not morally obligated to pursue health. Ever. This is true whether you live in a thin, easily accepted body or a larger body that others (or possibly you) struggle to accept.  We are living at a time when we talk about health like it is the “be all and end all” of our existence, but none of this is a prerequisite for worthiness.

At Be Nourished, we broaden the definition of health to include not just your physical health, but also your mental, emotional, spiritual, and social/relational well-being. We question whether we can diet and feel emotionally well at the same time. We believe health includes acknowledging your own inherent worthiness (which can be quite a journey). When it comes to fitness, we recommend a focus on metabolic rather than cosmetic fitness.  A metabolically fit person has the stamina to do the things they want to be doing in their life, and better physical markers of health and well-being (e.g., blood pressure, cholesterol/lipids, blood sugar, heart rate, etc) are within the recommended range.  It is important to note that many cosmetically fit people may not be metabolically fit.

For those of you who have been working to define health for yourself, we ask:

Do you want to look fit, or actually be fit?

Do you want to look strong, or actually be strong?

Do you want to look healthy, or actually be healthy?

Because there is a big difference!

I recently saw a story about some dude in Hollywood that has had all kinds of plastic surgery so he can look fit.  He never exercises. He’s just had a bunch of cosmetic implants that make him look fit: pectorals, deltoids, etc.  So he might look like he works out every day, but he hasn’t lifted weights in years.

So what are we talking about, people and health care providers?  Do we want people to look healthy?  Or do we want to help them actually feel well?

If you are one of those “concern-trollers” that likes to tell fat people: “It isn’t about your weight, I just want you to be healthy,” then you might want to look at the research on how shame impacts a person’s ability to care for themselves.  Shame is highly correlated with addiction, depression, bullying, aggression, eating disorders and so on.  It is poorly associated with good self-care.  So if you really, truly want to help support someone in becoming healthier, then stop being an a**hole and do your research on what actually supports a person’s health and well-being.

People of all shapes and sizes can improve their health and well-being, and in the process they may or may not lose weight. At Be Nourished, we do something pretty radical in this culture and emphasize healing your relationship with food, your body and yourself to support engaging in more compassionate forms of self care. We love this Deb Burgard quote:

“I make a point of reminding a new patient that I cannot tell by looking at them what they might be doing with food or exercise, and that in my experience, symptoms of restricting, bingeing, and purging have been present in people at every conceivable weight. Sometimes, this is the first time the person has been explicitly told that it is their unique experience, not their body size, that will be the focus of our interest.

I am listening to them and also weaving in a lot of theory and information about the science of eating disorders, mammalian weight dynamics, cultural history, relationship dynamics, and so on. I am relating the principles of a Health At Every Size® (HAES) approach, which takes a person’s day-to-day practices as the centerpiece of consideration rather than the number on the scale. HAES assumes that the size a person is when they are doing the practices that support health is, by definition, their healthy weight. The number on the scale is an outcome that we cannot know ahead of time; we cannot choose the number, we can only choose our day-to-day practices and be honest about what is sustainable in our unique lives.”

(From Deb Burgard’s chapter Developing Body Trust: A Body-Positive Approach to Treating Eating Disorders in the book Effective Clinical Practice in the Treatment of Eating Disorders: The Heart of the Matter)

So many people in our culture are focusing on their weight under the guise of health.  And we want you to know it doesn’t have to be this way.  There is a different path available to you, an alternative to the traditional weight paradigm, and it is where you will find freedom and making lasting peace with food and your body.

You don’t need to try harder.  We are pretty sure you’ve already tried really hard.  So think about trying different.

Shift your focus to compassionate, weight-neutral self-care practices and trust your body to sort out the weight.


Dana Sturtevant, MS, RD, is a trainer, mentor, Kripalu Yoga teacher, and dietitian specializing in Health at Every Size® and intuitive eating. She is the cofounder of Be Nourished, a revolutionary business helping people heal body dissatisfaction and reclaim body trust. Dana loves incorporating mindfulness and self-compassion practices into her work. A member of the International Motivational Interviewing Network of Trainers, Dana has facilitated more than 300 workshops throughout the United States for health care providers looking to enhance their skills in behavior-change counseling. This month, she is offering two different trainings for helping professionals at the Kripalu Center for Yoga and Health. ( For more info about Dana, visit

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