Weight Loss – Not the Solution

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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22 thoughts on “Weight Loss – Not the Solution

  1. The joint issue really hits home for me. I used to be a runner then I started having really bad hip issues to the point that i could not walk up the stairs. One of the doctors i went to told me that the hip pain was from the excess weight. Then he told me to stop running until I lost weight. That was his answer. When I questioned him further he actually said to me that it would be better if I put off all exercise until I could get the weight off. !!!! Yeah, I was left feeling very confused. How do I get the weight off if I am being told not to move? Not that I was even trying to lose weight at that time, mind you. This was the same doctor who gave me a very odd look when I told him I had no problem with the way I looked. And while I’ve come a long way in accepting my fat self, I so wish I could erase that look from my memory.

    So, I went to another doctor. She was totally cool about it. She said it was not my weight and actually rolled her eyes at that notion! She said it was most likely bursitis and that there was a very high chance it was related to the fact that I have auto-immune thyroid disease. She said if the running seemed to be what was causing it to flare up that maybe I should cut back on running but that I shouldn’t quit all together if it is something I like to do (I do 5k fun runs with my oldest son and I didn’t want to give those up) she told me to absolutely not give those up. Then when I mentioned I also do kickboxing, she said she’d recommend giving up a few runs a week in favor of the kickboxing because the motions work different areas and actually might strengthen my hips. I did what she said and I’m doing soooo much better. I didn’t quit exercise all together and I didn’t have to stop running and when I do run, I have less hip pain than I had before. Such an easy solution and yet that other doctor was just ready to write me off.

    1. I went to a weight loss clinic that told me not to exercise until I was at goal. SO STUPID! Their point was that they didn’t want muscle gain to screw up the stats. WTF? I can’t think of a reason more ridiculous to sit on my couch. I am no where near goal (yes, I am losing weight so maybe shouldn’t be posting) but am more excited that i am out there doing things like 5ks, stair climbs, and even a half marathon.

  2. I recently started going to the gym most days. I have lost a little weight, perhaps a dress size. But I have now got great muscles. People still think I am unfit and unhealthy because I am fat. It gives me great pleasure when they suddenly realise I am physically fitter than they are, despite my size and spinal injury!

  3. For some reason, I am reminded of the first time I went to Weight Watchers (yes, first of probably 7) and the leader told someone to get a different job when the woman said work got in the way of eating the WW diet. This was before points and all that crap. Even then my thought was, “WTF?! Change jobs to lose weight?!” I should have listened to myself back then and saved tons of money and tons of rebound weight!

  4. Because as we know, only fat people get joint-and-muscle pain! And if they haven’t gotten it, it’s just because they’re not old yet!
    Uh… No.
    I’m thin and 21 years old. I’m currently curled up in a ball on the couch, waiting for the ibuprofen to kick in because my back-and-joint pain is SO BAD today. (I really need to see a physical therapist. Uuurgh, health insurance).
    So yeah, thin people have joint problems too.

  5. Hi Ragen, I agree whole heartedly. It’s ironic to note though that when I clicked thru to the More magazine article, the banner ad above it was “Chelsea lost 145 pounds with Slimband – click here to find out more.”

  6. First of all, this entry is amazing. Thank you, Ragen!

    Secondly, “I’m also not that interested in dating someone who wouldn’t date me as I look now.” Thank you! I’ve been saying this for YEARS, but none of my friends get it. Even if I did lose all that weight and keep it off, I’d still be completely resentful that my supposed “soulmate” was not or would not have been interested in me as a fat person. Thanks, but not thanks, rather have someone who likes me for me!

  7. Hello! I loved the hypothetical story about the four women who went to the doctor… this is what I’ve tried to explain to others before as well. Why encourage people to harm themselves in the pursuit of superficial beauty masked as good health?

    The MORE.com article was also great also, in its message that obviously it is better to promote HEATHLY LIFESTYLE than weight loss. I hope people reading this entry are following that link. I recently started going to Overeaters Anonymous meetings because I truly do have an unhealthy relationship to food. Specifically, I binge. It is harmful to my digestive system, it doesn’t make me feel good, and yet I compulsively do it. I would like to learn how to not do this. I would like to learn how to not think about food obsessively. But of course, even at O.A. this culture of weight loss=success persists. I just want support for my food addiction. I don’t want to have a sponsor tell me I have to engage in other neurotic food behaviors like weighing everything I eat! (How’s that going to keep me from constantly thinking about food???)

    In O.A. instead of how many pounds a person has lost they say I’ve “released such-and-such number of pounds.” I had a woman tell me that as I’m trying to find a good sponsor for me, one question I might want to ask is how many pounds she’s “released.” As if that is a measure of how healthy she now is in her relationship with food. I would like to have a sponsor, because it would be great to have the support, but I feel like it will be difficult to find someone who isn’t of this “weight loss is everything” mentality.

    1. that makes me sad. Keep looking for the right doctor. I have found one after having one for years that told me I should have WLS…something I oppose for me. I want to be healthy and I am not convinced that being healthy means a certain number on the scale. My current doctor is very supportive all the workouts I do and is constantly trying to help me meet my physical challenges.

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