Issues with Terminology and Statistics in Weight Science - Part 1

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In the past I’ve written pieces specifically about issues and mistakes that are made with terminology that is used…let’s call it differently in weight science as well as common statistics mistakes and mishaps. Today I’m offering an update on terminology as part 1 and in part 2 we’ll talk about the statistics.

Terminology Trouble

It’s not “weight loss” it’s “ob*sity *treatment”

It’s absolutely weight loss. This change in terminology is part of weight loss industry marketing, feeding into their goal of having simply existing in a higher weight body (regardless of health status, cardiometabolic profile, etc.) be considered a “chronic lifelong disease” requiring lifelong treatment. Spoiler alert the “treatment” is…wait for it…weight loss. This is problematic both because it almost never works long-term and because higher-weight people are constantly, uncritically, being told to lose weight to cure/prevent health issues that thin people get.

The weight loss industry also uses this to dodge, duck, dip, dive, and dodge important questions about whether or not their “treatments” (even if they did lead to significant, long-term weight loss, which they almost never do) do anything to improve actual health. By calling it “ob*sity treatment” they are able to call body size change (often even a tiny amount) a “successful intervention” thus avoiding an awkward discussion around the fact that becoming thinner and improving actual health measures (cardiometabolic health etc.) are two different things (understanding of course, that “health” is an amorphous, individualized concept and is not an obligation, barometer of worthiness or entirely within our control.) They are also using it as part of a strategy to get around insurance rules that forbid the coverage of weight loss treatment. To paraphrase the Bard of Avon, weight loss treatment by any other name would still have a nearly 100% chance of long-term failure.

Weight-related conditions

This is a term that is used for health conditions that have been correlated with being higher-weight. As we often talk about in this publication (and as they discuss on the first day of literally every freshman research methods class,) correlation does not imply causation. Which is to say that just because two things happen at the same time, we cannot assume that one causes the other. We have to, at the very least, explore the possible confounding variables (which, here, include weight stigma, weight cycling, and healthcare inequalities) I wrote about this in detail here.

So a ton of research, much of it cranked out by the weight loss industry, correlates being higher-weight with health issues, studiously avoiding controlling for, or even discussing, known confounding variables. Then these correlated health conditions get called “weight related” and used by the weight loss industry and others in arguments about why being higher-weight requires “treatment.”

In truth “weight-related conditions” are just health conditions that happen to people of all sizes that get called ‘weight-related” when higher-weight people have them.

“Sustained” weight loss

When we hear that a study or intervention resulted in “sustained weight loss” it may conjure the assumption that participants lost weight and maintained that weight loss. More and more though I’m seeing the term “sustained weight loss” (in everything from research, to weight loss industry press releases, to media articles) used to mean “subjects lost weight and were steadily regaining it but hadn’t gotten back to their baseline weight when we stopped tracking it.”

This seems to be a weight loss industry tactic to counter the fact that they haven’t been able to create a weight loss method that actually creates sustained weight loss, so they simply re-define “sustained” and start using it to mislead people about the outcomes of their interventions (much like they’ve done with “relapsing/remitting.”)

Whether it’s making up terms or re-defining common words to suit their purposes, we have to remember that the weight loss industry (including within the healthcare system) is a for-profit industry, and it markets like one. Thus, we have to be careful and diligent when we are reading media, press, and research created, directed, and/or influenced by the weight loss industry.

In part 2 we’ll take a look at some statistical shenanigans.

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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.