We’ve discussed why obesity is not the problem. As I talked about in that blog, obesity is scapegoated as the root cause of many problems so it then follows that weight loss is touted as the solution to all those problems and more.
I’ve heard people say that weight loss is the cure to everything from being single to having strep throat. That last one was from a doctor to me. It resulted in me saying, with as much incredulity as I could muster (which, it turns out, is a lot), “You are trying to tell me that I have obesity induced strep throat?” His response was “well, losing weight couldn’t hurt the strep”. Let’s take a look at this phenomenon and why I think it’s the wrong way to go:
Weight Loss as a Cure for Social Stigma
People are told all the time that the way to get a job, get a partner, be happy is to lose weight. Once again, I know unemployed, single, miserable thin people so right there I already know that my problems will probably all be waiting for me at the bottom of the BMI range.
I’m also not that interested in dating someone who wouldn’t date me as I look now. Since most people who lose weight gain it back within 5 year it seems like losing weight and getting married to someone whose love for you is contingent upon your body size sets you up for a pretty tragic scene 5 years from now.
In these arguments weight loss is a proxy for social acceptance. The argument they are making is actually “Society stigmatizes you because you are fat, we think it’s possible for you to look the way that we think you should look, and so it’s your responsibility to do that and then we will
stop bullying you find something else to bully you about. Otherwise it’s your own fault.”
In this case there are definitely some benefits that are gained from being aesthetically pleasing to society and I would never begrudge someone who is trying to reap those benefits. But while it’s true that giving the bullies your lunch money may save you from some beatings, the cure for social stigma is not weight loss. Instead of all fat people losing weight, all people who have a bias against fat people could pull their heads out of their asses and it would have the same effect. Also, while there is no intervention proven to lead to successful long-term weight loss, a colo-rectal head extraction does seem possible for most people.
Weight Loss as a Proxy for Healthy Behaviors
Healthy is multidimensional, not entirely within our control, not a barometer of worthiness, not an obligation, and not anybody else’s business. In the much exaggerated case against obesity, weight is used as a proxy for health. Similarly, when people prescribe weight loss as a cure for something, they are typically using weight loss as a proxy for behavior change.
For example: Four women go to the doctor and present with elevated blood glucose. They are told that they need to lose weight.
The first woman goes on a crash diet and drops her calories but eats mostly carbohydrates, she goes a long time between meals and doesn’t eat regularly. She may lose weight (at least initially) but it’s unlikely that her glucose would be controlled.
A second woman gets liposuction. She would lose weight but would not likely see a change in her blood glucose.
A third woman becomes addicted to Crystal Meth. She loses a ton of weight, but this intervention helps only in as much as her blood glucose level is now the least of her problems.
The fourth woman changes her eating habits in ways that support blood glucose control. She also increases the amount of movement she does. This may result in no weight loss, or in a bit of weight loss that she regains over time, but we would likely see a positive change in her blood glucose levels.
Weight loss (making your body smaller) is not what has an effect on your health. It’s the changes in actual behaviors that can can create health changes. Weight loss is a possible, but not guaranteed, and in almost all cases short term, side effect of these behavior changes.
Additionally we need to take into account factors such as past behaviors, environment, stress level and genetics and realize that our health is not entirely in our control. We also need to realize that measures of health, not weight, are what determine if a health intervention is working. Using weight loss to determine the efficacy of a high blood sugar intervention is the exact same thing as using weight loss to judge how successful a round of chemo is. It makes no sense to do that when we can clearly measure the health impact of the intervention.
Let’s Talk About Joints Baby (to the tune of Salt N’ Pepa’s “Let’s Talk About Sex”)
Ok, cheesy 90′s songs aside, this is one I hear a lot – the body can’t take this much weight, at some point if you’re fat you’re going to have joint trouble, I have to lose weight to solve my knee pain etc.
First, let’s realize that thin people get joint pain and are not prescribed weight loss, so if I’m experiencing joint pain I’m going to ask how they would treat it in a thin person. Joints do not work alone, while you can try to put less stress on them by losing weight, you could also strengthen the muscles around them, correct any muscle imbalances or issues (like a tight IT band) that may be pulling them out of alignment, and work to correct movement patterns that put undue stress on them (interventions that, unlike weight loss, actually have a good chance of actually working).
Besides, Weight Loss Rarely Works
Every time I talk about this here someone leaves a comment that says “Please stop saying that, everyone knows that weight loss is possible if you just eat less and exercise more” which I delete because if the internet had existed in the 1600′s I’ll bet that Galileo would have been a blogger and would have had to deal commenters saying “Shut up Galileo, everyone knows that the sun revolves around the Earth” and I would hope that he would have deleted those comments and continued with his work. While I’m no Galileo, I think that it’s extremely important to point out areas where our conclusions don’t match our data.
When I say that weight loss rarely works, that’s not me guessing, or my uninformed opinion, or stuff I’m saying just to irritate the fat haters (that’s just a side benefit). It is my understanding as a trained researcher who is looking at the actual research. But don’t just take my word for it. Check out this great article featuring the brilliant Dr. Linda Bacon in More magazine. She talks about the case against weight loss as seen in the research, and why the idea that weight loss “couldn’t hurt might help” is erroneous and dangerous.
So it turns out that instead of weight loss being the cure for everything, it’s actually not the cure for anything. To me the bottom line is that we need to remove weight from the health conversation. The only people benefiting from the conflation of weight and health are the Diet Industry who make 60 billion dollars a year selling a product that almost never works. I’d like to see us take our health and money out of their wallets and accomplish some other things with 60 billion dollars a year.
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I do size acceptance activism full time. A lot what I do, like answering over 4,000 e-mails from readers each month, giving talks to groups who can’t afford to pay, and running projects like the Georgia Billboard Campaign etc. is unpaid, so I created a membership program so that people who read the blog and feel they get value out of it and want to support the work I do can become members for ten bucks a month To make that even cooler, I’ve now added a component called “DancesWithFat Deals” which are special deals to my members from size positive merchants. Once you are a member I send out an e-mail once a month with the various deals and how to redeem them – your contact info always stays completely private.
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