See Michelle’s Top 3 Takeaways

Before giving birth in May 2015, I developed gestational hypertension. Despite concerns that it could lead to additional health complications — such as placental abruption, premature birth, or organ damage — I delivered a healthy baby girl.

Over the next year, my blood pressure remained high, and I wasn’t able to lose weight. At a checkup, my doctor noted that Black women tend to be overweight, and he recommended increasing the dose of the hypertension medication I’d started after my daughter was born. He did not suggest lifestyle modifications, like changing my diet or exercising more.

I’m a healthcare researcher, so I knew that his statement concerning Black women was statistically correct. Based on the data, the number of higher-weight Black women is disproportionate compared with other demographic groups for reasons that aren’t entirely understood. A partial explanation is well-established, however: Body mass index overestimates obesity in Black people because it doesn’t account for differences in body composition.

Nevertheless, this didn’t necessarily apply to me — I hadn’t been hypertensive or overweight before I tried to get pregnant. I wanted to find the root cause of my hypertension and weight retention, and I wanted to focus on lifestyle changes before I treated the problem with more medication. I hoped to find another physician to partner with on this wellness journey.

 

Rising Pressure

I got pregnant in 2014, about a year after marrying my college sweetheart. I was a little underweight after my first trimester, so I started drinking protein shakes with breakfast.

Living in Chicago helped too — the city is full of great food. My husband and I ­enjoyed eating at nearby burger joints, taco bars, and pizza places. I made friends with the baker at a local doughnut shop, who always waved me in and gave me one of my favorite glazed long johns.

By the middle of my third trimester, I had gained almost 55 pounds. My blood pressure had also increased — so much so that my physician advised me to come in every other week for checkups. At the time, I didn’t think much about the condition. I felt OK and I’d been reassured that my numbers would normalize after giving birth.

People with hypertension may not experience symptoms, so the condition is not always taken seriously. But it is a genuine threat to health, known as a “silent killer.” Gestational hypertension increases blood-vessel resistance, reducing blood flow to the mother’s essential organs and the placenta. This has the potential to deprive the developing baby of necessary nutrients and oxygen.

We were lucky. Although my blood pressure remained high during the weeks leading to my due date, my baby, Sarai, was born in good health.

The Fourth Trimester

Four months after I gave birth, my healthcare provider advised that I start taking a low-dose medication to manage my blood pressure.

I was having a difficult time ­recovering physically and emotionally from childbirth. The experience had been hard on my body, and adjusting to life with a newborn was a challenge — even with the help of my mother and mother-in-law. Sarai wasn’t feeding well, and she was sleeping all day and awake all night.

At a six-week follow-up visit, I was diagnosed with postpartum depression. I started seeing a therapist on a regular basis, and she helped me learn how to prioritize my own needs while figuring out how to take care of Sarai. I began by simply making sure I was eating, showering, and getting some sleep.

By November 2015, I was starting to adjust to my new life. But my blood pressure remained high. For months I had been living in survival mode. I ate as I had during pregnancy, not thinking about sodium or macronutrients, and I felt more stressed. I lacked the capacity to focus on better nutrition or exercise.

But now that I was finding balance in other areas of my life, I felt ready to address the root causes of my high blood pressure.

I found a new doctor who was willing to focus on nutrition and exercise before increasing my medication. It was the ­motivation I needed to make a change.

Taking Back My Power

I began working with a nutritionist who recommended I reduce sodium and take a month off from eating out. To follow this advice, my husband and I became more intentional about grocery shopping. I focused on produce and meat and was mindful of food labels. On Sundays, I prepped food for the week ahead.

I also made exercise a priority. I’d been athletic as a child and young adult: I played basketball and volleyball in high school and continued with basketball through college. But fitness took a back seat after I graduated. With my health on the line, it was time to tune in to my once-active spirit. I started by attending fitness classes two or three times a week.

Although ­results came slowly and gradually, I never felt like I was sacrificing. I maintained a regular workout routine; chose whole foods over processed ones; modified portion sizes to match my nutritional needs; opted for a salad over a burger when I ate out; and ­requested one pump of syrup instead of two in my ­coffee drink.

It all took about 18 months, but I was committed. Consistency was more important than a quick fix.

By fall 2018, my blood pressure had normalized and I had lost 75 pounds.

My doctor said I could go off the meds — cold turkey. My blood pressure was stable when I saw him again a month later, and it’s remained stable ever since. Today, it’s in the range of 110–120/80, and I only see my doctor once a year for a wellness exam.

I now know what my body needs to be healthy.

Reaching and Keeping the Goal

My goals have changed since my blood pressure stabilized. In 2018, I joined Life Time, motivated by the amenities offered for children. Sarai was an active toddler by then, and I wanted her to learn how to have fun with fitness at a young age.

I started working with a personal trainer who created a routine that I can adjust as needed. I add more yoga classes during stressful times. I’ve also trained for and competed in a variety of races, including obstacle-course events and a half-marathon. I like the opportunity to modify my training and connect with other people in the fitness community.

I love being active with Sarai, who is now 10. We like to throw the football or shoot hoops together, and I’ll run alongside while she bikes.

Nutrition is an important part of our lives, and my husband and I have ­incorporated the phrase “nutrient-dense foods” into the family vocabulary. I hope my journey ­teaches Sarai she has the power to take control of her physical, mental, and spiritual health.

I’m also preparing to return to medical school. I hope to join an emerging field of physician nutrition specialists who work with patients with chronic disease. My dream is to run my own team and conduct research that incorporates nutrition. I want to help more patients learn how to improve their health outcomes through manageable lifestyle adjustments — like I was able to do for myself.

Michelle’s Top 3 Takeaways

1. Take control of your health. “I was waiting on doctors to cure me, until I realized I had to partner with my doctor and help myself,” says Michelle.

2. Take hypertension seriously. “What starts with obesity and hypertension becomes cardiac disease, then kidney disease, [and this can] lead to death. Try to prevent that early on.”

3. Make small changes over time. We often expect a quick snapback after birth, she notes. Huge change is not realistic. Reach the goal, then keep the goal.

This article originally appeared as “Easing the Pressure” in the the July/August 2025 issue of Experience Life.

In my late 30s, I was in the best shape of my life, cycling 20 to 30 miles daily, pumping iron regularly, and eating a plant-forward Mediterranean diet. Digestive issues I’d been dealing with had dissipated, and I was sleeping well after years of insomnia. I felt healthier than ever.

Imagine my surprise when my doctor told me I was overweight.

Many of us have faced this puzzling experience. Definitions of overweight and obesity often stem from misleading metrics such as the body mass index (BMI) my doctor used. These classifications can lead to a range of misunderstandings about what a higher body weight means for your health — not to mention the significant stress of being told you’re unhealthy solely because of your weight.

Given this confusion, some healthcare providers are turning to other metrics, including measurements of metabolic health, to determine whether a patient’s weight poses a health risk. They may deploy tests that measure stress hormones, glucose regulation, hormonal balance, thyroid and gut health, and inflammation, all of which affect how well your body converts food into energy and offer insight into your metabolic functioning.

The questions that follow examine why a metabolic framework for obesity might be a better starting point for determining the true status of your health.

Why do we gain weight?

While we typically assume weight gain is primarily about dietary choices — and they certainly can play a role — it can be influenced by a variety of factors. These include genetics, hormone dysregulation, sleep, stress, and certain medications.

Researchers are also investigating the role played by exposure to environmental toxins, sometimes called “obesogens.” These chemicals are often found in everyday items and include bisphenol A (BPA), which is employed in making plastics, and phthalates, endocrine disruptors commonly used in personal-care products. They can disrupt the body’s normal metabolic processes and endocrine function, promoting fat accumulation.

Excess weight can contribute to impaired cardiovascular function, joint stress, and breathing challenges, like sleep apnea. These physical impacts can be significant. Still, weight alone doesn’t provide a complete picture of a person’s overall metabolic health.

What’s wrong with relying on BMI as a measure of weight health?

Your body mass index is the measure of your weight in kilograms divided by the square of your height in meters. It’s widely used by healthcare providers to classify people as underweight, normal weight, overweight, or obese. (Learn more at “Beyond BMI: Why True Health Is About More Than What You Weigh.”)

“Physicians typically use BMI to measure a patient’s ‘weight health,’” explains Stewart Lonky, MD, in his book, Outsmarting Obesity: A Doctor Reveals Why We Gain Weight, Why It Matters, and What We Can Do About It.

Yet BMI is a blunt tool with significant limitations. It was first developed in the early 19^th century — and updated by physiologist Ancel Keyes in 1972 — strictly as a research tool for measuring weight trends in populations. Neither of its creators were medical professionals, and they never intended BMI for medical use.

It was first developed in the early 19^th century — and updated by physiologist Ancel Keyes in 1972 — strictly as a research tool for measuring weight trends in populations. Neither of its creators were medical professionals, and they never intended BMI for medical use.

The original study in which BMI was used didn’t include women and most of its participants were white men. This means its current status as a universal metric misdiagnoses a wide diversity of body types.

Most importantly, BMI reveals nothing about body composition. “The most significant drawback of BMI is its inability to differentiate between fat and muscle,” explains Lonky. “While it’s not accurate to say that muscle weighs more than fat, it is denser. This density is why a cubic inch of muscle weighs more than a cubic inch of fat.”

In a recent paper published in The Lancet Diabetes and Endocrinology, a commission of global experts argue that BMI-based definitions lead to overdiagnosis and underdiagnosis, labeling people as unhealthy when they aren’t and missing those who may be at risk despite a “normal” BMI. This can result in poorer health outcomes for everyone.

For example, a fit, muscular athlete might have a BMI over 30, qualifying them as obese strictly because of their weight-to-height ratio. On the other hand, someone with a “healthy” BMI of less than 25 might have metabolically active visceral fat (more on why that matters later) that puts them at risk for cardiovascular disease.

In neither case does their BMI explain anything about their actual health status.

Does the location of fat matter?

Where fat is stored may be more indicative of its risks than weight alone. “BMI tells you nothing about body composition or where you’re putting on weight,” explains holistic nurse practitioner Monique Class, MS, APRN-BC.

Visceral fat stored around vital organs in the abdomen appears to be particularly risky. Unlike subcutaneous fat, which is stored under the skin, visceral fat is sometimes described as “metabolically active” because it can produce hormones and inflammatory molecules. Fat around the midsection has been associated with systemic inflammation, insulin resistance, and cardiovascular risks.

Visceral fat can also be an indication of metabolic syndrome, a cluster of conditions — including high blood pressure, high blood triglycerides, low levels of HDL cholesterol, and insulin resistance — that occurs together. Metabolic syndrome increases a person’s risk of heart disease, stroke, and type 2 diabetes.  (Listen as Jim LaValle, RPh, CCN, explains the factors that contribute to insulin resistance, how to measure and monitor blood sugar, and the habits we can adopt to manage blood sugar effectively at “Breaking Insulin Resistance: Your Guide to Blood-Sugar Mastery.”)

What is “metabolic obesity”?

The global commission of experts involved in The Lancet Diabetes and Endocrinology report recommend defining obesity through clinical signs — such as tissue and organ alterations — that better capture when excess fat genuinely impacts health. This definition ensures a more precise identification of those in need of intervention and could lead to more effective treatment.

This approach acknowledges that caloric intake or physical-activity level are not the only factors influencing a person’s metabolic health. Chronic stress, sleep quality, thyroid health, hormone regulation, gut health, and genetics all play an important role. Understanding the root causes of disruptions in metabolic health would be the focus of any intervention.

By this definition, a thin person with metabolic syndrome could be classifiably obese while a heavier person may or may not. What matters most are factors like insulin regulation, blood pressure, and cardiovascular function.

By focusing on metabolic health, clinicians can identify and address issues such as hormonal imbalances and the role of visceral fat in driving inflammation and cardiovascular risks.

Are there other ways to classify higher weight and obesity?

Some researchers classify weight metabolically using these phenotypes:

• Metabolically Unhealthy Normal Weight: People who have a BMI of between 18.5 and 24.9 but exhibit metabolic problems commonly associated with obesity or metabolic syndrome, such as insulin resistance and high blood pressure. Despite their lower weight, these individuals may face health risks due to underlying metabolic dysfunction.
• Metabolically Unhealthy Obesity (MUO): Individuals with high weight and additional metabolic complications, such as high blood pressure, insulin resistance, and abnormal cholesterol levels. MUO is associated with higher risks for cardiovascular disease and type 2 diabetes.
• Metabolically Healthy Obesity (MHO): People with a BMI over 30 without metabolic risk factors typically linked to obesity. Even if a person categorized as MHO has healthy metabolic markers, it’s important to manage those markers over time by remaining active and eating a quality diet. While MHO offers a lower immediate risk, studies have shown that up to 50 percent of individuals with MHO develop metabolic complications within a decade or so, driven by aging, weight gain, and declining insulin sensitivity.

Weight is only one aspect of overall metabolic health, so it’s important to recognize that the number on the scale tells the whole story. It makes perfect sense to question an obesity diagnosis, especially if it’s based on BMI, if you know you’re healthy, rested, and strong. The metabolic numbers are the ones that count.

There are several hypotheses about how UPFs harm the body, though there’s still no consensus about the exact mechanism that causes the damage. Still, the research is moving quickly, says Schmidt. “Finding . . . [that mechanism] is the holy grail of nutrition science right now.” These are some of those theories.

1) Calorie Density

In 2019, a study correlated UPFs and weight gain for the first time. The randomized controlled trial, conducted by the National Institutes of Health, divided 20 healthy adults into two groups. For two weeks, one group ate only ultraprocessed foods while the other ate foods that were minimally processed. Then the groups switched diets and continued for two more weeks.

To increase the study’s accuracy, participants lived at the research center. Their meals contained an identical number of calories and grams of sugar, fat, sodium, fiber, and macronutrients. At mealtimes, both groups had an hour to eat as much or as little as they chose.

Researchers found that the subjects who were eating the UPFs consumed about 500 calories more per day than those eating minimally processed foods. After two weeks, members of the UPF group had gained an average of about 2 pounds.

By the end, researchers found that the subjects who were eating the UPFs consumed about 500 calories more per day than those eating minimally processed foods. After two weeks, members of the UPF group had gained an average of about 2 pounds.

2) Speed of Digestion

The body perceives industrially processed foods as essentially prechewed and predigested. That perception produces a host of repercussions along the digestive tract, starting in the mouth. Studies have shown that the longer a food must be chewed before it’s swallowed, the more satisfying it is to eat and the fuller a person feels afterward.

Research has also shown that people who chew their food longer consume fewer calories. In the NIH study, participants eating the ultraprocessed diet swallowed more calories per minute than did their counterparts. The combined eating speed and caloric density is what led to the extra 500 calories a day.

When we eat whole foods, the foods’ cells don’t break down completely, explains Juul. She compares whole ­almonds and almond flour: Whole almonds involve some serious chewing. After you swallow, your body absorbs only about 75 percent of their calories, she says, because the nut’s structure is still partly intact.

Once almonds are turned into almond flour, a higher percentage of their calories is absorbed into the bloodstream. This speed of absorption affects everything from blood-sugar levels to satiety hormones.

Evidence has suggested that highly palatable foods can dampen the body’s satiety signals, which can lead to over­eating. As van Tulleken writes, “The signals that tell you to stop eating haven’t evolved to handle food this soft and ­easily digested.”

(After the gut, the mouth contains the most diverse microbial community in the body. As a result, the oral microbiome has a significant influence on your overall health. Learn more at “Everything You Need to Know About the Oral Microbiome.”)

3) Missing Nutrients

Studies suggest that UPFs are crowding out the nutrient-dense foods on our plates. In a 2021 meta-analysis, researchers noted a correlation between the increasing number of UPFs in meals and decreasing amounts of dietary fiber, protein, potassium, zinc, niacin, and vitamins A, C, D, E, and B12.

4) Novel Molecules

On a cellular level, nutrients exist in a certain structure within a food, and synergies exist between different nutrients and non-nutrients, says Juul. This is known as the food matrix, and it’s destroyed by industrial processing.

Our digestive system is designed to slowly and methodically break down a food’s matrix to glean the greatest nourishment for the body — and specifically for the microbiome.

Likewise, our signaling pathways evolved over millions of years to distinguish good molecules from bad. A molecule that is a shade different from one found in food can cause real problems with human chemistry, says Robert ­Rountree, MD, a Boulder, Colo.-based integrative family medicine practitioner. “Xenobiotic molecules gum up the works.”

5) Inflamed Gut

New evidence suggests that food ­additives, such as emulsifiers, thickeners, and artificial sweeteners, may cause gut inflammation. This can lead to a variety of gastrointestinal issues, including IBS.

Presently, more than 60 types of emulsifiers are used in UPFs, including polysorbate 80, carboxymethylcellulose, and carrageenan. Studies have found that mice exposed to these substances developed gut inflammation after 12 weeks.

There’s also a potential cocktail effect from multiple food additives in a single UPF, as well as in the many combinations that might be eaten in a handful of foods at one sitting.

“All of us are subjects in a food experiment that humans have never encountered before,” says Devries. “As a result, we are seeing a greater spectrum of digestive problems than have ever been observed before.”