It's the Diets That Fail, Not the Patients They Are Prescribed To

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Studies show that the vast majority of diets fail. Even professional fatphobe Meme Roth admits that the failure rate is around 95%. Somehow people still believe that it’s because 95% of people just aren’t doing it right.

In truth, there is a lot of research about the physiological changes the body goes through in response to weight loss, for the specific goal of weight regain. An Australian research team studied people who had lost weight in an effort to understand some of these changes. A year after their initial weight loss:

·         A hormone that suppresses hunger and increases metabolism – Leptin – was still lower than normal

·         Ghrelin, nicknamed the “hunger hormone,” was about 20 percent higher

·         Peptide YY, a hormone associated with hunger suppression was abnormally low

·         Participants reported being much more hungry and preoccupied with food then they had prior to losing weight

A year after losing weight these people’s bodies were still biologically different than they had been prior to the weight loss attempt, as they desperately (and successfully) worked to regain the weight (participants had already regained about 30% of the weight they had lost in the first year.) One of the study’s authors characterized it as “A coordinated defense mechanism with multiple components all directed toward making us put on weight.”

I do not believe that body size is a medical issue to be treated. But if the healthcare industry is claiming it is then, at the very least, they need to ask whether or not weight loss meets the requirements of ethical, evidence-based medicine (spoiler alert: it does not.) The fact is that, regardless of why a treatment doesn’t work, if a healthcare intervention fails the vast majority of the time (and has the exact opposite of the intended effect the majority of the time) then there is a problem with the intervention, and an issue with meeting the criteria for evidence-based medicine. That is the situation with intentional weight loss attempts. The difference is that when it comes to attempted weight loss, the healthcare industry blame the patients for the intervention that failed them.

The thing that blew my mind when I realized it (thanks to the brilliant Deb Burgard) is that the entire basis of prescribing weight loss for greater health is built on the decidedly unscientific premise that if we make fat people look like thin people, they will have the same health outcomes . There is not a single study that shows that people who lose weight have the same health outcomes as people who were never fat, or better outcomes than if they had just engaged in healthy habits and stayed fat (in fact, research shows that people with the same habits have similar health statuses regardless of weight.)

This whole thing is just a guess – so all the work and money going into figuring out how to make fat people thin so that we can be “healthier” may well be a complete waste. Or worse, it may be doing harm, since research shows that the weight cycling that is the most common outcome of more than one weight loss attempt is associated with serious health risks. So it’s not just that it doesn’t appear that long-term weight loss is possible for most people – it’s also that, when it comes to health, weight loss may not even be a worthy goal.

What’s ridiculous to me is that it’s not being widely publicized that we have a mountain of evidence that shows that healthy habits are the best chance for healthy bodies of all sizes for those who are interested in that (and there’s no obligation). Plenty of studies show that people who get 30 minutes of moderate movement 5 days a week get tremendous benefits without weight loss. Another study shows that people who get moderate physical activity, 5 servings of fruits and vegetables, drink moderately and don’t smoke have the virtually the same health hazard ratios regardless of BMI.

It’s important to note that our culture’s attachment to weight loss as the path to health is not based on evidence. It is at best an “everybody knows situation” akin to the time when everybody “knew” that the sun revolved around the Earth (which could be why those of us who are pointing out the evidence are getting told to sit down and shut up faster than they put Galileo under house arrest). At worst, our attachment to weight loss is a combination of profitability and pride. The diet industry doesn’t want to give up the over $70 Billion a year it rakes in, doctors are enjoying lucrative weight loss practices, and others just don’t have the guts to admit that they’ve traveled so far down the wrong road and given so much bad advice to so many people.

So why do people who have all of this information keep trying to diet? I think it has a lot to do with the potential rewards and everyone’s belief that they can beat the odds. I was watching a documentary about the Green Beret selection process (I’m a documentary junkie). They know that 50% of people will fail but every person there is sure that he will beat the odds. At one point one of the guys is so out of it that they ask him “Do you know where you are” and his answer is, I swear to god, “hashbrowns”. But as they drive him away to see a medic he keeps yelling that he’s fine, he can do it. Golda Poretsky at Body Love Wellness wrote a great post about this phenomenon as it pertains to weight loss. I get e-mails all the time “I don’t agree with you because I’m losing weight right now and I just know I’m not going to gain it back.” To which I want to reply “hashbrowns.”

The truth is that weight stigma is real, and it harms fat people in every aspect of our lives – employment, recreation, dating and relationships, and more. The idea that we could move ourselves out of an oppressed class can be very tempting, even when we know that it is very unlikely to work. Even if it doesn’t work, professing self-loathing/the desire to be thinner can glean better treatment by those who perpetuate weight stigma.

I think a lot of the reason that people still believe that weight loss works if we try hard enough is that it almost always works short term. But it almost always fails long term and the dieting industry has done a great job of taking credit for the first part of a biological reality (short-term weight loss) and blaming dieters for the second part (long-term weight regain.) I get so many e-mails from people who say “I believe in HAES, but I’m doing [insert diet here] and I’ve lost X pounds so it’s working!”

There is so much societal reward when people are in the weight loss phase of their weight cycling that they can get a huge rush, and it’s easy to forget that there is a 95% chance that they will be back where they were (and a good chance that they’ll be heavier than they started) in two-five years, when they will be forced to reckon with the fact that they now know that everyone in their lives – and strangers on the internet – like them better when they are thin.

Recommending intentional weight loss is recommending that people do something that nobody can prove is possible for a reason that nobody has proven is valid and it does not meet the requirements of ethical, evidence-based medicine.

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More research:

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.