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.
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.
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.)
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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In case you missed it, my adorable dog and I have a poem to help you resolve (for the first time, or again) to ditch diets. I’m having fun doing videos like this so there will definitely be more – if you want to make sure not to miss future videos, you can subscribe to my YouTube channel!
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!)
I’m (still!) training for an Iron-distance triathlon! You can follow my journey at www.IronFat.com .