Doctors Must Stop Telling Higher-Weight Patients to "Eat Less and Exercise More"
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One of the most common experiences for higher-weight patients is to being told to “eat less and exercise more” by a healthcare practitioner who has little to no information about what we eat or how much we exercise. This is a practice that must absolutely stop for any and all of the following reasons:
Healthcare Practitioners should be practicing medicine, not stereotypes
Typically healthcare practitioners give this advice because they believe (often because they’ve been taught) that all fat patients eat too much and don’t exercise enough. This is absolutely untrue. There are thin and fat patients who eat and exercise in the exact same ways. Making wild guesses about patients’ eating and exercise habits based on stereotypes, and then giving advice based on those guesses is not the ethical practice of medicine.
People of all sizes have all types of eating disorders
Disordered eating and eating disorders, including food restriction and over-exercising, occur in people of all sizes. Giving this advice to all of your fat patients will result in you telling patients with anorexia to eat less, and telling patients dealing with compulsive exercise to exercise more. This can be complicated by the fact that some practitioners believe there is almost no such thing as too little food or too much exercise for fat patients. This is part of a pattern that Deb Burgard describes as prescribing to fat people what is diagnosed and treated (as disordered eating and eating disorders) in thinner patients. Eating disorders can be deadly so making this mistake can be fatal for patients.
It makes you untrustworthy
As a fat patient, when a healthcare practitioner tells us to eat less and exercise more (especially without even asking what we eat or how much we exercise) it’s an immediate red flag that this is a practitioner who is likely practicing from deep weight bias. That means that we have to second guess every recommendation they give us since they are willing to risk our health (and even our life) on stereotypes and weight loss advice that is not remotely evidence-based, which brings us to…
Intentional Weight Loss fails for the vast majority of people
Even if all of the above wasn’t true, this advice is almost certain NOT TO produce significant, long-term weight loss, and very likely to produce harm through weight cycling, weight stigma, disordered eating, and eating disorders.
The good news is that this one is an easy fix. Just stop doing it. Remove the phrase “eat less and exercise more” from your vocabulary. If patients want help with food and eating, consider referring them to weight-neutral nutrition resources/providers. When it comes to fitness, another phrase to ditch is “just walk” you can refer to weight-neutral fitness professionals, and if you are recommending movement as medicine, there is a guide for that here.
If you want to know more about first-person experiences, I posted about this on Twitter and it kind of went viral (pretty sure it’s the first of my tweets to ever get more than 2 million impressions). There are hundreds of responses of patients who have been subjected to this (and, content note - sadly there were plenty of people either still honestly invested in the myth of eat less and exercise more, or disingenuously using it to engage in fat-shaming for fun. I hide them as I see them but this thread is big enough that I’m almost certain some have slipped through the cracks.)
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Really I think it comes down to having a conversation with patients, rather than a lecture.
Exercise more is often seen as the “less harmful” of the two because “everyone” supposedly benefits from exercise. But this is not true! Exercise, even what many consider gentler or fun movements or activities, can be contraindicated for people with certain disabilities and/or medical conditions like ME/CFS. We’re now seeing Long Covid as very similar to ME/CFS so this is an increasing population for whom exercise can be harmful. One of the key recommendations to reduce chances of developing Long Covid is to rest and avoid exercise and any inessential activity for longer than you think necessary if you have Covid, up to several weeks after symptoms have stopped. Fat people, however, are those most likely to be pressured to exercise even when it is not helpful and can be actively harmful to physical and/or mental health.