Ample evidence has demonstrated a significant bias against individuals with overweight or obesity (1). People living in larger bodies are judged based on visual appearance, stereotyped as unhealthy, and deemed to have poor eating and physical fitness habits and lack of self‐control. Weight bias remains one of the most socially acceptable forms of stigma or prejudice in our society (1). The experience of weight stigma, including negative stereotypes, social devaluation, and weight‐based teasing, has significant health consequences that include psychological, behavioral, and stress responses (2). Notably, weight stigma is an obstacle to losing and sustaining weight loss (3), and it is an impediment to engaging in behaviors known to improve health such as healthy eating and physical activity patterns, lifestyle program adherence, and acquisition of medical care (4).

In the present issue of Obesity, Muttarak (5) explores the danger of “normalizing” overweight and obesity. The author asserts the assumption that visual recognition of overweight status is a prerequisite for weight‐loss attempts, and that cultural change to provide clothing or other products to accommodate larger sizes, while aiding in less stigmatization and potentially improved psychological health, could make it less likely that people may take action to lose weight.

This assumption is incorrect. Perceiving oneself as overweight has been shown to be counterintuitively associated with an increased risk of future weight gain in adults from the United States and the United Kingdom (3). Furthermore, “weight labeling” by parents or schools during childhood and/or adolescence is correlated with weight gain later in life (3). Therefore, rather than increasing the likelihood that individuals with overweight or obesity will make positive behavior changes if made aware of their “status,” the stigma and associated stress may have the opposite effect.

Muttarak's study (5) did not include measures of health indices, only noting BMI, a person's recognition of their size and whether they were trying to lose weight. It has been well documented that the relationship between BMI and health is complex (6). The risk for mortality is highest for people with BMI < 18.5 and > 35 (7). The assumption that individuals with higher BMI consistently experience poor health is a concern, as within‐category variance on health indices (e.g., cardiometabolic health) is large (8). Using BMI categories as the main indicator of health may misclassify many adults as cardiometabolically healthy or unhealthy (6).

The concern with using BMI for all health recommendations is two‐fold. If people living in smaller bodies are assumed to be healthy based on their lower BMI, health conditions may be overlooked. If recommendations for people living in larger bodies are based on BMI alone, and not their more in‐depth medical profile, weight‐loss treatment could have negative physical and/or psychological consequences. If a person is metabolically healthy, should a weight‐centric focus always be taken? The answer based on the scientific obesity literature might be “yes.” In the eating disorder and body appreciation literature, one would say “no.” Is there a middle ground to be had here?

There is evidence that taking a functional approach to the body, or focusing on health behaviors for the benefits, promotes greater adherence than an appearance‐based focus. For example, regular exercise is an important lifestyle behavior for promoting physical health (e.g., strength, endurance, reduced risk for type 2 diabetes and cardiovascular disease) and mental health (e.g., reduced anxiety and depression, improved sleep). External (appearance) motives to exercise are associated with disordered eating and lack of adherence, whereas functional motives (e.g., challenge, stress reduction) have the opposite effect (9). In fact, when people fail to achieve their desired weight loss or appearance goal in the short term, they may give up the health behavior all together. Appearance as the driver of health behavior change is usually a failed strategy. Acceptance of body appearance and healthy behavior are not mutually exclusive; that is, given the data, hating our bodies is not a motivator for health behavior. Is teaching people to better visualize their obesity the way to combat the obesity epidemic? The available evidence would say “no.” Adherence to most lifestyle interventions is poor, and long‐term results are often modest. This function‐focused paradigm shift (a focus on functional tests of performance vs. solely on BMI standards) is already being utilized in high‐performance populations (i.e., the military and athletes).

We are at a crossroads in our thinking about how to bring behavior change to promote health. We need a shift in perspective and an acknowledgment of the complex relationship between weight and overall health. Small amounts of weight loss may improve health (10), including exercise interventions in the absence of weight loss (11). Therefore, the middle ground to be found here may be a focus on the health behaviors themselves and outcomes not solely based on the amount of weight lost. A stigma‐free functional approach (including attention to social determinants) to the health consequences of overweight and obesity may be the perspective we have been looking for.