Debating Health at Every Size and Weight Loss

Everybody knowsI’m often called upon to debate the research around Weight Loss and Health at Every Size – sometimes it’s as a professional speaker in an organized panel or debate, sometimes it’s at the doctor’s office when I’m insisting on evidence-based treatment, sometimes it’s when someone has posted some weight loss thing on my social media and I feel like engaging them.

Before we get too far into this, people are allowed to do whatever they want with their bodies, for whatever reason they want – that includes weight loss or practicing Health at Every Size, or something else – regardless of the evidence.  And no evidence is needed for the fact that fat people have the right to exist in fat bodies (there’s a full discussion about that here.) This post is about those who choose to discuss and debate the research around weight loss and Health at Every Size

When I started at this, my first instinct was to lead with a ton of research that supports a Health at Every Size approach, and then state the fact that there isn’t a single study where more than a tiny fraction of people are able to maintain weight loss for five years for more, and that no study exists that compares the health of fat people who have suppressed their weight long term to fat people who have stayed fat and/or fat people who practice Health at Every Size to show that they those who lost weight actually have better health.

But there were some issues that made this approach ineffective. By far the most common was that a combination of scientific illiteracy and hubris leads many people to believe that “common knowledge” (ie:  “Everybody knows that people who regain weight just went back to their old habits” or “Everybody knows that being fat is unhealthy.” etc.) is actually the same thing as fact.

So I would provide multiple studies, and they would simply state that those studies must be flawed because “everybody knows” that their (completely unsupported by evidence) beliefs are true, and then claim to have won the debate. To paraphrase an old saying, arguing with “everybody knows” is like playing chess with a pigeon, no matter how good your research is, the bird is going to shit on the board and strut around like it won.

When I then brought up the lack of evidence to support their point, people would insist the pervasiveness of their beliefs proved their that they are true, and that I had to prove that no study exists. Of course it’s basically impossible to prove that a study doesn’t exist so there would be more shitting and more strutting.

This is irritating in debates, but not unexpected.  Those who aren’t on “team everybody knows” are always at a disadvantage in these situations because we have the same amount of time to introduce and prove an entire paradigm, as the person who is saying “you’re already right about everything.” I knew that’s what challenging paradigms wass about when I decided to do it.

Where this started to create a serious issue for me was in the doctor’s office when it was standing in the way of good, evidence-based medical care.  A doctor would prescribe weight loss (for a condition that thin people also get.)  I would talk about HAES and go through the shitting/strutting situation I just described, and leave without the care I needed, or with the care but completed exhausted and possibly in need of blood pressure medication!

I’ve found it’s much more successful to flip the strategy.  When people want to debate weight loss with me, I put the burden of proof on them – if they think that people are able to lose weight long term, and that doing so will make them healthier, then they ought to be able to produce some evidence for that – especially if they are a doctor who has an ethical responsibility to provide me with evidence-based medicine and informed consent, and I’ll be happy to discuss that evidence.  This is often pesky for them as no such evidence exists – and fair warning, if you are telling me about a study where 70% of people dropped out and the rest lost 2 pounds you’ve not made your point.

I’m happy to produce and discuss research to support Health at Every Size, but I now realize that it’s not my job to provide the evidence for both sides of the debate, and it’s not acceptable to me for people to bring “Everybody Knows” to a research fight.

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10 thoughts on “Debating Health at Every Size and Weight Loss

  1. There may be some small hope for the medical community, but I don’t see any for the general public. I’m old enough to remember when “everyone knows” ulcers are caused by stress and spicy food. “Everyone knew” that the proper treatment was bland food and no stress. “Everyone knew” that until some researchers proved that ulcers are caused by a bacterium. Even then, rather than give up their “everyone knows” belief, those researchers were denounced and ridiculed by a lot of physicians.

    Eventually though, the evidence was too overwhelming and the medical community had to change their *opinions* and acknowledge the actual facts. So when it comes to weight, they will probably eventually come around. The $60 billion dollar weight loss industry will fight tooth and nail to see that doesn’t happen, but I think health care providers will eventually admit the truth. The general public? Not so much.

  2. “Arguments are not evidence.” Bill Nye The Science Guy. (“That’s a sweet show.”)

    Thank you for reminding me that I can ask for evidence when they ask/tell me to do something that I know is wrong-headed.

  3. I had a conversation like this with a friend yesterday. One of our neighbors has lost a lot of weight over the past few months, and I said something to my friend about it. She said the woman had been on Weight Watchers and didn’t she look great, and wasn’t it so good for her health? I gave her my short elevator speech (losing that much is bad for you, most gain it back plus more, Weight Watchers sucks), and she looked at me like I was crazy, said “lifestyle changes.” I said you can do those without trying to lose weight and it will help your health more. Response: total skepticism. But at least I tried. (Side note: my friend works in the field of public health research for NIH. I wish we could get someone there on our side. But it probably won’t be her.)

    1. I lost weight on purpose, partly on Weight Watchers. A lot of it. To the tune of just over 40%. So far at least, I am one of the 5% to keep it off. It’s been years now. Remains to be seen if I remain in the 5%when I go off to the Happy Hunting Grounds. Hadn’t planned on losing quite that much, but the body had its own ideas. I’ve learned to love it and listen to it again, like I did for the first 25 or so years of my life, so if it wants to be tiny, so be it.

      People are frequently terribly disappointed, even angry at me when I tell them that all those super marvey wondrous things “they” promise you will happen to your health, your life, and the universe at large if you would “just lose weight” didn’t actually happen. I did what I did because I wanted to, and I’m not sorry. But if I’d done it because I thought I *should* becuase of what “they” say, I’d feel a bit cheated somehow. People often REALLY don’t like it when I say that WW sucks and I don’t recommend it. Others look baffled, like they think I am a bit nuts. Butif they ask an honest question, they are getting an honest answers out of it.

  4. I have had this same discussion with my mom (I’m a very large woman). Possible triggers below:

    To her, “it is common sense” that my heart has to work much harder to pump blood because of my weight.

    She blames my late grandma’s large size as the reason/main reason for her demise in 2004. When I pointed out to her that the average lifespan of a woman in 2004 was 75 or so (she passed at the age of 71), I was brushed off immediately.

    I also mentioned Grandma’s huge family size (6 kids), and at least one miscarriage, not to mention her poor eating habits and sedentary lifestyle, all things that thin people do too. My grandparents were also poor when my mom was growing up, and being such doesn’t exactly give one the best healthcare, right?

    Then there’s the stigma, the constant nagging from loved ones (she was diabetic too).

    Nope — it MUST have been solely her weight that got to her. End sarcasm.

    1. Your mom would have a real problem with my wife’s grandmothers. Her maternal grandmother was always thin, and not very healthy. She smoked and did not stay very active. She tended towards a sour disposition and a negative outlook in life.

      Her paternal grandmother was always heavy. She never smoked and remained active throughout her life. Despite having outlived at least two husbands and at least a couple of her children, she remained upbeat and pleasant. I think she was in her 70s when she climbed the pyramids in Mexico. In her 80s, she was teaching the other residents of her apartment building how to dance the Charleston (wish I had lived close enough for her to have taught me). I believe she was in her 80s when she beat up a would-be purse snatcher in Nevada (he probably thought a “fat old lady” would be easy pickings – boy, was he wrong!).

      The paternal grandmother lived well into her 90s, survived and recovered from a serious stroke in her late 80s, and was walking to the dining room of her retirement home when she died.

      The maternal grandmother died in either her late 70s or very early 80s.

      While I cannot prove it either way, my inclination is the lifestyles and outlooks of the two women had more of an effect on their lifespans than their weight did. Stress and sedentary living is much more detrimental to our health than weight.

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