A Canadian panel has released new guidelines for “obesity management” that seem to be based on the adage “admit what you can’t deny, deny what you can’t admit,” while co-opting the language of fat activism in an attempt to keep their profession profitable.
Let’s start with them admitting what they can’t deny. As the paper’s lead author told The Guardian:
“The common medical advice to eat less and exercise more doesn’t really help most patients…whenever people decrease their calories, they activate a bunch of hormones and neurochemicals within their brain, within their gut, that drive the weight to come back on. So we’re failing people all the time when we say go on a diet so they can lose a little bit of weight, [because they often] regain all of it, if not more,”
This is something fat activists have been saying for literally decades, but I guess thanks to the “experts” who have been harming fat people and profiting off of this idea for those same decades for finally catching on? Still, this is a victory for fat activists.
That’s the “good” news, but here’s the bad news. Instead of just admitting that bodies come in lots of sizes, Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons (the group who drafted the guidelines and who, it should be pointed out, all have a tremendous financial motive to say this) are pushing the idea that being fat is “a complex chronic illness” that needs to be treated with a “variety of methods” including dangerous (and expensive!) and often completely ineffective diet drugs and surgeries.
If you want to know how absolutely ridiculous this is, take a look at their new “definition” of “obesity”
“It’s not about the amount of body fat, it’s not about where the body fat is. It’s not about the type of body fat,” said Arya Sharma, scientific director of Obesity Canada and one of the more than 60 authors. “It’s just a very, very simple question. And that is: Does this person’s body fat or excess body fat affect their health? If it does, we’ve got obesity. If it doesn’t, we just have a large person with a lot of body fat.”
This is anything but a very, very simple question. Since fat people get the same health issues that thin people do, the assumption that body size is what is affecting health is the root of the problem and, it must be pointed out, the root of the profit. (Especially considering the health effects of constant stigma as well as the treatment disparities caused by medical fatphobia.) But of course we are talking about a world in which being “Board Certified in Obesity Medicine” is a thing. so a LOT of people have a stake in maintaining “fatness” as a profit center.
To put this into sharper relief: if a thin person in Canada develops a health condition they are simply a thin person with a health condition. But if a fat person in Canada develops that exact same health condition, they now have two health conditions and one of them is the size of their body – which is the same size as it was the day before.
This does not smack of scientific rigor. It does sound like a desperate attempt to keep a branch of medicine (that has only succeeded in harming fat people) alive and profitable. They still seem to be recommending “counseling” interventions that have been shown to be no more effective than just giving every fat person (or, I guess now every fat person with a health issue) a pony as well as interventions that can and do kill fat people.
In fact, Dr. Sharma (who, full disclosure, has positively shared my work on a number of occasions despite our disagreements) told The Globe and Mail:
“There’s this idea that if you’re using medication or using surgery, then you’re somehow cheating,” he said. Yet he noted no one would think someone is cheating or “taking the easy way out” if they took insulin for diabetes or received a kidney transplant if they had chronic kidney disease.
It’s not about the easy way out – it’s about risking our lives and quality of life for no reason. Since evidence-based interventions for the actual health conditions that fat people (and thin people) get already exist, these body size manipulation interventions are completely unnecessary and serve only to create profit for healthcare professionals and harm fat people (including not just being blamed for intervention failure, but also risking our lives and quality of life.) I imagine they’ll also be using this as a loophole to sell these interventions as a solution for cultural weight stigma, but that remains to be seen.
Now, do I think every doctor who believes this is driven only by craven self-interest? Not necessarily. It’s possible that they are so high on their own supply of fatphobia that this seems reasonable to them, but that doesn’t make it any less harmful or wrong. The important thing here is that this will result in the continued unnecessary harm to fat people, despite good research that weight-neutral healthcare can be effective without the risks.
While there is some value here, both in finally admitting that the typical “eat less, exercise more” recommendation is, and always has been, useless, as well as at least claiming that they want to reduce the stigma fat people face, the result could actually cause more problems for fat people.
First, I note that they were not in a hurry to take responsibility and apologize for all the fat people who have been harmed by doctors’ insistence – despite a complete lack of evidence- that this is a successful intervention and those fat patients who failed (which was nearly all of them) were to blame/liars/lazy/weak-willed etc.. Intead choosing to simply move forward to subjecting fat people to more dangerous (though often no more successful) interventions. The organizations behind these interventions have long been trying to increase “access” to dangerous and expensive surgeries and drugs and so they will no doubt use these guidelines to try to do that, putting more fat people’s lives at risk while driving the very profitable interventions that they sell.
So how can we use this? Well, in doctor’s appointments we can point out that even experts have now been honest that diets don’t work, and then when they recommend these dangerous interventions we can pivot and ask for the same interventions that a thin person would be given.
In the meantime, we must keep fighting for a world where the diversity of body sizes is respected and affirmed in healthcare and the world at large.
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ALRIGHT! WHERE IS MY PONY! I was not told we were getting ponies! I want one of those miniature ones I can carry around in a bad, oh and a vest that says: “Don’t not pet or feed baby carrots to the palomino, Therapy Pony.”
Hmn, we’re having a major shake up in the rest of the world on race, sex, gender, sexuality, etc. So we are going for “kinder- gentler” crazy dysmorphic all out hatred of fat people? This one is gonna be a hard sell. Haters can fall back on: “They were not “Born That Way.” Even if they were.
Mr. SlimGoodBody isn’t dead yet…
Keep up the good work! And let’s go after corporate wellness. There is no reason at all corporations should be weight-shaming their employees. Other than it is very profitable for brokers and vendors, and companies get to fine empoyees who can’t lose weight.
And of course there is cheating involved, whcih is very unhealhy. My most popular post by far (100,000 hits almost) was my tongue-in-cheek “how to cheat in a corporate weight loss contest,” which apparently is easily findable by employees intending to do exactly that. https://dismgmt.wordpress.com/2016/11/28/how-to-cheat-in-a-corporate-weight-loss-contest-spoiler-alert-this-gets-gross/
Hi Ragen
I am one of the readers who sent you a link about these guidelines. It really is a case of “near and yet so far”. It is like they finally get it but dare not admit too much wrong doing. After all there is money to be made in bullying fat people into manipulating their body size. Thank you for providing such an excellent critique of this “new and improved” policy.
I, for one, am apt to forget how much a profit motive underlies the medical communities obsession with pathologizing fat bodies. Trust you to make the connection very clear. Keep up your amazing work!
Agreed. And history shows that change is rarely a smooth straight line. So maybe “getting it” is us/you/me/them getting back on the freeway together and “not daring to admit too much wrongdoing” makes us get off at the next exit.
*sigh*
I’d been seeing “obesity counseling” and “obesity-specific behavioral therapy” thrown around as “alternatives” to dieting for some time now, but I had no idea what either of those things actually entailed. So I looked it up. Here, according to Medicare.gov, is the definition of “obesity counseling” – and I lifted this directly from the site, word for word, though the emphasis is mine:
“An initial screening for BMI and behavioral therapy sessions that include a dietary assessment and counseling to help you lose weight by focusing on diet and exercise.”
So, basically, “obesity counseling” is “eat less, move more” under a different name. Their lauded alternative to dieting is… dieting. They’re condemning the “eat less, move more” paradigm as ineffectual *and promoting it at the same time,* continuing the reduction lobby’s long, noble history of talking out both sides of its mouth.
I have to be honest. When I first read this thing over on its initial release, I thought it was flawed but an improvement over what came before it. But when I actually started seriously looking into what it’s suggesting, I found it isn’t. It’s the “lifestyle change” of obesity guidelines, very much a meet-the-new-boss-same-as-the-old-boss situation. The premise is still that we just eat too darned much and sit around too darned much and are just too darned stupid to figure out how not to without some kind but firm thin hand perpetually on our throats. They’ve just figured out we’re much harder to dupe into exposing our throats if they’re that honest about it, so they’ve started calling eat-less-move-more CICO dieting “obesity counseling” and surgeries and pills “evidence-based medical care” and a reluctance to engage in said practices, either as a fat person or as a potential provider, “weight stigma.”
And as long as their idea of addressing fat people’s medical and social disparities amounts to figuring out how to get us to eat less, no matter what language they use to describe it, they will never be doing us anything but harm.
Agreed. And history shows that change is rarely a smooth straight line. So maybe “getting it” is us/you/me/them getting back on the freeway together and “not daring to admit too much wrongdoing” makes us get off at the next exit.
I apologize….I posted this duplicate comment above in error. I meant to say that I like how you broke down these definitions.
Heh, it’s okay; and thanks. It actually did bother me that as much as they condemned the medical community’s long history of dismissing and misdiagnosing fat people, they didn’t bother to apologize for any of it… but again, after I read the whole thing, it made sense. *They didn’t apologize because they don’t think they did anything wrong and have absolutely no plans to change what they do.*
Thank you *so much* for addressing this! I read about this and, at first, it sounded great…then I said, oh, carp. So near, and yet so far. It’s the same stuff under a different name, just as you pointed out, and I’m so glad to have been reading your columns for so long so I could recognize it right away. You pointed out aspects of the issue that I’d missed, as often happens, and I’m grateful. Back to work!!
“A large person with a lot of body fat.” Or, a fat person. Not exactly groundbreaking, Doctor. But the huge fuzzy bee in my bonnet is that the weight of a thin person is generally not looked at in connection with the health concern that brought them to the doctor. I’m guessing that it does happen but probably not the first “go to” like it is with a fat person (or if you prefer: big person with a lot of body fat). I’m not picking on thin people though. A person at any specific # of pounds should not be treated according to their weight (vs the health concern that brought them to the doctor – be it asthma, migraines, hammer toe, STD, diabetes, high BP…). My point is that it’s odd, dangerous, defeating and unethical when a change in body weight is the prescribed treatment for the health concerns I mentioned or any of the thousands of others out there. I wrote this in an emotional state…am I making sense?
It’s so F*ng stupid, nuf said
I was very lucky when I had a silent heart attack (despite having always had cholesterol within normal range). I was waiting for the lecture, and in the end I asked the cardiologist when I should expect it. He asked me “what lecture” and I said the one I meant. He said that they don’t give that lecture in that hospital because weight loss diets increase weight in the long term, but the vast majority of people gain more than they lose. And many diets (he names a couple of popular ones) are very bad and very UNhealthy. And WLS kills people. I didnt think hugging a consultant was appropriate, but we went on to have a chat about the whole subject. On the ward they picked up that all I ordered was a jacket potato for lunch and dinner each day – I have my own gluten free cereal for breakfast. They were concerned in case I was “trying to manipulate my body size” by not eating sufficient food. In fact – the gluten free food was inedible and swimming in grease – I don’t enjoy greasy food and never have. But my family were bringing me fillings for the potatoes when they visited – there was a Marks and Spencer Food Shop in the hospital. So there is at least one hospital in the world who get it! For the record, it is Wythenshawe Hospital in Manchester UK.