I really appreciate this, especially since the first one re: this only being about fad diets and not "lifestyle changes" (huge eye roll) is so damn persistent. Even with people who say "diets don't work," they often actually think this means "fad diets don't work," and will follow it up with, "...so try these other things!" It's so frustrating!
I've brought this up in the past with some medical professionals and one reply I've gotten is (paraphrasing) "5% success rate is great! I tell to stop smoking, stop drinking alcohol, stop using illegal drugs to all my patients who do so, and the success rate is far smaller than that!" often followed by "a 5% success rate means that you have to give it 20 serious tries and you'll eventually succeed." I haven't really found a great counter to these arguments. One physician even took my counter argument about not being an alcoholic - just obese - by telling me that my liver essentially looks like the liver of someone who's an alcoholic, and pinned it down to the huge amount of sugar I ate. She explained that alcohol and sugar are in practice the same substance as far as the liver is concerned and are equally bad for me.
This is a great question, thanks - I may end up writing an answer for a separate post, but the here are some quick thoughts on this:
5% success rate does NOT mean that you have to give it 20 tries. That is factually incorrect. The chance of success in intentional weight loss does not increase with repeated tries, but what does increase is weight cycling which is independently linked to harm. You might ask the practitioner what medications they prescribe to patients that only have a 5% success rate.
You cannot compare weight loss with smoking or drinking for several reasons. First, smoking and drinking are specific, single behaviors, while body size is incredibly complex. Second, someone is healthier for every cigarette they do not smoke, even if they are ultimately unsuccessful at quitting, that's not the case for those who diet because of the harm of weight cycling.
The liver thing is also pretty questionable. First, I would ask if your doctor actually had images of your liver or was making assumptions based on your size (and thus practicing stereotypes instead of medicine.) There are people (of all sizes) who eat "tons of sugar" who don't get liver issues, and people (of all sizes) who don't eat "tons of sugar" who do have liver issues, including NASH (which literally stands for "Non-Alcoholic SteatoHepatitis specifically to make it clear that it's not the same as liver damage brought on my alcohol.) My understanding is that, while some studies show a correlation between sugar consumption and NASH, no causal mechanism has been proven.
It's also more complicated than fat=liver damage and weight loss = fixing liver damage, both because there are fat people who don't have liver issues and thin people who do, and because one of the symptoms of liver damage can be weight loss, and one of the risk factors for getting liver damage is gastric bypass surgery.
Alcohol and sugar are not, in practice, the same substance and I'm a bit horrified that a medical doctor thinks that they are. Many hard alcohols (like vodka, gin, tequila, rum and whisky) contain little to no sugar and are not metabolized into sugar. Alcohol harms the liver by causing inflammation and scarring. The belief around sugar consumption is that it might cause harm to the liver by causing it to create too much fat, some of which stays around the liver causing fatty liver but, again, this appears to be a combination of correlation and hypothesis and even if it's true it's still not the same thing as alcohol. It should also be noted that many alcoholics don't have serious liver damage, so there is no such thing as "the liver of an alcoholic" just like there's no such thing as "the liver of a fat person." So that blanket assumption by your doctor is also not medically sound.
There is a HAES Health Sheet about it here if it's helpful:
I really appreciate this, especially since the first one re: this only being about fad diets and not "lifestyle changes" (huge eye roll) is so damn persistent. Even with people who say "diets don't work," they often actually think this means "fad diets don't work," and will follow it up with, "...so try these other things!" It's so frustrating!
I've brought this up in the past with some medical professionals and one reply I've gotten is (paraphrasing) "5% success rate is great! I tell to stop smoking, stop drinking alcohol, stop using illegal drugs to all my patients who do so, and the success rate is far smaller than that!" often followed by "a 5% success rate means that you have to give it 20 serious tries and you'll eventually succeed." I haven't really found a great counter to these arguments. One physician even took my counter argument about not being an alcoholic - just obese - by telling me that my liver essentially looks like the liver of someone who's an alcoholic, and pinned it down to the huge amount of sugar I ate. She explained that alcohol and sugar are in practice the same substance as far as the liver is concerned and are equally bad for me.
This is a great question, thanks - I may end up writing an answer for a separate post, but the here are some quick thoughts on this:
5% success rate does NOT mean that you have to give it 20 tries. That is factually incorrect. The chance of success in intentional weight loss does not increase with repeated tries, but what does increase is weight cycling which is independently linked to harm. You might ask the practitioner what medications they prescribe to patients that only have a 5% success rate.
You cannot compare weight loss with smoking or drinking for several reasons. First, smoking and drinking are specific, single behaviors, while body size is incredibly complex. Second, someone is healthier for every cigarette they do not smoke, even if they are ultimately unsuccessful at quitting, that's not the case for those who diet because of the harm of weight cycling.
The liver thing is also pretty questionable. First, I would ask if your doctor actually had images of your liver or was making assumptions based on your size (and thus practicing stereotypes instead of medicine.) There are people (of all sizes) who eat "tons of sugar" who don't get liver issues, and people (of all sizes) who don't eat "tons of sugar" who do have liver issues, including NASH (which literally stands for "Non-Alcoholic SteatoHepatitis specifically to make it clear that it's not the same as liver damage brought on my alcohol.) My understanding is that, while some studies show a correlation between sugar consumption and NASH, no causal mechanism has been proven.
It's also more complicated than fat=liver damage and weight loss = fixing liver damage, both because there are fat people who don't have liver issues and thin people who do, and because one of the symptoms of liver damage can be weight loss, and one of the risk factors for getting liver damage is gastric bypass surgery.
Alcohol and sugar are not, in practice, the same substance and I'm a bit horrified that a medical doctor thinks that they are. Many hard alcohols (like vodka, gin, tequila, rum and whisky) contain little to no sugar and are not metabolized into sugar. Alcohol harms the liver by causing inflammation and scarring. The belief around sugar consumption is that it might cause harm to the liver by causing it to create too much fat, some of which stays around the liver causing fatty liver but, again, this appears to be a combination of correlation and hypothesis and even if it's true it's still not the same thing as alcohol. It should also be noted that many alcoholics don't have serious liver damage, so there is no such thing as "the liver of an alcoholic" just like there's no such thing as "the liver of a fat person." So that blanket assumption by your doctor is also not medically sound.
There is a HAES Health Sheet about it here if it's helpful:
https://haeshealthsheets.com/fatty-liver-disease/
Hope that helps!
Great blog post! I'm definitely saving this one as a reference. Fatphobia runs so deep unfortunately, that many people cannot seem to face facts.