Body image activists push a message of acceptance and self-love, even for people carrying around extra weight.

On social media, where this appreciation and affection for one’s self can wane with the better-than-perfect images so many people present, these activists fight back with hashtag campaigns such as #loveyourbody and #positivebodyimage.

The idea is to help promote appreciation for the skin you’re in, to learn to love yourself exactly as you are.

The message is optimistic and uplifting, but it carries with it several possible negative consequences.

Two of these concerns are the “healthy obesity” and “fat but fit” monikers that researchers say do overweight and obese individuals a disservice for their health and future.

A British study found that only about 10 percent of obese people in Britain know they are overweight.

Participants in the study were asked to self-report their height and weight and classify where these factors put them in a weight category. Options included very underweight, underweight, about right, overweight, very overweight, obese.

Only 10 percent of people who were clinically obese put themselves into that category.

Additionally, only 10 percent of people in the study knew what their body mass index (BMI) was and what it meant for their health. People who did know their BMI, the researchers said, were more likely to classify themselves as obese.

Do people not know they are overweight or obese? Or are they in denial about a problem that feels too overwhelming to tackle?

Both possibilities are likely, the researchers in this study concluded.

Many people who have problems managing their weight may be in denial about what their scale number really means. Likewise, they may have difficulty grasping what a weight issue looks or feels like because reliable indicators are few and far between.

“I have dealt with many individuals who are in denial about their state of health,” Mitchell Zandes, MS, RD, CSCS, a clinical dietitian and personal trainer, told Healthline. “I find this to be particularly true when patients compare themselves to their family members and friends, who may also be overweight or obese.”

The findings of this study point to a larger problem that doctors and weight-loss experts continue to struggle with when caring for their patients. The measurements and markers for knowing who is overweight or has obesity are difficult to understand, even for people with years of experience.

BMI has been the gold standard for weight measurements for decades, but it has come under fire in recent years as experts look for a more recognizable way to understand a person’s weight status.

“Not even the most qualified experts truly understand obesity,” said Chris Shuff, RDN, LDN, a certified specialist of obesity and weight management. “So patients certainly don’t. It’s an issue with millions of variables that’s so complex and winds through every facet of someone’s life.”

The problem with BMI

According to the Centers for Disease Control and Prevention (CDC), one in three adults in the United States is overweight.

Additionally, one in three U.S. adults has obesity.

That means two-thirds of American adults are overweight or have obesity.

These classifications are set by BMI measurements. A BMI number is designed to give you an idea of how much body fat you have as a ratio to your height and weight.

It’s measured by taking your weight in kilograms and dividing it by your height in meters squared.

A reading over 30 means you’re obese. A reading over 40 is extreme obesity.

Confused yet? You’re not alone.

“BMI can be a difficult way for the common person to know their degree of overweight or obesity,” Shuff told Healthline.

Additionally, BMI can’t take into account muscle you might be carrying, which means false readings are possible.

“BMI is not useful to measure an individual’s health,” said Dr. Charlie Seltzer, a weight loss expert who is board certified in obesity medicine and certified by the American College of Sports Medicine as a clinical exercise specialist. “By BMI standards, most NFL running backs are obese. In addition, I have found that doctors come off as judgmental when they say things like, ‘Well, your BMI says you’re obese.’”

The consequences of weight

The increasing weight of the average American carries with it real consequences for today and for the future.

Metabolically healthy obesity (MHO) is a term used for individuals who are overweight or obese but have no indications of health issues, such as increased insulin levels or high cholesterol.

But a new study in the Journal of the American College of Cardiology says overweight individuals shouldn’t hang their hats on those readings.

The researchers found that MHO isn’t a reliable indicator for future health. In fact, slightly less than half of the people in the study who had MHO developed metabolic syndrome within 10 years.

Metabolic syndrome puts you at an increased risk for cardiovascular disease, diabetes, and other health complications.

Likewise, a study from Imperial College London and the University of Cambridge found that obese individuals with normal blood pressure, cholesterol, and blood sugar levels were about 28 percent more likely to develop heart disease than people with a healthy weight.

These studies point to the impending issues many overweight or obese individuals will face, regardless of their current health.

That’s why doctors and dietitians are working to craft more useful ways to help their patients understand obesity and weight issues.

5 ways to know if you’re overweight

These five methods may be easier to use and understand than a BMI reading.

The experts Healthline interviewed say they hope these encourage more individuals to seek help with their weight issues and have an honest discussion with their doctor.

Waist measurement

The best way to tell if you’re at a healthy weight is from your waist size, says Michelle Routhenstein, MS, RD, CDE, CDN, the owner of Entirely Nourished, a nutrition counseling and consulting private practice.

“A waist circumference greater than 35 inches in women and greater than 40 inches in men could not only determine overweight status but put a hard-and-fast number on one’s health,” she told Healthline.

“Waist circumference above these numbers indicates excessive belly fat, a dangerous type of fat surrounding vital organs, which increases one’s risk of diabetes, high cholesterol, high blood pressure, and the metabolic syndrome.”

It’s also an easy-to-understand tool, Zandes says.

“The advantage of this tool is that it is quick to perform and is a rather reliable predictor of risk for type 2 diabetes, hypertension, and heart disease,” he told Healthline.

To measure your waist circumference, Routhenstein says all you need is a measuring tape.

“Place it on the top of your hip bone, bringing it around your body and level with your belly button,” she said.

Resist the temptation to suck in, and don’t make the tape too snug. An inaccurate reading only hurts you.

Snoring

“If your partner, best friend, or even you notice excessive snoring and you wake up restless, it may be a good reason to check your weight,” Routhenstein said. “If you snore frequently and rarely get a good night’s sleep, you may suffer from sleep apnea.”

Sleep apnea is a condition that causes your breathing to repeatedly stop and start again when you’re sleeping. It can cause loss of oxygen and extreme fatigue during waking hours.

“When your body stores fat around the neck, it may narrow the airway causing shallow breathing or pauses in breathing,” Routhenstein said.

Frequent heartburn

Changes in your body weight, even slight ones, can lead to more acid reflux, Shuff says.

More than one-third of overweight and obese individuals experience gastroesophageal reflux disease (GERD).

Other symptoms of this condition include belching, nausea, a bitter taste in your mouth, and abdominal pain.

Achy joints

Obesity is a risk factor for osteoarthritis, the most common type of arthritis.

Osteoarthritis is a disabling disorder that leads to joint deterioration, pain, decreased joint mobility, and a reduced quality of life.

Carrying around extra weight applies increasing levels of pressure on all of your joints, and as you gain weight, the pressure climbs.

If you have achy knees or hips, or chronic back pain, you may be experiencing signs of a weight problem.

Chronic fatigue

Excess weight puts additional pressure on your organs, including your lungs.

If simple tasks, such as tying your shoes or cleaning a room, lead to fatigue, shortness of breath, or difficulty breathing, you may have a weight problem.

Likewise, overweight and obese individuals have a greater risk of developing asthma.

People with weight problems may experience chronic inflammation because of the excess weight. This may lead to inflammation in airways and can make breathing more difficult.

Where to look for help

Weight gain often happens slowly, Seltzer says.

“You add a couple of pounds here, a couple of pounds there. Even just five pounds per year adds up,” he said. “People don’t recognize the slow creep of weight gain, and when you’re looking at yourself every day, it’s hard to see.”

Seltzer says most people see themselves in a picture from 5 or 10 years before, and that’s what brings them in — realizing how slowly the weight has piled on.

“A lot of people would be offended if a doctor told them they were overweight or obese,” he said.

“My experience has been different from that. You don’t ask someone directly. You instead ask, ‘Are you happy with your weight?’ Sometimes patients want help, but they’re afraid to ask.”

Starting the conversation is difficult for both patient and doctor. Doctors rarely have the time to dedicate to a lengthy discussion about weight, weight loss, and the risks of obesity, according to Seltzer.

In a five-minute appointment, it’s easy for both patient and doctor to ignore the obvious weight issue and instead focus on the immediate need.

In the future, however, the weight issue may rear its head if the reason you’re visiting is because of the impact of excess weight on your body.

Routhenstein advises opening up to the discomfort of the conversation, seeking out the healthcare provider you believe can help you, and being ready for a broad and far-reaching conversation.

“It’s important for the doctor or dietitian to have an open and honest conversation about weight and what it means for that individual,” Routhenstein said.

“It is important for the patient to have a thorough assessment that includes a waist circumference reading to determine where the weight is, medical history, social history, and blood work that includes diabetes screening, lipid panel, and patient specifics that may cause increases in weight.”