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A reader sent me the marketing email for a heart health seminar that perfectly demonstrates many of the issues that we see with weight science, weight stigma, healthcare, and pharmaceutical industry money. I want to acknowledge that the people who put this together may have been well-intentioned, but that doesn’t erase the harm.
Content warning that the pictures (and alt-text) contain weight stigma and misinformation.
It begins with this picture:
The use of “us” and “them” here can easily be read as “health-care practitioners” and “higher-weight people” as if those are two separate and distinct categories. These “us” and “them” categories do nothing but reinforce stereotypes that harm people of all sizes. It others and erases higher-weight practitioners, it encourages stereotype-based interactions in which higher-weight patients are assumed to be ignorant and conversely, encourages assumptions that lower-weight patients don’t need their practitioners to invest time with them to teach them about heart health.
Also, if what patients are being taught is grossly inaccurate and possibly harmful, the time would be better invested elsewhere, but we’ll get to that in a moment.
Next we have:
Holy weight stigma Batman. Calling the existence of higher-weight people “shocking” is, in and of itself, weight stigma and can create/reinforce negative provider attitudes toward their higher-weight patients. Also, a reminder that “overw*ight” and “ob*se” are concepts that were made up to pathologize bodies based on shared size rather than shared symptomology or cardiometabolic profile (largely architected by the weight loss industry.) More about that here.
I have no idea where they pulled the statistic that more than half the people who fall into this height/weight ratio don’t know it and 35% haven’t spoken to a healthcare provider about it, but I’d like to see a citation. If it’s true, then I think that’s great for them since it means that those people may be avoiding some of the dangers of the weight stigma that all this pathologizing and hand-wringing adds to.
Data do not, in fact, show that “even moderate weight loss of 10% can improve or prevent related risk factors for cardiovascular disease.” In fact, research suggests that it’s behavior changes and not the small amounts of (typically temporary) weight loss that create health changes. I wrote in depth about a study specifically about this here, and other studies here and here.
And if they are going to suggest intentional weight loss, it doesn’t seem ethical that they don’t - at the absolute least - mention that the most common outcome of intentional weight loss attempts is weight cycling and that weight cycling is independently linked to negative health outcomes including increased risk factors for heart disease and higher mortality.
Moving on:
It’s highly doubtful to me that, at the end of this program, patients will know the answers to these questions, given that medical science doesn’t know the answers to most of these questions.
What are healthy weight ranges?
There is no such thing as a “healthy weight range.” There are people of the exact same weight with wildly different health statuses and there are people of very different weights with the same health status. Weight is not an appropriate proxy for health or behaviors.
How do excess weight and ob*sity lead to heart disease?
We don’t know that they do. The confounding variables of weight cycling, weight stigma (which this campaign actively engages in,) and healthcare inequalities are rarely discussed and never controlled for in studies that link being higher weight to heart disease.
How is diabetes related to excess weight and ob*sity?
The relationship between diabetes and weight is complicated (for example, diabetes can cause both weight gain and weight loss) and, in truth, the relationship between weight and any health condition is, again, deeply unclear due to the confounding variables we just discussed. More to the point, though weight loss has a very long track record of long-term failure, Type 2 Diabetes can be managed in a weight-neutral way.
How can diet and exercise help reduce weight?
Only for a short period of time, based on about a century of research
What medicines are available to manage weight?
None that have shown long-term efficacy or safety.
What’s the best way to get motivated to take ownership of my health and control risk factors?
Well, you could consider getting off the weight loss roller coaster, leaving this deeply flawed and utterly failed (though highly profitable) weight loss paradigm behind, and approach health from a weight-neutral paradigm on your own terms.
So, who is teaching all of this?
Per openpayments.cms.gov, between 2015 and 2021:
Dr. Jhalani took $129,524.60 from pharmaceutical companies that sell weight loss drugs.
Dr. Kumar took $131,149.64.
Dr. Yaghoobzadeh has taken $1,083.56 in 62 separate food and beverage payments suggesting that he is spending significant time receiving education from the companies that sell the drugs. Research has shown that a single small payment can influence practitioners, and he’s taken 62 of them.
Importantly, their financial relationships were not disclosed in the ad (or on the website for the event that I could find.)
Again, the people who put this together (and the speakers themselves) may have good intentions, but that doesn’t erase the harm. If medicine is ever to actually support the health of higher-weight people, it must do better than regurgitating weight stigma and poor science propped up by pharmaceutical industry money.
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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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
The "link" between being fat and diabetes has to GO. They've known for 50+ years that unwanted weight gain is a symptom of diabetes, not a cause, but that doesn't sell medications and quack notions, so it's now a very solid factoid believed by too many. Data over the past 20+ years has shown that issues linked to poverty - including 'forever chemicals,' general pollution, higher crime rates, bad and dangerous housing, and more, plus the stress from poverty itself (money struggles, having to work multiple jobs, juggling work & children without regular childcare, etc.) and racism are a very big contributor to bad health, including diabetes. Add to that the 5-year study published in April that says that the rate of diabetes in fat people is stable, but the rate in "lean" people, especially those of color, is climbing. It all says that body weight is not the smoking gun they desperately want it to be. (Trends in the Prevalence of Lean Diabetes Among U.S. Adults, 2015-2020 DOI: 10.2337/dc22-1847 )
On top of that, we have to remember the Look AHEAD study, which was going to prove that weight loss saved the lives of people with Type 2 diabetes, by reducing heart disease and CVD events. It was going to be a 20 year study but was stopped after 10 years, because people in both the "weight loss" and control groups were dying from CVD at the same rate. Weight loss did NOTHING to prevent diabetic-linked heart disease, so why should it do anything for non-diabetics?
Brutal brutal brutal. I think the conflict financial interest irritated me the most. “Helping” professionals. Yeah right.