LA Times |

An article hit my feed from LA Times today and it seemed to offer some refreshing news. It seems 4 doctors, weight-loss specialists set out to say what so many of us have been saying for so long now. They admit that for the vast majority of obese children and adults in this country, telling them to eat less and move more is a prescription for failure.

They acknowledge that once a fat body begins to lose weight, a whole lot of processes, hormonal and otherwise kick in. Hormones increase hunger signals. Metabolisms slow down. The body struggles to maintain the weight.

Furthermore, the 4 weight loss experts admit that a body that has lost weight are biologically quite different from bodies that have never been fat. One states:

“Few individuals ever truly recover from obesity,” the authors wrote. Those that do, they add, “still have ‘obesity in remission,’ and are biologically very different from individuals of the same age, sex and body weight who never had obesity.” They are constantly at war with their bodies’ efforts to return to their highest sustained weight.

So far, so good. Many of us have been pointing out the studies that show these results for years. So after this, those docs recommend a behavior-based approach where we focus on exercising and eating well for their own sakes (as both have been demonstrated to improve health regardless of whether or not they are accompanied by weight loss), right? Right?

Well, as it turns out, no not so much. The docs are suggesting that we simply increase awareness of other tools for weight loss (pills, potions, surgeries and devices) and turn to them sooner. They suggest we increase fear mongering in the overweight to help keep them from becoming obese. They suggest a greater focus on weight maintenance for those who have lost weight in order to help them keep it off. (They somehow neglect to tell us how this is going to work or how it will help.)

The funny thing is, that the doctors see the stigma. They see how telling patients to just eat less and move more is cruel, since it for the most part doesn’t work. They see how stigmatizing fat patients and simply labeling them as non-compliant isn’t the answer.

But they simply substitute in another bad answer. And this bad answer is likely to drag along much more devastating side effects than the original bad answer. At least suggesting people move their bodies more and eat more nutrient-dense foods is likely to improve health, regardless of whether or not it leads to the holy grail of weight loss. While pills and potions and surgeries and devices are slightly less ineffective than diet and exercise alone for weight loss, these methods can also carry significant dangers like increased heart rate, higher blood pressure, heart defects, permanent disfigurement, malnutrition, depression, suicide and death from other causes. And there is not much evidence that in the long run, the few people who do sustain weight loss from the pills and potions and surgeries and devices end up any healthier than the people who stayed fat.

Meanwhile, there is ample evidence that eating well and exercising have a positive impact on health regardless of whether they are accompanied by weight loss.

So why on earth are we not just focusing on healthy behaviors here? Why do we insist on focusing on weight loss at all? Well these docs do label themselves as weight loss specialists and that may have a lot to do with it. And as a society, we do love to blame fat people for stuff. So I guess they took a few steps out into the light and then fell into a deep, dark hole.

Oh well.

I for one am going to continue my focus on living the best life I can in the gloriously wondrous body I have now. So if you’ll excuse me, I’mma gonna get on with it.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to talk about evidence-based medicine and wellness at your school or organization? Learn more HERE.

Yup, higher shoe size means higher BMI. Maybe we should re-institute foot binding for better health?

The LA Times has published another awesome article, this time taking aim at BMI. The article headline states “For nearly 1 in 5 Americans, BMI may tell the wrong story”. Although one of the main studies actually places the misdiagnosis statistic closer to 2 in 5 Americans, I have to give the LA Times credit for posting this story which goes on to detail something that many of us in the HAES (R) universe already know: BMI is not a good predictor of individual health. In short:

Having a high BMI does not mean you have poor metabolic health. Having a low BMI does not mean you have good metabolic health.

So why is this important? Well for a lot of reasons. First off, if your doctor is using BMI to determine whether or not you should get further screenings or tests, he or she is using an extremely unreliable metric to make this determination. This means as a fat person you may be exposed to a lot of tests you really don’t need. This means as a thin person, your doctor may miss some stuff that is really important or even life-threatening. I often wonder if a significant proportion of the medical costs associated with fat people are because we have so many more tests done. Or even if higher percentages of certain diagnoses among fat people are in part because we look so much harder for these diagnoses among fat people.

Another reason that BMI bias is such a big problem is that the workplace wellness gurus are using it to coerce or even force us into interventions that may be entirely inappropriate for us. For example, I’ve been talking a lot about this Michigan “walking program” for fatties. BMI was used as the sole determinant as to who had to participate. Those with higher BMIs were told they either had to wear a pedometer that reported their steps to the “home office” or they had to go to Weight Watchers. There was no initial fitness assessment done. There was no assessment of eating behaviors. The program simply assumes that people with higher BMIs don’t engage in fitness and eat very poorly. It’s entirely possible that people in the program had to reduce other, more strenuous and more enjoyable exercise programs in order to comply with the stupid walking rules. It’s entirely possible that people in the program with well-balanced healthy eating habits were encouraged towards more disordered eating habits after their new stint with Weight Watchers. It’s almost certain that people with low BMIs who are also sedentary and eat nothing but junk food were patted on the head and told to “keep up the good work”.

But we’ll never know because they never tested this stuff.

You know what? When company money and government money and my money gets spent on stupid health programs that are just as likely to make people less healthy than before, and nobody bothers to test the hypotheses because “fatties” I get pretty annoyed. In fact I’m crossing right over the line towards enraged.

It’s not like this research is all new. It’s not like the problems inherent in the BMI as a measurement of individual health haven’t been known for decades. But as long as entire industries are set on putting their fingers in their ears and chanting, “La, la, la, I can’t HEAR you!” I’m just gonna have to keep on saying the same things over and over and over. As long as people walk around with misdiagnosed brain injuries because doctors simply think they need to lose weight, as long as thin people miss out on important medical screenings because they are assumed well, and as long as some insurance programs think it’s okay to strap a piece of hardware to my a@@ to track whether I’m moving enough just because of my dress size, I’m gonna keep on talking.

You hear that universe? I’ll keep shaking my chubby fist and you and shouting that your BS. Measuring. Instrument. is not a valid way to understand anything about who I am.

Love,

The Fat Chick

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