Intentional Weight Loss and Lottery Logic

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You can’t win if you don’t play.

That’s what the PowerBall ad said. I could pay $2 for a ticket and possibly win a $20 million jackpot. Of course, I have a 99.9999997 percent chance of losing which may be why my stats teacher used to say that the lottery was a tax on people who didn’t pay attention in her class.

Still, the lottery says, you probably won’t win but imagine if you did. Imagine being $20 million richer overnight. You can’t win if you don’t play.

What’s left is a risk/benefit analysis. There’s almost no chance of winning, so how good or bad of an idea it is to play the lottery comes down to how much someone can afford to lose the $2 (or however much they are spending on tickets.) If someone can easily afford it then they might decide that it’s no big deal then even though there is almost no chance they will win. However, if someone is in a position where they need $2 to pay for food, rent, gas etc. then they might decide that the risk is too high.

Or they might decide that the chance of winning $20 million is too much to give up - and you can’t win if you don’t play. People get to make that choice.

So why am I going on about the lottery in a newsletter about the intersections of weight science, weight stigma, and healthcare?

Because I hear a similar type of “logic” all the time from the weight loss industry, lay people, even doctors. Sure, weight loss might not work, they say, but you’ll never lose weight if you don’t try.

I’ve noticed over the time that I’ve been talking about/teaching about the failure rate of intentional weight loss interventions, there has been a shift in the most common response when I explain that about a century of research shows that intentional weight loss fails about 95% of the time (only 4.9999997% less than the lottery, but who’s counting.) In the early days they would say something like “that statistic is just from one study in the 1950’s” (which is false). Now, a much more common response is something like “That’s true, but you just have to keep trying until you get in the 5%.”

Now, I’m aware that not everyone studied statistics, and that’s completely reasonable. (And while they teach statistics in medical school, they teach a lot of things in medical school so it’s understandable if a med school student was so busy trying to figure out what the spleen does or how to diagnose lupus that they didn’t exactly give statistics their all.) But I did study statistics and I can tell you, that’s not how it works.

Besides being, essentially, lottery logic, there’s the assumption that past/current attempts do not impact future attempts (that is, it’s based on an unproven assumption that a weight-loss attempt that results in losing and regaining weight will not impact the chances of success of the next attempt.) Moreover, it ignores the fact that when weight loss interventions fail (and let’s be clear that it’s the interventions that fail, not the people attempting them) that failure is not benign. People are harmed by unsuccessful weight loss interventions.

Imagine if they changed the lottery rules so that if you failed to match any of the numbers you had to pay $5. What if it was $10? Or $100?

What if it was your health?

Weight cycling (losing weight and then regaining weight) is the outcome of the vast majority of intentional weight loss attempts. It is also independently correlated to numerous mental and physical health issues including high blood pressure, type 2 diabetes, cardiovascular disease, and increased overall mortality. (I have an in-depth piece about this here.) That changes the risk benefit analysis considerably.

Another response to the reality of the massive failure rate of intentional weight loss is “Sure, but what else are we supposed to do if we want to be healthy?”

Understanding that health, by any definition, is not an obligation, barometer of worthiness, or entirely within our control, a significant body of research suggests that weight-neutral interventions can have the same (or greater) benefits as intentional weight loss without the risk. In fact, it might be that weight loss itself doesn’t have many if any health benefits but, rather, the health impacts of the behavior changes that people make are simply getting credited to weight loss.

So behavior-based weight loss interventions have almost no chance of success, and a high chance of failure, and failure causes harm (and weight loss surgeries and drugs have high failure rates and much higher risks.)

Lottery logic says “You can’t win if you don’t play.”

Said another way, though - you can’t be harmed if you don’t play.

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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.