The American Heart Association, the American College of Cardiology, and the Obesity Society released new guidelines urging doctors to be “more aggressive” in urging fat patients to lose weight. I don’t know what doctors other people go to, but the doctors who I see couldn’t get any more aggressive unless they started threatening me with a weapon.
But what do they mean by “aggressive?” The guidelines are [trigger warning]:
- At least once year, calculate patients’ BMI, measure their waists and tell them if they are overweight or obese.
- Develop a weight-loss plan that includes exercise and moderate calorie-cutting.
- Consider recommending weight-loss surgery for patients with a BMI of 40 or for those with a BMI of 35 who also have two other risk factors for heart disease such as diabetes or high blood pressure.
- Refer overweight and obese patients who are headed for heart problems to weight-loss programs. Specifically, discuss enrolling them in at least 14 face-to-face counseling sessions over six months with a registered dietitian, psychologist or other professional with training in weight management.
First of all, BMI and waist circumference are not measures of health at all, the suggestion that doctors should recommend any intervention based on these numbers is highly problematic, especially with so many studies that show that habits, not body size are the best determinant of health.
Even if weight loss was a health intervention (and I don’t believe it is), there is not a single study where more than a tiny fraction of people have maintained long term weight loss. Weight loss simply does not meet the requirements for evidence based medicine doctors attempting to “develop a weight-loss plan that includes exercise and moderate calorie-cutting” will be repeating an intervention that has been nearly completely unsuccessful in every study that exists. Most people will lose weight in the short term and, when their body adjusts, they will gain the weight back and many will gain back more than they lost. Prescribing something that a mountain of research has told us almost never works, and telling people that everyone who tries hard enough succeeds, absolutely defies medical ethics.
Weight loss surgery is dangerous including horrific life-changing complications, and a seriuosly increased chance of death and the evidence for efficacy is dubious at best: “most comprehensive independent review of bariatric surgery, conducted by the Emergency Care Research Institute, a nonprofit health services research agency, examined evidence from seventy studies. The investigators reported that while significant weight loss occurred, patients still remain obese. However, they noted that the evidence demonstrating that associated diseases improved was weak, and it was not evident that surgery resolved heart disease or extended life span. They report that claims of improved “quality of life and long-term health impacts are less conclusive.”
Oh, and that counseling? “The panel [that recommended the counseling intervention] acknowledged that one problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.” Why are medical professionals so willing to let go of the concept of evidence-based medicine when it comes to fat people? Not to mention the idea that someone’s height to weight ratio suggests that they need counseling is highly problematic. This is about trying to force fat people to be the non-consenting participants in experimental medicine and blaming us when, like almost every time of the many, many times before, the experiment fails.
You all know that I do not ever want to tell you how to live or what to do (unless I’m telling you not to try to steal other people’s civil rights by an inappropriate use of power and privilege). That said, I want to implore you to please speak up against this if you in a position to be able to. This is not our fault but it becomes our problem and in my experience the way to change things is for those of us who can speak up against it, to speak up against it.
When the doctor suggests counseling or a diet intervention, we can demand the evidence that it will 1. lead to long term weight loss of the amount that they suggest you need to lose and 2. that the weight loss will cause the health improvements that they are suggesting. They will not be able to provide us with this because it does not exist. There is no study showing that even the tiny fraction of people who manage to maintain weight loss actually have improved health because of it.
If the doctor suggests weight loss surgery ask about the increased mortality rate,or if they can guarantee that you will not experience horrific side effects, or just tell them that you refuse to be have your vital organs mutilated or amputated for a surgery that brings no guarantees of long term weight loss or improved health, and often results in the opposite.
Demand health interventions (not body size interventions) for health problems, ask if thin people get this health problem (Pro-tip: they do), ask what they prescribe to thin people, insist on that intervention. Yes, even if the problem is with your joints.
We have the right to refuse to be the subjects of experimental medicine. We have the right to demand evidence-based medicine and the evidence basis for interventions the doctor prescribes. We have the right to be treated as individual patients and not ratios of weight and height.
If you want more information on how to talk to your doctor, including some practice, I’m teaching an online class this Saturday the 23rd from 12-2pm Pacific. The class will include scripting to use with your doctor, a discussion of patient rights, the research on weight and health, and optional chances to practice, ask questions, and role play. You can join by audio, or video and participate or just listen in. There are only 8 slots, and the class is $35 ($15 for danceswithfat members). You can sign up here. If there on no spots left just shoot me an e-mail at firstname.lastname@example.org and I’ll get you on the list for first dibs on the next class.
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