I’m often contacted by someone who has just been diagnosed with a health issue, and their healthcare provider has blamed it on their size and, in most cases, suggested dieting. The person contacting me has been practicing Size Acceptance/Health at Every Size (usually after a lifetime of failed dieting) but they are wondering if maybe they should try dieting again considering this new diagnosis.
Of course I’m not a doctor and I’m not giving medical advice, but I always tell them what I would do. If it were me I would look at it in two parts. First – is it true that body size causes this issue. Second, if so is attempting to control my body size a good healthcare option?
Part 1 – Is it true that body size causes this issue
Determining this can be tricky because our medical system is so steeped in fatphobia that people extrapolate causation from correlation, and extrapolate correlation from nothing (I’ve had doctors prescribe dieting to me for a broken toe, a separated shoulder, and strep throat, so we have to assume that healthcare professionals may be viewing our health through an extremely fatphobic lens. Almost any fat person can tell you that “diagnosis fat/prescription weight loss” is a huge barrier to fat people getting competent healthcare.)
When it comes to health issues that can affect, or are affecting, mobility plenty of this is just ableism re-packaged into fatphobia. The desire to manipulate someone’s disability – including and especially lying to them about the possibilities of changing their disability through weight loss – is a form of ableism that should absolutely called out and eradicated.
The question that I’ve found to get to the bottom of this is “does this happen to thin people” If the answer is yes (and it always is,) then I know that being thin can neither be a sure preventative nor a sure cure. (If the answer is “yes, but it happens more often in heavier patients” The follow up questions would be “based on what research” and “how much more often are heavier patients tested for this than thinner people.” )
Part 2 – Is attempting to control my body size a good healthcare option?
If I were to decide that my size is causing this issue, the next question would be “is attempting to control my body size a good healthcare option?”
There is not a single study where more than a tiny fraction of people have succeeded at long-term weight loss, and very often these “successes” lost only 5-10 pounds. Almost everyone who attempts to manipulate their body size (through whatever method, whether it’s called a diet or lifestyle change, or something else) ends up gaining back their weight, and the majority gain back more than they lost and end up at a higher weight (that was exactly what my dieting attempts led to)– so if we’re considering body size to be the “problem,” then attempting to manipulate my body size is the worst possible choice based on all the research, and my personal history with dieting. So that would be a no on the weight loss attempt.
I would ask my healthcare provider(s) what thin people are told to do for whatever this health problem is, and I would go from there in terms of choosing a course of action.
I think that doctors telling fat patients to attempt to become thinner (to solve health problems that thinner people also have) is not just lazy healthcare, it’s unethical, unsupported by evidence, incompetent healthcare and, if I can help it, I won’t put up with it.
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