The 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.
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