In my blog post about Health at Every Size and the burden of proof, I talked about having research to back up the idea that intentional weight loss is a good idea. I got a lot of questions about exactly what that research would have to show, so I thought I’d write about that today:
Ethical Research Practices
The research around weight loss doesn’t just show poor outcomes, it’s typically poorly done – huge numbers of subjects drop out and are not, in any way, accounted for in conclusions, people lose 5 pounds over two years and the intervention is called “successful” etc. Good research would have to be done with ethical research practices.
Significant
There would have to be a significant amount of weight loss. There’s a lot of confusion here because the medical profession and weight loss companies keep moving the goal post (and still failing to declare victory.) Originally they want by the ver strict Met Life height/weight tables, but they couldn’t get people to lose that much weight so they started saying 20% was significant, but they couldn’t get people to lose 20% of their weight, so they dropped it to 10%, and then 5%.) Those numbers were each, in turn, referred to as the amount of weight that needed to be lost for “clinically significance.” They aren’t the result of research, but rather of simple attrition because of the massive failure of intentional weight loss attempts. If a healthcare provider is using BMI categories (which are bullshit, but if that’s what they are using then an amount of weight loss that I could achieve with a haircut and vigorous loofah in the shower doesn’t count.
Long-term
Almost everyone is able to achieve short term weight loss, but almost everyone regains their weight (with the majority gaining back more than they lost) within 2-5 years. So what many studies do is only study people for a few weeks to a maximum of 2 years. For example, the conclusion is basically “Subjects lost 10 pounds in year one, by the end of year two they had gained back five pounds, so we stopped weighing them, and claim success because most subjects were lower than they started.” Without explaining that the trajectory suggested that weight gain would continue. The choice of weight loss company’s to only do short-term studies (indeed, one of the founders of our movement Lynn McAfee was at the Federal Trade Commission meeting about Deceptive Trade Practices when Weight Watchers refused to commission longer studies because “the results will be too depressing for our clients.” It’s very basic scientific fact that someone losing a little weight short-term (which research shows is possible) does not, in any way, suggest that anyone can lose a lot of weight and/or maintain weight-loss long-term (which there are no studies to support.)
Causality
Even if research showed that significant, long-term weight loss was possible for most people (and it doesn’t!) it would also have to show that weight loss attempts not only lead to significant, long-term weight loss, but also that they also cause health improvements.
We are in a place right now where tons of healthcare practitioners claim that losing 5% of our body weight will lead to health improvements. Even if you believe that, the issue here is causality. Someone changes their behaviors – perhaps they add more water, some movement, more sleep etc. – they experience health benefits and, at least in the short term, a little weight loss. Because of the fatphobia inherent in our medical system, hcp’s automatically assume that the weight loss caused the health improvement, when it’s just (or more) likely that the health improvements were caused by the behavior change (especially considering large studies like Wei et. al, Matheson et. al. and the Cooper Institute Longitudinal Studies have found that behaviors correlate to health benefits regardless of weight, and we don’t find those same health benefits from, for example, liposuction.)
To me (understanding that health is not an obligation, barometer of worthiness, or entirely within our control) the research that exists around weight and health made my choice to follow Health at Every Size blatantly obvious. Of course other people are allowed to make different choices for themselves, but if they want to try to convince me – including and especially if they are a healthcare practitioner trying to tell me that weight loss will make me healthier – they’ll need to provide some actual evidence.
Finally, just to be clear, even if there was research that becoming thinner was possible and would lead to greater health, fat people still wouldn’t be obligated to pursue it (just like nobody is forced to get enough sleep if they can, just because it’s shown to improve health,) because fat people have a right to live in fat bodies without shame, stigma, bullying or oppression and it doesn’t matter why we’re fat, or if we could become thin(ner).
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UPCOMING APPEARANCE!
I mentioned that I want to have more fun with my activism this year. As part of that, I’ll be doing a stand-up comedy set as a guest performer at the FATCH New Year, Same You show on January 10th at 9pm at the Upright Citizens Brigade Theater on Sunset in Los Angeles. Tickets and info can be found here (Accessibility info: there is a fat-friendly bench in the front, the rest of the seating is stadium theater seats with arms up at least one step. The venue is wheelchair accessible, but there is limited space for wheelchairs.)
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Book and Dance Class Sale! I’m on a journey to complete an IRON-distance triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here! (DancesWithFat Members get an even better deal, make sure to make your purchases from the Members Page!)
Book Me! I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!
I’m (still!) training for an Iron-distance triathlon! You can follow my journey at www.IronFat.com .
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Dances With Fat 
Nailed it. I’m always astonished that, if this is really such a public health threat, why long-term research (like the Framingham Heart Study) isn’t done on weight loss. I guess it’s because no scientists want to try to go against the dogmatic idea that it just takes a leeeeetle reduction in calories and a tiny bit of movement and “the pounds will melt off.” The actual results are never accurately reported anyway—a study where 12% of the participants lose an average 6 lbs is always hyped as a successful weight loss experiment, as you say, and we all know.
Like you, Ragen, the last time I decided to lose weight (long ago now), I figured I had been doing it wrong all this time, because I kept regaining, so I looked for the WL companies’ studies that showed how much their adherents lost and how long they kept it off. There were NO studies. There were NO “typical results.” That was when I first smelled a rat. They’re running rampant in the diet industry.
It’s sad and frustrating to me that the best way to be sure that weight loss has almost no chance of success is to read the research that is used to promote it. I remember reading through studies when I was searching for “The Best Diet” and just having WTF moment after WTF momemt – wait, 70% of the participants dropped out and they didn’t even mention it? The average participant lost 2 pounds in 2 years but the conclusion just says it’s a “successful intervention” For a minute I thought I forgot how research (and math…and logic) worked!
I know, right? I think my favorite discovery (for a certain value of “favorite”) was the paper where the researchers lied about the data they collected, blamed it on a “computer error” when they got caught, and then continued to use their misreported “findings” to promote weight loss. -_-
Part of the resistance to logic is emotion. When my emotions get involved, my common sense shuts down. Thank you so much for continuing to write about this stuff, since I still have moments when I just want to lose weight so clothes are easier. Being reminded that it a) won’t work and b) will probably make me fatter and angry about it lets me step back from the roller-coaster ride of weight loss attempts.
When I finally got off my last ridiculously extreme diet, my shape changed rapidly (as one would expect). I decided to make sewing my own clothes my new hobby. I enjoy the heck out of it, and it’s so empowering to have such control over the fit of my clothes. There are some great face book communities around the subject, my favorite being the Curvy Sewing Collective.
Thank you for the suggestion, Lauri, I’m trying to find time/space for sewing, and I’m enjoying the Curvy Sewing Collective
You know, the diet/weightloss lie brigade has been going strong for decades, now relativism has hit the mainstream. May not be so good for humanity in the long run as we drift toward Blade Runner and 1984, but at least it will all be even in the bs department.