Header image credit: me // Featured image credit: De’Andre Bush (freely available via Unsplash)

Okay, here comes the unpopular perspective: the body positivity movement might be doing more harm than good.

There I said it.

Now, before anyone jumps down my throat, hear me out.

Let me begin by saying that I have no intention or desire to shame anybody or any body type. I do not want to promote a one-size-fits-all approach that suggests that beauty is limited to a certain few kinds of appearances. Quite the opposite. I believe that everybody—and every body—is a beautiful creation and worthy of being honored, regardless of size, shape, color, ability, or any other characteristic.

But, here’s my concern: when we focus too much on body positivity, we risk normalizing and turning a blind eye to unhealthy habits—habits that will destroy the bodies we profess to honor.

That doesn’t sound like love. And it doesn’t sound very positive.

The Appeal of Body Positivity

Now don’t get me wrong; I totally understand the appeal and potential value of body positivity. We are all uniquely beautiful creations that deserve to be celebrated and loved. Moreover, rarely—if ever—has any good ever come from shame. When was the last time you were shamed into having healthier habits? Exactly. I can’t think of an example either. But love and encouragement? Yeah, those work really well to inspire positive change. So, in that sense, there’s great potential value in body positivity.

And there’s an abundance of research confirming this potential, in particular, in terms of the relationship of self-esteem to well-being. I’ll highlight a small snapshot of the research. In a recent study of international post-secondary students, self-esteem was found to be positively correlated with life satisfaction (though not as strongly as self-efficacy was) and negatively correlated with depression (Gebregergis et al., 2018). Additionally, self-esteem is positively correlated with resilience (Karatas & Cakar, 2011). If you think about this, it makes complete sense: when you have a greater sense of self-worth and a greater belief in your competence, you’re going to be happier with who you are, you’re going to bounce back better when life knocks you down, and you’ll feel more empowered to carve out a life that you find fulfilling.

But, lest we think that self-esteem is all it takes to have a satisfying life (wouldn’t that be great?), let’s look at some of the more sobering research. In a comprehensive 2003 review that proved rather shocking at the time (even to the researchers themselves), given the impact that the self-esteem movement had garnered, Baumeister and colleagues found that the effects of self-esteem were far weaker than anticipated. They concluded that high self-esteem is reliably positively correlated with happiness and so-called “initiation” (i.e., a willingness to act upon one’s beliefs) and negatively correlated with bulimia, but that connections to other phenomena and outcomes are minimal: self-esteem is not a strong determinant of school performance (though it can be associated with greater persistence on tasks); it is not related to being more well-liked by others (though people with high self-esteem tend to think they’re more well-liked); and it is not related to the use of alcohol or other drugs. As Baumeister and Vohs state in a 2018 follow-up article,

“Those two advantages [happiness and initiation] are substantial, but again they are far less than was widely assumed during the peak of the self-esteem movement, and they hardly seem adequate to justify widespread efforts to increase self-esteem throughout the population (or even throughout children).”

Baumeister & Vohs (2018, p. 138)

So, yes, there is value in cultivating self-esteem, but it is of minimal scope and potency, and, at least in terms of life satisfaction, its benefits are dwarfed by those of cultivating a healthy lifestyle. When it comes to quality of life, chief among these lifestyle characteristics are supportive relationships, physical health, and functional ability (Low & Molzahn, 2007; Ponce et al., 2011). When it comes to not just quality of life, but length of life itself, relationships and health again top the list of important predictors (Leong et al., 2015; Nosraty et al., 2023; Srikanthan & Karlamangla, 2014). (For more details about these studies, see the annotated bibliography below.)

Moreover, a recent systematic review found that physical activity is an effective treatment for depression and anxiety, even more effective than the traditional approach of psychotherapy and medications (Singh et al., 2023). And I’m sure you don’t need me to tell you that physical activity benefits our physical health, so I’ll spare us the details on that.

So, putting aside considerations of aesthetics or weight loss, maintaining good physical health is one of the best things you can do for yourself. Period. It’s good for your body, your mind, your well-being, and your overall life. This means that when it comes to body positivity, physical health (which we develop through smart movement and nutrition) is essential.

So why isn’t it essential in the body positivity movement?

What Body Positivity Misunderstands

Given the essential importance of physical activity to physical health (and of physical health to overall well-being and quality of life), why does the body positivity movement not endorse what should be its core tenet?

While I can’t claim to know its reasoning as to why, I can surmise a guess: it conflates love with acceptance. As with many other movements in recent years, acceptance is seen as the highest—and, dare I say, only acceptable—form of love. But it’s not. While there is some overlap, acceptance and love are wildly different.

Acceptance is part of love, but there’s more to love than acceptance. Love is a wholehearted desire for the best for the beloved. As such, love accepts the person but will not and cannot accept anything that might destroy the person, including their own bad habits. Thus, while acceptance will turn a blind eye to the bad habits in the name of “love”, real love cannot; instead, it will confront the beloved on those habits in the hopes of pointing the beloved to a better life. So while love without acceptance is a false love—something akin to manipulation, perhaps (withholding acceptance until they become who you want them to be)—the reverse is also true: to accept someone without loving them is not love; it’s enablement.

Can you imagine a loving parent saying, “I accept that my kid wants to play in the busy street, so I’m going to let them”? No! That would be absurd. Real love loves the beloved too much to enable dangerous behaviors. Real love accepts the beloved as they are while wanting them to be better. Real love embraces the beloved while not allowing destructive habits.

In other words, real love is more of an action than a feeling.

So, if you truly love your body and want to live a happier life, that will manifest in engaging in a healthy lifestyle: keeping active, eating healthy foods, getting good sleep, cultivating meaningful relationships, and minimizing stress. Not only does such a healthy lifestyle provide more benefits in terms of happiness, physical health, and mental health than self-esteem does, an unhealthy lifestyle, as would be expected, is associated with a whole host of unpleasant health outcomes—outcomes you wouldn’t want to simply accept.

But here’s where self-esteem plays a key part: esteeming and loving yourself enough to make the hard, healthy changes. You won’t always feel the like you value or love yourself, especially if you have a history of low self-esteem, but the good news is that the feeling doesn’t matter, because this kind of love is an action, not a feeling; it’s a choice to do something. So choose to do what is good for your body. And then let cognitive dissonance do the rest.

Check out my earlier post if you want more info on cognitive dissonance, but the gist is this: as much as our emotions and motivations can influence and determine our behaviors, they are in turn influenced and determined by our behaviors; it is very much bidirectional. So don’t wait until you feel like doing something you know you should do, because that feeling may never come; just start doing it and the feeling will catch up. In other words act first, feel later. Or, to rephrase Bill Wilson’s quote about acting your way into right thinking, don’t try to feel your way into acting differently; act your way into feeling differently.  

The solution, therefore, is simple (though not easy): when it comes increasing body positivity and self-esteem, we should choose active love over passive acceptance. Instead of willing yourself into loving and respecting your body, start engaging in healthy habits that show your body the love and respect it deserves: being active; getting sleep; focusing on eating a diet rich in produce and whole foods and minimal in added sugars, artificial sweeteners, and other processed garbage. Not only will your body start to feel better and healthier (which can boost mood, health, and perhaps even the self-esteem you’re craving), but you’ll start to believe that you’re worth love because you have already been loving yourself.

This is how my own journey has gone. I used to be horribly unhealthy and quite overweight. I didn’t like the way I looked. So I started doing something about it. I started being more active and I started changing my diet. Over time, that resulted in big changes in my appearance, and I like those changes. But the more valuable change has been in my attitude: I have a much greater appreciation, respect, and love for my body now than I ever did back then. I love how healthy I feel; I love how well my body moves and allows me to enjoy the activities that make life fulfilling. And because I love how I feel and move now, I want to keep that up, so I keep making healthy choices as an act of love and respect for my body, because when I respect it, it will respect me. Now when I make food or exercise choices, my biggest concern is not how that food/activity is going to affect my waistline, but how it’s going to affect my health—my energy, my vitality, my resilience to illness, etc. In addition to helping me keep a healthy lifestyle, this perspective has been amazingly freeing.

What Body Positivity Misses Altogether

Hopefully I’ve made it abundantly clear by now that real body positivity comes down to health: a healthy body is a well-loved body. And while healthy bodies can come in different shapes and sizes, there is a limit to that. And here’s where I might get some backlash, but, again, please know that I’m not trying to shame; I’m just presenting the evidence. Knowledge is power, and my hope is that this knowledge empowers us all to be the best, healthiest versions of ourselves.

There is a somewhat narrow range of body composition that is healthy. Being too far to either end of the body composition spectrum is associated with health risks. A certain amount of body fat is essential for human physiology, so it’s no surprise that being too underweight is associated with a whole host of health complications (see figure below). Moreover, while the risk for cardiovascular disease is greatest in individuals who are overweight (50%) and obese (96%), being underweight also increases the risk of cardiovascular disease (19.7%), and that risk largely independent from other risk factors, which is not the case for overweight or obesity (Park et al., 2017).

 Source: Golubnitschaja et al. (2021)

But the opposite is also true: too much body fat is unhealthy. In addition to the abovementioned cardiovascular risks, obesity is associated with a whole host of issues, from cancer to metabolic issues to asthma to liver and kidney issues and more (Manna & Jain, 2015). And the issue would seem to be the fat itself:

“Recent studies have shown that obesity-associated risk factors depend not on excess body weight per se, but rather on the regional distribution of the excess body fat. In light of this, it is now well recognized that abdominal fat is a significant risk factor for obesity-associated diseases; in fact, visceral fat accumulation stimulates pro-oxidant and proinflammatory states.”

(Manna & Jain, 2015)

In other words, too much fat leads to excess inflammation; and, as I discuss in my book on stress, inflammation is associated with pretty much every disease we know of, from cancer to heart disease to Alzheimer’s and more.

And lest you think it’s just physical consequences, there can be profound cognitive consequences of obesity as well, as it is correlated with decreased brain volume (Bobb et al., 2014; Janowitz et al., 2015).

Source: Manna & Jain (2015)

So here’s the hard question I want to pose to the body positivity movement: given the vast literature on the health consequences of being overweight, why is that something we should accept? Why should we accept and celebrate something that is literally killing people and costing upwards of $170 billion in healthcare costs (per the CDC)? We don’t celebrate diabetes or high blood pressure or any other health complication, so why do we accept weight? Why would a movement all about having positive views towards bodies celebrate something with such well-documented negative consequences on the body?

And on the one hand, I get it: it’s hard to be healthy and it’s hard to lose weight, and modern culture (at least in the U.S.), with its processed foods and sedentary lifestyle, doesn’t make it any easier. And there’s no short cut; there’s no miracle pill or cure. It comes down to what it has always come down to and always will come down to: eating healthy and being active.

(For those of you thinking, “But obesity is genetic; there’s nothing some people can do about it”, let me tell you that that is blatantly untrue. Yes, there are genetic components that can increase someone’s risk of developing it, just as with Alzheimer’s or cancer or heart disease, but, except in a very rare subset of cases, it is not a genetically determined disorder [Loos & Bouchard, 2003]. It develops because of behavior and it can be reversed through behavior. And I hope you find that empowering rather than disheartening, because it means that you have the power to do something about it!).

But on the other hand, as hard as it is to get and stay healthy, being unhealthy will be harder, if not today, then some day: having to take time off work for illness, learning to manage a chronic disease, paying exorbitant hospital bills, having no energy to do things, and the list goes on.

There’s no escaping the hard, but you can choose your hard: making the hard choices to be healthy, or dealing with the hard consequences of living an unhealthy life.

Which hard will you choose?

Final Thoughts

I know that this is a contentious topic and may have been a tough pill for some to swallow, so thank you for making it this far. And because I want to make sure that y’all understand my heart behind this, and because it’s an important message for everyone to hear, let me say this one last time: everybody and every body is beautiful and worthy of love and respect. And that means you and your body.

Image credit: Anh Nguyen (freely available via Unsplash)

So celebrate your body. Honor and love your body. But remember that love is more than just acceptance, more than just a feeling; love is an action. So love your body in a real, active way. Make that love do something good for your body. After all, you only get one body in this life, so treat it right. And here’s the good news: when you treat it right, it will treat you right.

Hopefully I’ve made it clear that none of this is a matter of size, but a matter of health; that it’s not about how the weight looks, but about what the weight does. So let’s stop normalizing unhealthy habits and accepting people’s unhealthy weight under the guise of body positivity, because it is anything but positive in the long run. Instead, let’s normalize taking good care of our bodies and let’s love and respect ourselves and others enough to encourage healthier choices: eating primarily whole, unprocessed foods; moving our bodies each day; getting adequate sleep. I’d wager you’ll find that that’s the most positive thing you can do for your body.

And let’s extend this one step further and focus less on how our—and others’—bodies look and more on how healthy they are and what they can do. So next time you watch a ballerina, instead of envying her leanness, celebrate the beauty and power with which she dances. Next time you see a ripped guy at the gym, instead of wishing you could be that big, admire the time and dedication he took to get there. And next time you do something active, thank your body for being able to do it. Next time you look in the mirror, make a point to enjoy what you see. Even if you don’t feel like saying or doing something positive, do it anyway. Act first; feel later. Choose love. Choose to honor your body. Choose health. That’s true body positivity.

Yours truly,
D. R. Meriwether, Ph.D.
Renaissance Man and Abundant Life Liver

Annotated Bibliography

Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4(1), 1–44.

• In a comprehensive review of the literature to date on self-esteem and its correlates, they concluded that its effects are not as strong as the self-esteem movement believed them to be. At the end of their summary, they write, “Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.”

Baumeister, R. F., & Vohs, K. D. (2018). Revisiting our reappraisal of the (surprisingly few) benefits of high self-esteem. Perspectives on Psychological Science, 13(2), 137–140.

• In a follow-up to their 2003 review article, the authors comment on why that article had such an impact on the field and address challenges facing the study of self-esteem, namely the overreliance on self-report data and the effects of confounding variables (e.g., mental health, substance use).

Bobb, J. F., Schwartz, B. S., Davatzikos, C., & Caffo, B. (2014). Cross‐sectional and longitudinal association of body mass index and brain volume. Human Brain Mapping, 35(1), 75–88.

• Examining data from over 300 individuals, the researchers found a negative correlation between BMI and grey matter volume throughout the brain (all four cortical lobes as well as subcortical areas) in both the control group and the group with a history of exposure to lead. There were no such correlations with white matter. Moreover, longitudinal data show that a higher baseline BMI was associated with a greater reduction in grey matter volume in temporal and occipital lobes five years later.

Gebregergis, W. T., Tekie, D., Yikealo, D., & Habte, A. (2019). Antecedents of psychological adjustment of international students studying in China: The roles of self-efficacy and self-esteem. Open Journal of Social Sciences, 7(2), article 90818.

• In a study of 328 international students (representing over 100 countries) studying in China, self-esteem was moderately negatively correlated with depression (r = -.47), weakly positively correlated with life satisfaction (r = .29), and moderately positively correlated with self-efficacy (r = .43); self-efficacy was weakly negatively correlated with depression (r = -.29) and moderately positively correlated with life satisfaction (r = .43). Follow-up analyses revealed that the effect of self-efficacy on depression was mediated by self-esteem and life satisfaction, and that the effect of self-efficacy on life satisfaction was mediated by self-esteem, suggesting that self-efficacy comprises self-esteem and life satisfaction (or, in other words, that self-esteem is a crucial component of self-efficacy).

Golubnitschaja, O., Liskova, A., Koklesova, L. Samec, M., Biringer, K., Büsselberg, D.,…Kubatka, P. (2021). Caution, “normal” BMI: health risks associated with potentially masked individual underweight—EPMA Position Paper 2021. EPMA Journal, 12, 243–264.

• With almost 125 million children around the globe being overweight, and another almost 200 million being underweight (both figures as of 2016), healthy weight, even in adolescents, is a global concern, especially as being overweight and being underweight “are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies,” such as cardiovascular disease, inflammation, cancer, mental and neurological disorders, and more. The main focus of this review was the numerous health complications associated with being underweight and the underlying mechanisms.

Janowitz, D., Wittfield, K., Terock, J., Freyberger, H. J., Hergenscheid, Völzke, H.,…Grabe, H. J. (2015). Association between waist circumference and gray matter volume in 2344 individuals from two adult community-based samples. NeuroImage, 122, 149–157.

• In a combined study of over 2300 individuals, waist size was negatively correlated with grey matter in all four cortical lobes as well as the cerebellum and several key subcortical structures. The association remained largely unchanged when controlling for age, gender, blood pressure, diabetes, and blood lipid levels, suggesting that, beyond more well-established risk factors, waist size is a predictor for brain health and a potential risk factor for neurological disorders and cognitive decline.

Karatas, Z., & Cakar, F. S. (2011). Self-esteem and hopelessness, and resiliency: An exploratory study of adolescents in Turkey. International Education Studies, 4(4), 84–91.

• A study of 223 adolescent boys and girls (ages 15–18) revealed a weakly positive correlation between self-esteem and resilience (r = .30) and found that self-esteem significantly predicted a certain amount of resilience in the adolescents.

Leong, D. P., Teo, K. K., Rangarajan, S., Lopez-Jaramillo, P., Avezum, A., Jr., Orlandini, A.,…Yusuf, S. (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet, 386(9990), 266–273.

• In a longitudinal, multi-national study of almost 140,000 adults, grip strength was not associated with diabetes incidence, respiratory problems, fall injuries, or fractures; however, it negatively correlated with all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality, and with heart attack and stroke. Moreover, it was a better predictor of all-cause mortality and cardiovascular mortality than was blood pressure. Assuming that grip strength is a meaningful proxy for overall strength and functional health, these findings suggest that focusing on strength and functional ability is a key means of reducing the risk of heart disease and death.

Loos, R. J. F., & Bouchard, C. (2003). Obesity – is it a genetic disorder? Journal of Internal Medicine, 254, 401–425.

• In an extensive review of the literature on the genetics of obesity, the authors acknowledge that there may be a very rare set of cases of that are genetically determined, but that, otherwise, “obesity is a complex multifactorial disease”, one in which genetic components may predispose certain individuals to more readily develop obesity, but which ultimately requires environmental factors (namely, energy imbalance) to manifest.

Low, G., & Molzahn, A. E. (2007). Predictors of quality of life in old age: A cross-validation study. Research in Nursing & Health, 30, 141–150.

• Examining 420 older adults, the authors found that home environment was most strongly positively correlated with quality of life (r = .546), followed by perceived health (r = .469), functional ability (r = .467), purpose in life (r = .448), physical environment (r = .435), emotional support (r = .399), finances (r = .375), and, finally, meaning in life (r = .368).

Manna, P., & Jain, S. K. (2015). Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: Causes and therapeutic strategies. Metabolic Syndrome and Related Disorders, 13(10), 423–444.

• In a critical review, the authors claim that obesity is “the primary health burden of the 21^st century” and argue that obesity itself, via the oxidative stress it creates, is a risk factor various health conditions (asthma, diabetes, cardiovascular issues, cancer, and more). Moreover, obesity is also indirectly, via the effects of dysfunctional adipose tissue, a risk factor for a similar host of issues.

Nosraty, L., Deeg, D., Raitanen, J., & Jylhä, M. (2023). Who live longer than their age peers: individual predictors of longevity among older individuals. Aging Clinical and Experimental Research, 35(3), 677–688.

• Examining a sample of almost 1500 Finnish adults, the authors found that, along with respiratory disease and endocrinological/metabolic disorder, being single (never married, widowed, and divorced were all comparable) was associated with dying sooner; conversely, self-rated health and mobility were associated with greater longevity.

Park, D., Lee, J.-H., & Seungwoo, H. (2017). Underweight: Another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA. Medicine, 96(48), e8769.

• A cross-sectional study of almost half a million US individuals revealed that being underweight is associated with an almost 20% increased risk for cardiovascular disease (relative to individuals at a “normal” weight); that risk is 50% for overweight individuals and 96% for obese individuals. Moreover, when other cardiovascular risk factors (age, sex, cholesterol levels, blood pressure, diabetes, physical activity, and smoking) were factored out, the relative risk for underweight individuals increased, the relative risk for obese individuals decreased, and the relative risk for overweight individuals essentially disappeared, suggesting that within a “healthy” range (normal and overweight), the greatest risks are other lifestyle and health factors, whereas when it comes to weight, underweight and obesity are still risk factors in and of themselves.

Ponce, M. S. H., Lezaeta, C. B., & Lorca, M. B. F. (2011). Predictors of quality of life in old age: A multivariate study in Chile. Journal of Population Ageing, 4, 121–139.

• In a multi-study sample of 1613 Chilean adults, the top predictors of quality of life were having sufficient income, having quality family relations, having high self-efficacy, being educated, being active outside the home, reading, and functional ability.

Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E. M., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal or Sports Medicine, published online ahead of print.

• In a critical examination of 97 systematic reviews examining the effects of physical activity on mental health outcomes (depression, anxiety, and distress), the authors conclude that all modes of physical activity—aerobic, resistance, mixed, and yoga—“were effective, and higher intensity exercise was associated with greater improvements for depression and anxiety.” Importantly, the effect of physical activity on improving depression and anxiety was stronger than the effect of traditional psychotherapeutic and pharmaceutical interventions, suggesting that lifestyle interventions should be considered as a primary prescription for treating mental health disorders.

Srikanthan, P., & Karlamangla, A. S. (2014). Muscle mass index as a predictor of longevity in older-adults. American Journal of Medicine, 127(6), 547–553.

• Examining over 3600 older individuals, the risk of mortality was significantly greater in those with the least amount of muscle mass. When looking at non-muscle mass and overall BMI, the effect was not significant, suggesting that muscle mass, and by extension, strength and functional ability, are important predictors of longevity.