One of the things that I find incredibly frustrating in discussions that I have about weight and health happens when I point out that there is not a single study where more than a tiny fraction of people have succeeded at maintaining long term weight loss, and people agree with me. Stay with me, I’ll explain:
Typically it goes something like this:
Person: There’s good research that shows that if fat people with knee pain lost weight, their knee pain would get better.
Me: I have issues with the research you’re referencing, but let’s move forward as if it were valid. It doesn’t actually matter because there isn’t a single study of any intentional weight loss method where more than a tiny fraction of people are able to maintain any significant weight loss long term.
Them: I understand, I know that’s the case, but if they could just lose [insert pretty much random amount of weight or percentage of body size] their knees would feel better.
Me: But again, even if that’s true, there’s no research suggesting they could do that. The long term data we have shows that, by far, the most common outcome of an attempt at weight loss is weight gain – the exact opposite of the intended effect. So if you are suggesting that your patients lose weight because you feel their weight is causing their knee pain, you are suggesting an intervention that is most likely to make the “problem” you’ve diagnosed worse.
Them: I understand, but isn’t it worth trying if the research shows it could help?
Me: Think of it this way: It’s a certainty that knee pain that occurs with walking would get better if the patient could levitate and fly, but absent evidence that we can help them do that safely, it’s unethical to suggest that they jump off their roof and flap their arms really hard because it probably won’t work, and they’ll probably end up more injured than when they started, but it would be so great for their knees if they actually flew. And let’s remember that people are only about 5% more likely to lose weight long term than to fly successfully, and even among the tiny fraction that succeed their weight loss is often only around 5 pounds.
It doesn’t matter what you think being thinner will do for someone, because you have literally no idea how to make them thinner – as we both agree, there isn’t a single study of any intentional weight loss method where more than a tiny fraction of people succeed, and “success” is often an incredibly small amount of weight (like the amount of weight that one might lose with a thorough exfoliation.) Do you agree that there aren’t any studies that support the idea that significant long-term weight loss is possible for the vast majority of people?
Them: Yes, I agree.
Them: But what if they are having back pain? I mean, there are good studies that show that if they lost weight their back pain would be better.
What I’m thinking: OMGWTFHOWAREYOUNOTGETTINGTHIS?!
What I do: Slow blink while I control my urge to start screaming and throwing things. Then start the whole thing over. This is made worse by the fact that the diet industry has worked hard to link everything from knee pain to swine flu to being fat, so people seem to think that manipulating your body is the solution to almost every problem.
By the way, if you are a fat person dealing with knee pain, and you’re being told that weight loss is the only option, you are being lied to. I wrote a piece to help that you can check out here.
I’m always a little shocked when this happens, and especially when it happens with doctors. They suggest I lose weight (most often apropos of nothing, just because I exist in a fat body and I happen to be in their office for an issue that has absolutely no relationship to weight.) I point out that the complete lack of evidence and that the most likely outcome is weight gain. I would say 8 times out of 10 they agree with me, then continue trying to convince me to attempt weight loss.
Such is the state of the “science” when it comes to weight and health. It seems like everyone still believes in the Wizard, even though they admit that they know it’s just a dude (or, preferably, Queen Latifah) behind the curtain. Seriously, weight loss doesn’t work so, if you’re thinking of recommending weight loss, it’s time to think again.
And, just to be clear, I’m talking about the science of weight and health, and you may not agree with me, but it has nothing to do with treating fat people with respect. Fat people have the right to exist in fat bodies and it doesn’t matter why we’re fat, what being fat means, or if we could (or want to) become thin. The rights to life liberty and the pursuit of happiness are not size or health dependent (by any definition of health.)
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