NHS – Just Give Fat People a Pony Already

Bad DoctorThe National Institute for Health and Care Excellence (NICE) is suggesting that the NHS send fat people to so-called “lifestyle weight management programs” like  Weight Watchers. They claim that it will save money because people who are overweight or obese can enjoy “significant health benefits” by losing 3% of their weight.


Carol Weir, guidance developer for Nice and head of nutrition and dietetics at Leeds Community Healthcare NHS Trust, said “Obviously, if you need to lose weight, the more weight you lose the better, and the health benefits derive from that, but even a 3% loss, kept up long term, is beneficial and that is why we are recommending sensible changes that can be sustained life long.”


Too bad she doesn’t have any actual evidence to back up her claims.  This is one of the consistent problems with health professionals and weight loss, they are happy to say that sustained weight loss is possible despite the fact that there is no study that exists that shows that significant weight loss can be sustained for more than five years for more than a tiny fraction of people.  They are also happy to claim that weight loss leads to health improvements even though there is no evidence for that either.

Even the Look AHEAD study, which included fat people with Type 2 Diabetes, and managed to get those people to maintain a 5% weight loss for four years was cancelled for futility because of the lack of cardiovascular health improvements.  Mann and Tomiyma’s 2013 study also failed to find a causal link between weight loss and health improvements.

The idea that there is a percentage of weight loss that will lead to better health for all fat people is a long perpetuated farce. As Mann and Tomiyama point out in a great article about this,  the claim started with very specific height weight ratio, but people failed to diet into those categories, then:

In the absence of more effective diets to recommend, researchers simply changed the definition of success. Their new standard was to lose 20 percent of one’s starting weight. However, a review of diets from that era found that only 5 percent of obese dieters succeeded even by that definition. The solution? Change the definition again.

Eventually, the medical community settled on the current standard of losing just 5 percent of one’s starting weight, despite having no scientifically-supported medical reason for doing so. As a result, dieters can be deemed successful without achieving notable amounts of weight loss or, as in the Look AHEAD trial, meaningful improvements in cardiovascular health. And remember that the majority of dieters do not even lose enough weight to meet this ineffectual standard.

Now we’re down to 3%.  So it turns out that going from 284 pounds to 275.48 pounds is probably not the key to my long term health, color me absolutely not surprised.

In addition to the irresponsible and misguided recommendation of diets to improve health, NICE recommends the irresponsible and misguided use of Body Mass Index (BMI) by doctors to determine eligibility.  It’s like they are trying to prove that they aren’t competent to make these recommendations.  If it means anything to you NICE, I believe that you’re incompetent, you can stop trying so hard to prove it.

What NICE is doing amounts to recommending a treatment that nobody has proven is possible for a reason nobody has proven is valid. If we’re going to do that, then might I suggest once again that they just give every fat person a pony – it has the same chance of leading to thinness or health (two separate things) as NICE’s recommendation, but when it doesn’t work, the fat people will still have a pony. Or maybe a pet of their choice?  Or maybe just not having to attend Weight Watcher’s meetings is enough.

This has to stop.  Doctors have to stop confusing body size with health and they absolutely MUST stop recommending what is at best experimental treatment to fat people as if it’s a proven intervention, denying us both evidence-based medicine and informed consent.  If they are going to do that I’d much rather they just give me a pony and be done with it.

Like the blog?  Consider becoming a member! For ten bucks a month you can support size diversity activism, help keep the blog ad free, and get deals from size positive businesses as a thank you.

What do member fees support?  I get hundreds of requests a day (not including hatemail) from academic to deeply personal. I get paid for some of my speaking and writing (and do both on a sliding scale to keep it affordable), but a lot of the work I do isn’t paid so member support makes it possible (and let me just give a huge THANK YOU to my members, I really can’t tell you how much I appreciate your support!)   Click here for details

Here’s more cool stuff:

Are you looking for a way to do some fun movement this summer (and get prizes for it?)  Consider a Fit Fatty Virtual Summer Vacation!

My Book:  Fat:  The Owner’s Manual  The E-Book is Name Your Own Price! Click here for detail

Dance Classes:  Buy the Dance Class DVDs or download individual classes – Every Body Dance Now! Click here for details 

If you are uncomfortable with my selling things on this site, you are invited to check out this post



33 thoughts on “NHS – Just Give Fat People a Pony Already

  1. I, too, believe in the incompetence of NICE. Please, for the love of catfish, STOP PROVING IT, NICE!


    Sorry for the cranky, but not only is this so damn old and infuriating it makes my liver snap, but my coffeemaker chose this morning to die a sudden, random death so I don’t even have sweet, sweet caffeine to help me face the stupid.

    1. I’m so sorry, had I known about the state of your coffeemaker I would have absolutely blogged about fluffy bunnies and rainbows!  I hope that your caffeine acquisition is swift and satisfying!



    2. Our Keurig machine died a few months ago too. I tried it again a week ago, but no luck. So we’re just going to get a regular coffee machine again.

  2. So… with this 3% number, is that their recommendation regardless of starting weight?

    And… when I am still obese AFTER losing 3% do they then tell me I need to lose another 3% and another 3%?

    There is NOTHING in the recommendation which makes sense EVEN IF the initial premise of weight loss = better health held up.

    1. Ya, nothing will make them happy. I’ve gone in with 10-20 percent weight loss and gotten the same speech about losing 20 percent from the same doctor. Look at my charts!!!

    2. I had a doctor who I have since fired tell me that the timing of one of my pregnancies was determined by my having reduced my body weight by 5 to 7 percent (can’t recall the exact figure since I gleefully dumped it down the memory hole, but it was small). She couldn’t explain how it worked, but she assumed that the weight lost was all fat and the fat was somewhere where it was, I dunno, trapping sperm or something.

      Knowing what I know now about where the initial weight loss comes from, I think that if my brief weight reduction had any effect, it was because I was less bloated for some reason. Better nutrition = less fluid retention, perhaps, or more activity = better circulation. Tissue health and circulation are factors that can actually affect the lining of the uterus. Butt fat, not so much!

      1. Wait…does this mean that women can go off the pill, etc. if they gain 5-7%? This is wonderful! Replace daily meds or devices with their own issues with… delicious foods? (I mean, if you’re gonna gain you might as well enjoy it & make the foods delicious!) My daughter has been having problems with her IUD & she will love to hear this!

  3. The pony is going to be a problem….it might be or GET fat, and then who is going to get the blame?

    Go to a pet-store (I go frequently, have 5 dogs—haven’t received my pony yet) and you’ll see the crates to keep dogs cooped up RIGHT next to the weight management animal food. Ridiculous!

    Animals too, need to eat and get to run around and play.

    Ok, sorry for the mini-rant. Back to your regularly scheduled comments…..

  4. If I’m going to be responsible for a large smelly animal whose food I’m allergic to, they damn well be giving me a horse. I rode a pony once, it was as unsatisfying as those 100 calorie packs that dessert & snack companies sell. A horse, on the other hand, can be a lot of fun to ride; I might not make their stupid 3% weight loss, but I’d enjoy the health benefits of regular exercise!

  5. Yeah, that 3% weight loss isn’t going to be enough for them. Once you’ve lost that, they’ll want you to lose another 3%, and then another 3%, and on and on until you get to the weight they think you should be. It’s just another carrot-and-stick approach to shaming and blaming fat people – “What?! You can’t even manage to lose 3% of your body weight? What’s wrong with you? Are you a glutton, or lazy, or do you just not care about your health?’ Been there done that and said good-bye to that years ago.

  6. I don’t know if anyone else remembers Lewis’ _That Hideous Strength_, but in that book, the National Institute for Coordinated Experiments were the bad guys.

    1. In all seriousness, Percherons are a lot of fun to ride. And I downright fell in love with a spotted draft horse a couple summers ago. 😉

    2. When I was young I wanted a Morgan (based on some fictional book I read in which the horse hero was a Morgan). Now, I think I would like a menagerie of miniature livestock–horses, donkeys, bantam hens, mini pigs. And fainting goats. If NHS will send them to an American, I’ll gladly give them my address 🙂

  7. Show me the evidence has become my go to response whenever anyone, be they medical, friend or stranger starts in on the weight loss talk. Then I helpfully tell them “Everyone knows” is not evidence. I even do the finger quotes to help them get the point.

  8. And, turns out there is evidence that pet ownership (one assumes ponies are included) can improve your health – here’s the top two articles that came up when I googled “How do pets improve your health” – with sources!



    I haven’t read the sources, but I’m willing to bet those studies are more reliable and results are more stable past the 5 year mark!

    1. I was actually thinking about that. However, ponies are high-maintenance; they take a lot of time and money to maintain, so the added stress might outweigh the benefits for many people. They should just give everyone a cat. I can’t think of a pet that requires less time and effort to take care of.

    1. Thank you for highlighting that! I just found the article and left an appalled response. I cannot get my head around the fact that someone thought that doctors should push this. CAN. NOT.

  9. NICE seems to be somewhat crazy to me, starting for the fact that they use BMI as something valid to measure health.
    In addition to their intent of reducing the BMI “overweight” category to a BMI of 23, because they discovered that non “over weight” non white people develops diabetes, and hypertention too. So they still managed to make this about fat.
    Prejudice towards fat needs to stop

  10. On a small tangent, I wonder if you could make a downloadable pdf of that evidence post? I am dealing with these issues at the moment, and it would be nice to have a neatly formatted printout to give to a couple of the doctors I see. It turns out that I have a rare blood disorder, and gosh, telling me to lose weight was a bit of a silly idea. Even if I could, it would do exactly five eights of fuck-all for my dodgy bone marrow activity.

    1. Hi Alethea,

      Try this post, it has some cards that you can print!  Hope this helps!


      What to Say at the Doctor’s Office

      What to Say at the Doctor’s Office If you are here for the Doctor’s Office Survival Kit, just scroll down!  Last week on Grey’s Anatomy (no spoiler) former Scrubs star Sarah Chalke guest-stars in a p… View on danceswithfat.wor… Preview by Yahoo


    1. Ugh. Weight Watchers. They want to force people to join Weight Watchers. Well, won’t that just be a huge waste of money and other valuable resources. Even I don’t think much good of Weight Watchers, and I’m in the tiny minority of their “success stories”.

  11. I had to deal with the NHS for more than a decade. I was once prescribed weight loss for an ear infection. the docs for whatever reason, are all on the weight loss band wagon and no amount of pointing out the evidence or showing them papers – to no avail. I have on occasion printed out a sheaf of papers showing them the evidence, only to be told that ‘one can get scientific papers to prove anything one wishes to prove…..I honestly think the whole reason behind this is to prevent fat people coming to the docs in the first place and relieve some of the pressure on the NHS. As my husband (bipolar and underweight, yet prescribed weight loss as a ‘lifestyle’ option to help him) says: if we’re dead the NHS doesn’t have to treat us.

    We moved back to Ireland before Christmas and so far I’ve been to the doc for another ear infection and was prescribed antibiotics – Holy Hell, that cleared up quickly!! As well as being told I have slim ear canals 🙂 And Al’s actually getting treatment of both the drug and peer support type for his bipolar. We pay to see the doc but at least we get treated when we go!!

    I strongly suspect WW and SW have made donations of some sort or another to the various political parties to get this on the go. ‘Bribe’? Of course not. Wouldn’t dream of suggesting it!

    1. How is Ireland? I’ve been thinking of moving there since opportunities in Canada seem to be low (not just jobs). Is the ethos there wholly different than N. America? Since you say you moved back, that means you were born there? I have so many questions!!!

      I totally agree with your husband’s “if we’re dead the NHS doesn’t have to treat us”. In Canada we have Health Canada which seems to be only about the food guide. There doesn’t seem to be any master governing body of doctors like the NHS/NIH.

  12. Think I’ll take my pony and let it poop right in the middle of a Weight Watchers meeting. Anything to get myself a lifetime ban from those intolerable meetings!


  13. Back in the day, doctors used to open patients’ veins to remove the bad blood they were just sure was the thing making them sick. Replace “blood” with “adipose tissue” and apparently doctors haven’t gotten any better since they were committing women to sanitariums for hysteria and throwing men into prison based on the shape of their foreheads.

    Furthermore… I’m trying to word this in a way it won’t sound alarmist, but NICE, do you really not see where forcing all the fat people in the UK onto a VLCD on pain of losing their health care could go very, very wrong? If you don’t, I’m not sure I could explain it to you… but I hope the NHS sees the problem, and frankly, much as I’m no fan of Weight Watchers, I hope they do, too.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.