Britain has launched a program called “Better Health” that is claiming that it will improve health by perpetuating fatphobia and convincing people to engage in so-called health interventions that almost never work (and promoting for-profit companies that do the same.)
It utilizes the “eat less, move more” theory that has been proven not to work since at least 1999. and that even Canadian Health Professionals who sell weight loss have admitted doesn’t work. But encouraging people to attempt intentional weight loss despite the fact that there isn’t a single study where more than a tiny fraction of people succeed at significant long-term weight loss is, sadly, nothing new.
Tying it to the equally questionable idea that fat people are at a higher risk for COVID-19/more severe symptoms because of their body size (and not because of the unequal treatment we receive in society, and the very medical weight stigma at the root of this program) is new, and terrible.
Quick history lesson – during the H1N1 outbreak, fat people had poorer health outcomes (and everyone jumped on the bandwagon to figure out exactly what about fat bodies was the cause.) It turns out the actual issue was that fat people were systematically treated later with antiviral medication than thin people. Per a study on the subject “After adjustment for early antiviral treatment, relationship between ob*sity and poor outcomes disappeared.” More about the issues with the claim that being fat increases COVID-19 risk/severity can be found here and here.
Besides which, we don’t know that making larger people (temporarily) a bit smaller will do anything to change their COVID-19 risk, nor do we know if encouraging people to restrict food and exercise to create a situation where their body has to consume itself to survive could actually make things worse. The idea that if we make fat people look more like thin people then their health outcomes will be the same is not remotely scientifically sound.
They are making the incredibly dubious claim (with absolutely no evidence) that if every person who is considered fat loses 5.5 pounds (an amount many menstruating people gain and lose each month, and that I could personally lose right now with a haircut and a loofah) it will save the NHS $135M in five years.
In fact, the only arguably “smart” (though still terrible) thing they did is make this only a 12-week program. Almost anyone can lose a little weight short term. Then, like almost every study on weight loss, they’ll stop tracking results before the vast majority gain it all back (with many gaining back more than they lost) and claim success, blaming the *almost everyone* who gains the weight back.
This will do an incredible amount of harm in the following ways:
First, any time there is a national campaign against fat people, it increases the stigma that fat people deal with. Studies have shown that this stigma is correlated to many of the same health conditions to which being fat is correlated. Making people hate their bodies does not improve health outcomes.
When programs like this correlate weight loss with health it sets people up to give up on supporting their health when they, almost inevitably, fail to maintain weight loss. Health, by any definition, isn’t an obligation, barometer of worthiness, or entirely within our control, but setting us up to believe the lie that the only way to pursue health is through weight loss, and then fail (often repeatedly) at weight loss does not improve health outcomes.
Many of the things that people are claiming may cause fat bodies to be at higher COVID-19 risk are actually correlated with weight cycling (yo-yo diet) which is by far the most likely outcome of multiple weight loss attempts, which Britain’s program will actually increase.
Consider weight cycling as an example. Attempts to lose weight typically result in weight cycling, and such attempts are more common among obese individuals . Weight cycling results in increased inflammation, which in turn is known to increase risk for many ob*sity-associated diseases . Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia . Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk [64–68]. Weight cycling can account for all of the excess mortality associated with ob*sity in both the Framingham Heart Study  and the National Health and Nutrition Examination Survey (NHANES) . It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself .
In addition to the calorie counting push being destined for failure based on all the research that exists, this kind of campaign does real harm to people who may develop, are living with, or are recovered from eating disorders.
The government is insisting on putting calorie counts on menus which has been found to do nothing to change food choices but increases the chances of triggering an eating disorder. (Also incredibly triggering is a massive media campaign that focuses on the idea that thin(ner) is better.)
Perhaps most frustrating of all, it is entirely possible to create public health interventions without weight stigma, thus actually increasing the upside while eliminating the downside for people of all sizes. (Though, of course, those don’t generate profits for diet companies, or shift the blame from the government’s piss poor handling of a global pandemic onto fat people for simply existing.) We should hold our leaders to this standard and refuse to participate in these farces that claim to be about wellness but are deeply, inextricably linked to fatphobia.
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Movement/fitness/exercise by any definition is never an obligation or barometer of worthiness. But for fat people who want to move our bodies – whether it’s because we enjoy it, or because of the benefit(s) we get from it (even if we don’t enjoy it,) whatever our reasons a fatphobic culture can create barriers, misinformation, and other difficulties for us. In this workshop we’ll explore tips, tricks, and information to help us move our bodies for our own reasons. (This workshop can also be helpful to fitness pros who want to create a fat-positive practice!)
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