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One of the fastest ways to get praised in our culture is to lose weight. It almost doesn’t matter how it happened. People will compliment weight loss that came from stress, burnout, illness, anxiety, grief, undernourishment, over-exercising, or even chronic illness before they stop to ask whether someone is actually well.
“I’ve seen firsthand how deeply we’ve been conditioned to associate thinness with health. And as a cancer survivor, I’ve also experienced how misleading that assumption can be.”
As a physician, I’ve seen firsthand how deeply we’ve been conditioned to associate thinness with health. And as a cancer survivor, I’ve also experienced how misleading that assumption can be. Some of the sickest moments of my life existed in a lighter body. I learned firsthand that the body can get lighter while becoming more depleted.
At the same time, I’ve cared for patients in larger bodies with excellent metabolic health, stable energy, healthy lab markers, strong muscle mass, and vibrant lives. I’ve also seen patients become physically depleted in pursuit of becoming lighter while being praised the entire way there.
The truth is, weight alone tells us very little about what’s actually happening inside the body. It doesn’t tell us about inflammation, hormone health, nutrient status, nervous system regulation, cardiovascular fitness, muscle mass, emotional wellbeing, or metabolic function. It doesn’t tell us whether someone is sleeping through the night, digesting well, recovering properly, feeling emotionally resilient, or living under chronic stress beneath the surface.
“Weight alone tells us very little about what’s actually happening inside the body.”
And perhaps most importantly, it doesn’t tell us whether someone feels alive in their own life.
This doesn’t mean weight is completely irrelevant, because it’s not. There are absolutely situations where changes in weight — and more specifically body composition and body fat distribution — can offer important information about someone’s health. But reducing health down to a number on the scale is one of the most incomplete ways we could possibly evaluate the human body.
Weight alone tells us little about function
Weight is simply one data point. Alone, it can’t tell us the most important measure of health: how well your body is actually working day to day.
From a functional medicine perspective, this is because the body is not a single system. It’s an interconnected ecosystem.
“The body is not a single system. It’s an interconnected ecosystem.”
I can’t tell you how many times I’ve sat across from patients who were being praised for looking “healthy” while quietly telling me they were exhausted, losing their hair, struggling with anxiety, waking up at 3 a.m., dealing with digestive issues, or feeling completely disconnected from their bodies.
A number on the scale simply cannot capture the complexity of all those moving pieces or tell us how well someone’s body is actually functioning. And function is the thing that matters most.
This is part of why BMI has become such a controversial measurement in medicine. BMI, or Body Mass Index, was originally developed in the 1800s as a population-level statistical tool — not as a comprehensive way to evaluate an individual person’s health. Over time, it became widely adopted in medicine because it was simple, inexpensive, and easy to calculate, but it doesn’t account for factors like muscle mass, bone density, inflammation, ethnicity, metabolic function, or body composition.
The scale also cannot tell us why someone fluctuated in weight. Was it because they started sleeping better and built some muscle? Or because they were chronically stressed and undernourished? Was it because inflammation improved? Or because they developed a chronic illness?
The scale cannot tell you what your body is made of
This is where body composition becomes much more important than body weight alone. In functional medicine, I’m often looking beyond the number on the scale and paying closer attention to things like muscle mass, visceral fat, metabolic flexibility, bone density, strength, and recovery capacity.
Muscle, in particular, plays a massive role in long-term health. Dr. Gabrielle Lyon often speaks about skeletal muscle as one of the body’s most important organs of longevity, and that perspective is incredibly important. Muscle influences blood sugar regulation, insulin sensitivity, metabolic health, hormone function, mobility, cognitive health, aging outcomes, and recovery from illness.
I’ve had patients gain muscle, lower inflammation, improve metabolic markers, and feel dramatically better without seeing major changes on the scale at all. I’ve also seen patients improve osteopenia and osteoporosis through strength training, nourishment, hormone support, and rebuilding lean body mass.
“I often remind people that body recomposition and weight loss are not the same thing.”
That’s why I often remind people that body recomposition and weight loss are not the same thing. A body can become significantly stronger, healthier, and more metabolically resilient while the number on the scale barely changes.
This is also why I’m cautious about over-relying on at-home “smart scales.” They can absolutely have value and sometimes help people track broader trends over time, especially when used consistently and interpreted in context. But many are using estimations based on bioelectrical impedance, hydration status, and algorithms that can fluctuate dramatically depending on factors like water retention, menstrual cycles, inflammation, or even whether you exercised that morning.
More advanced tools like DEXA scans, give a more accurate picture of body composition by looking at factors like lean muscle mass, bone density, and fat distribution. That said, not everyone has access to a DEXA scan, and tools like at-home smart scales can still be helpful when viewed as broader trend-tracking tools rather than perfectly precise measurements.
From a longevity perspective, understanding what the body is made of — and how those patterns are changing over time — is often far more meaningful than simply knowing how much it weighs.
What I pay attention to instead, as a functional medicine doctor
When I’m evaluating someone’s health, I’m paying attention to much more than weight. I want to know: How is this person functioning? How do they feel in their body? What is their physiology communicating?
“I want to know: How is this person functioning? How do they feel in their body? What is their physiology communicating?”
Some of the markers I care most about include stable energy throughout the day. Not just the ability to push through exhaustion with caffeine and adrenaline, but genuine, sustainable energy. I look at sleep quality too. Are they sleeping deeply? Waking restored? Or waking at 3 a.m. with a racing mind and a dysregulated nervous system?
I also pay close attention to blood sugar regulation and metabolic health. Energy crashes, intense cravings, and constantly feeling “hangry” often tell us far more about someone’s metabolic state than their weight alone. Hormones matter too. Menstrual irregularities, fertility struggles, low libido, severe PMS, worsening perimenopause symptoms, and thyroid dysfunction can all be signs that the body is under stress even if someone appears “healthy” externally.
Digestive function is another major clue. Chronic bloating, constipation, reflux, food sensitivities, and irregular bowel movements are not things to simply brush off as normal. I also look at strength and recovery capacity. Can the body recover well? Build muscle? Handle stress appropriately? Adapt? And perhaps one of the most overlooked markers of health is someone’s relationship with food and their body. Can they eat with flexibility? Can they enjoy meals without fear? Can they nourish themselves consistently without obsession, restriction, or guilt?
“Perhaps one of the most overlooked markers of health is someone’s relationship with food and their body.”
I also pay close attention to chronic stress and nervous system health because stress profoundly affects every system. When the body spends long periods of time in survival mode, it adapts accordingly. Over time, chronic stress can influence metabolism, recovery, hormones, and the body’s overall resilience.
Because someone can appear extremely “disciplined” from the outside while living in a constant state of physiological and emotional stress internally.
Sometimes what looks like a “weight problem” is not that at all
Sometimes what gets labeled as a “weight problem” is actually an inflammation problem, a muscle mass problem, a nervous system problem, and/or a metabolic problem.
Someone may gain weight that has very little to do with excess body fat at all. Chronic stress, elevated cortisol, inflammation, hormone imbalances, poor sleep, autoimmune conditions, digestive dysfunction, and fluid retention can all contribute to changes in body size and composition.
“Someone may gain weight that has very little to do with excess body fat at all.”
I also see this happen frequently when people chronically under-eat or over-exercise in pursuit of weight loss. They may technically lose weight while simultaneously losing muscle mass, slowing metabolism, dysregulating hormones, worsening blood sugar stability, and increasing physiological stress on the body.
Sometimes the patients who are most shocked are the ones who have spent their whole lives being told they were “healthy” because they were thin. Then we look deeper and discover blood sugar dysregulation, inflammation, low muscle mass, poor metabolic flexibility, or higher levels of visceral fat that no one had previously evaluated because their body size never raised concern.
“Sometimes the patients who are most shocked are the ones who have spent their whole lives being told they were ‘healthy’ because they were thin. “
This is why understanding why the body is changing matters so much more than simply reacting to the number on the scale. Because often the real issue isn’t weight itself, but what the body has had to adapt to underneath it.
When weight does matter
None of this means weight is irrelevant. There absolutely are situations where weight changes can provide important information about health.
Rapid unexplained weight loss or gain can sometimes signal underlying issues like thyroid dysfunction, insulin resistance, inflammation, hormone imbalances, digestive disorders, medication side effects, or chronic illness. Excess visceral fat is also associated with increased risk for cardiovascular disease, metabolic dysfunction, and inflammation.
“Rapid unexplained weight loss or gain can sometimes signal underlying issues.”
At the same time, loss of muscle mass as we age is deeply connected to frailty, injury risk, metabolic decline, and poorer long-term health outcomes.
We shouldn’t stop paying attention to weight altogether. The issue is when our culture reduces health down to weight alone and uses body size as the primary measure of someone’s wellbeing. Weight can be one piece of the puzzle, but it should never be mistaken for the full picture.
This is also why it’s important to pay attention to patterns in your own body and bring those observations into conversations with your healthcare provider. Rapid weight changes, shifts in energy, worsening symptoms, changes in body composition, or feeling persistently unwell are all things worth discussing and evaluating in a broader clinical context.
Health is about being able to fully participate in your life
One of the things I think about often is how differently my body has looked across different seasons of my life. Some of the thinnest moments of my life happened during periods where I was deeply unwell.
And some of the moments where my body changed in ways I wasn’t entirely comfortable with visually ended up holding some of the greatest joy I’ve ever experienced.
“Some of the moments where my body changed in ways I wasn’t entirely comfortable with visually ended up holding some of the greatest joy I’ve ever experienced.”
I think about being pregnant after wondering whether motherhood would even be possible for me after cancer treatment. I remember swollen ankles, physical discomfort, and watching my body change rapidly. But I also remember feeling overwhelmingly grateful that my body was carrying new life.
That experience changed the way I think about health forever.
At its core, health is about having the energy to show up for your life, the resilience to move through challenges, the strength to age well, the metabolic health to support longevity, the hormonal health to feel connected to yourself, and the capacity to experience joy, relationships, purpose, movement, and presence.
Health is wealth because it allows us to fully participate in the lives we’ve been given. And sometimes the healthiest body in the room is not the smallest one. Sometimes it’s the body that is finally nourished, supported, resilient, and alive again.
Dr. Jaclyn Tolentino is a Board-Certified Family Physician and the Lead Functional Medicine Physician at Love.Life. Specializing in women’s health and hormone optimization, she has been featured in Vogue, The Wall Street Journal, and Women’s Health. As a functional practitioner and a breast cancer survivor, Dr. Tolentino is dedicated to uncovering the root causes of health challenges, employing a holistic, whole-person approach to empower lasting wellbeing. Follow her on Instagram here for more insights.
