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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Dances With Fat 
THIS IS SO TRUE. In the past year, I have lost 30 pounds. Not because I have “tried” to but because I broke up with a guy who was a big drinker & since I am not out with him all the time, drinking beers & eating bar food, naturally I lost weight!
ABOUT JOINT PAIN. I suffer from arthritis … in my knees, my ankles, my back, my toes … I wish I could say that the pain has lessened because I lost those 30 pounds but it hasn’t. So losing weight so you will have less pain is a MYTH.
I get out & walk everyday. Part of this is simply because I don’t have a car & if I want to get anywhere, I have to walk. But it’s also because I like the exercise & I know it’s good for me … physically, mentally, emotionally & spiritually.
I am constantly amazed at all the BS we are told about weight & health. Thanks for your good work at exposing these lies. Hugs.
My doctor is REALLY obsessed with my weight. I’m 5’3″ and my weight varies between 260 and 265ish. I had gotten up to around 280 but lost weight because of changes die to finding out I had diabetes, high blood pressure, and my thyroid wasn’t working. I made some changes in order yo get my BGL under control, but realized I wanted to get more movement because heart disease ALSO runs in my family… And I wanted my heart to be stronger so I could have a better chance of avoiding a heart attack. The minute I mentioned this, my doctor jumped… Talking about how much weight he wanted to see me have lost by the next check up. 😒. I took a different approach. Instead of trying to convince him he was being ridiculous, I said how about this… I exercise, and if the weigjt comes off.. Great… And if it doesn’t, it’s still a success because I still get the heart benefits I’m actually doing this for. He looked like I had gotten thru, and said I was right. Unfortunately at the next appointment I HAD lost. In fact I lost twice what he wanted, which I know is likely temporary, but he got all excited and set another weight goal… Meaning I didn’t get thru to him at all. It made me really mad because I felt like even with the BP being good, the BGL being good and my thyroid numbers being normal with the meds and my cholesterol having improved… It wasn’t enough for him, as long as I was still fat. 😔 I keep encouraging him to stop worrying about the number on the scale and worry about the person, but it’s a draining battle. I wish I could find a doctor who could see me & not just my fat, but all the doctors in my area seem to be the same.
I actually left the ob/gyn that delivered both my children because of fat shaming. I tried with evidence, he gave me horrible advice about fasting that a quick Google search showed Harvard Medical school had research showing how detrimental this was to women. And he was treating women.
Done and done. Treat me as the patient I am not the one you want me to be.
My dad heard that “if you lost weight, your knees wouldn’t hurt” tripe all his life, and all it did was give him major depression when he couldn’t lose weight. My MIL heard that for years, until she moved to a rural area where an old country doctor told her “Ya can’t lose enough weight to restore the cartilage in your knees. Being fat doesn’t cause degenerative tissue disease.”
Old country doctors. Gotta love ’em.
Thank you, wysewomon and thank you, Old Country Doctor! I wish you could sit down for a good old fashioned jawin’ session on the front porch with all my big city doctors who don’t seem to have the sense God gave a newt.
This guy was a serious BAMF. He’s retired now. There are stories of him going on a back country rescue in his younger years and *strapping a guy with a compound fracture to the outside of a helicopter* to get him to the hospital. We used to live across the street from him.
Yes, seriously. And that’s an excellent reply to a doctor who suggests it: “How much weight do I need to lose before the cartilage grows back?” lol
And yet, when I can’t reach the items on the top shelf in the grocery store, no one tells me that if I just grew a few inches taller I’d have no issues with this. Imagine that.
I bet these docs who convince patients to drop pounds are receiving some sort of kick back from someone (insurance companies?). That’s why they’ll say anything to get folks to lose weight (regardless of the futility).
I too have the same problems, concerning height. Even in my own house I can no longer reach the 2nd shelf like I could a couple yrs ago.
I do think they receive profits/incentives. I know they receive large payouts from Big Pharma for prescribing certain drugs, or meeting quotas.
OMG my roommate is convinced that if she can get and stay thin, she will avoid the diabetes that runs in her family. Never mind that her body type is not naturally thin.
I wouldn’t care but she talks about dieting, trying to lose weight and doesn’t make any effort to find out what is actually recommended for diabetics to eat. She does have regular meals, but she also skips meals or makes do with coffee and a cookie.
I finally got her multivitamins because she spent over a month sick last fall.
Recently she’s talked about becoming vegetarian, but again, no effort to research it for making the best choices.
I know, I know, underpants rule. It is hard to watch someone you care about do things you know will not let them reach their own goals.
Would it be passive aggressive if I got her a basic book about being a vegetarian? If it isn’t, any recommendations?
I have been a vegetarian for 24 years. I’m also fat. Being a vegetarian won’t make her magically thin. 🙂 It’s also not necessarily going to make her healthier or help her avoid diabetes. Although I am happy being a vegetarian, I really don’t think one style of eating will work for all bodies and all people. It’s really something she needs to decide for herself. Possibly after research and/or discussing it with a dietician/physician. Who knows what she will or won’t do?
I think your initial thoughts about the Underpants Rule are the way to go here. It is frustrating when someone keeps talking with you about a goal that they then don’t go on to pursue. I think your best bet here is to tend your own garden. Her nutritional choices are not your problem. How freeing is that?! Her crazy doesn’t have to get all over you!! Perhaps you could set boundaries with her about not discussing diets and/or just keep repeating banal phrases at her when she brings these things up until she takes the hint or loses interest? You can also try the Rapid Subject Change Game:
HER: I’ve got to lose weight. Maybe I’ll try eating seeds and nuts only with occasional dandelion garnishes?
YOU: Have you seen the new Netflix series, TV Show, Movie, Billboard? Your pants are cute. Where did you get them?
I know how frustrating it can be to be in a forced Diet Culture Nightmare. I wish you luck!!!
Thanks for the reply Marie, maybe it is time to have a talk with her about boundaries. Or just switch topics. 🙂
I agree with Marie. She said it much better.
Also, the boundaries talk and/or Rapid Subject Change Game. Excellent.
I don’t have any recommendations, but please make sure that whatever book you give her gives lots and lots of options for PROTEIN. Diabetes NEED protein (and also fat! go figure!) to help keep their blood sugar steady. It can be vegetarian protein, but it is necessary, either way.
So, perhaps if you could find a book specifically about diabetic diet, and if it’s a vegetarian diabetic diet, that would be better.
But I doubt she’d read it, anyway, if she’s made no effort to even google stuff, already.
Also, I think I read somewhere on this site that if you lose weight (10-15% of your body weight), you will delay the onset of diabetes, but not actually avoid it. Basically, right now it seems that if you’re going to get diabetes, you’re going to get it. However, weight aside, controlling your blood sugar has a much more profound effect on delaying diabetes, and dealing with it, when/if it strikes.
So, instead of worrying about losing weight, she’d be better off testing her blood sugar, and learning about her own body, and how it reacts to different kinds of foods, as well as stressors, so that she can keep the blood sugar within a good range, before diabetes even becomes an issue.
Has she had her A1C checked? That sick for over a month thing is ringing alarm bells for me. She might already have a problem with undiagnosed diabetes, as it really can hinder healing.
Well, good luck with all that. You can’t control what she does, or how she deals with her own health issues. And sadly, you can’t control how she talks about you, even if it bothers you.
I’d ask her why she’s interested in vegetarianism. If it’s a moral issue, then yeah, she should do what she feels is right. If, however, she heard that it will solve all her problems, making her thin and perfectly healthy, she needs to be told that it is not magic. It MIGHT help, but that’s not a guarantee, and really, individual bodies need different things. what works for one might now work for another. So, it MIGHT be helpful for her, but she shouldn’t put all her hopes on it, because a lot of that is hype from the weight-loss juggernaut. After all, there are fat vegetarians and fat vegans. And they have their reasons for maintaining that diet that have nothing to do with changing their size.
Yeah, I warned her she needs to make sure she gets complete proteins and she seemed annoyed. Not by me, but I think she is still hoping for a magic wand. I can’t remember if she’s been tested or not. I’m not sure she’s had a good physical in the last few years.
But I should probably follow the underpants rule. She might talk about how expensive it is to go to the doctor, but I just found out she’s joined Gwynnie Bee, which is a minimum of $50 a month. To be fair, it might just be a trial and she will cancel once it runs out and not spend money on it after all.
FYI – Gwynnie Bee claims to have sizes 10-32, and you get clothes, keep them for a bit, then you can opt to buy them or send them back for something different. The subscription covers shipping and their cleaning costs.
You mean, you can order clothes online, try before you buy, and send them back, without paying extra for shipping? AWESOME!
You know, if she finds some good-looking clothes that actually FIT her, she might not feel quite as great a need to lose weight.
The underpants rule doesn’t say you can’t help. It says you don’t stick your nose in where it isn’t wanted. Perhaps ask her if she wants your help, and if she does, offer her all the resources at your disposal. If she doesn’t want your help, then ask her to please not diet talk in front of you.
Good luck. It’s a sticky situation, isn’t it? Hugs, if you want them.
Oh honey, Gwynnie Bee is an entire internet closet! You basically rent the clothes to wear and send them back if you are done.
My roomie is also very concerned with her appearance. Which I find weird since I’m not that way myself. She still thinks she needs to be thinner.
Maybe I will offer my roomie help.
*HUGS* back at ya!
I find that standing tall, with proper posture, and wearing clothes that FIT, actually make me look thinner.
The baggy/camoflauge look, on the other hand, makes me look fatter.
So, I’m glad she’s got this Gwynnie Bee thing going. It sounds great!
I found an article that was published in 1992 in a sports journal, that said it’s a common misconception that diabetes is insulin resistance. The insulin actually signals the cells to stop releasing protein to make sugar (it’s easier to make sugar from protein than fat, which is why fat loss is last). Also, since the diabetic body is a wasting body, protein is needed to replace/repair the decaying cells. This is something that gets lost by even doctors, who prescribe a diet high in sugar, creating a cycle of high-low blood sugars that requires constant vigilance and drugs to control.
On Sandy’s old blog, this was done and those who had the tightest control, checked their blood 10 times a day, and had multiple injections throughout the day. They also had far more hypoglycemic episodes and hospital stays, and lower quality of life. But the proxy outcome was better control. If the message of better control is to become a neurotic and self-absorbed prick, is that the takeaway that medicine wants to give?
The inability to understand that weight gain is the most probable outcome of weight loss for some people, even those that have experienced it time and again, is mind blowing. For me, it came down to killing the hope that this time I will succeed. When that hope was gone, it got a lot easier to see and accept the truth about body size manipulating. I know the diet industry has to keep that hope alive to keep selling their snake oil but the fact that doctors and other health professionals don’t question it even when they witness it failing time and again is the most infuriating part.
OMG! Thank you so much for this post! I feel I’m talking to a wall when I tell people that I’m actually HEALTHY and fat (and I know many people that are unhealthy and thin). I have been fat all my life. When I actually do have a medical issue/injury the first thing I’m always told is to lose weight. So I tell the doctor/nurse that losing weight is not an option for my medical issue/injury and to treat me the way they would treat a thin person. My weight has been stable my whole adult life. I can wear clothes I bought 10+ years ago because of this.
I have chronic neck pain and have been told that weight loss will help. Apparently it’s those extra ounces of flesh on my head that are causing the whole problem. I’m constantly thankful that it’s my neck and not my knee that hurts, because at least half of my doctors DON’T mention weight loss as a solution and that’s impressive.
Decapitation: solves all those neck issue!
Seriously, what are they thinking???
“I understand, but…”
Few things are as frustrating to me as trying to have a conversation with someone where they feign agreement or comprehension then immediately show that they disagree or don’t comprehend what’s being discussed. I had a co-worker who would respond to almost everything with an abrasive “I know,” then proceed to argue against what he claimed he knew. It was entertaining to watch, but very frustrating if I was the one talking to him.
The research is clear! You just need to accept the research! It’s clear!
Thank you so much for this and lot of previous posts 🙂 …. year and half ago i had terrible migrating joint pains & morning stiffness (once i even could not walk for a week due to terrible pain in a hip with any move), went to doctor, was told only old people and fatties get joint pain and i should loose weight. She absolutelly ignored to tell me people at my young age can have rheumatoid arthritis (which matches my symptoms by the way…). So i went to other doctor and oops – positive Rheumatoid factor and to rheumatologist i went …. . As there was 3+2 months long waiting time for appointment i googled a lot, thought about food sensitivities etc, noticed i ate lot of nuts lately so stoped them to see … and tadaa i got about 98% better (ocassionally i have a pain starting somewhere which goes away quickly with a little magnesium).
And least you were able to figure out something for yourself, and did get that future appt. That is some shitty care from that doctor. If old people get joint pain, is the treatment de-aging? Does it work?
Brilliant Regan.
I fired my GP when she told me that my neck pain was due to my weight. I had actually asked for a referral to physical therapy, as I have been in several car accidents and have some joint degeneration, which she knew about. So I went home and googled PT exercises for my neck and guess who felt better after about a week of faithful exercise? It kills me because she was my GP for over a decade and only started harping on my (mostly stable over that period) weight for a few months. I don’t understand it.