Responding to Weight Loss Recommendations
Part 2 - Weight Loss Research Should Be Five Years - At Least
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In part one we discussed the issues with short-term weight loss intervention studies. As promised, today’s newsletter will discuss what can be done about it. In truth, significant systemic change is needed, and I’ll discuss that in a moment. In the meantime, as consumers and patients, we can immediately start having some conversations/asking questions of those who are prescribing/suggesting/promoting/selling weight loss to us (including healthcare providers.)
I know that, historically, these kinds of interventions have shown weight loss in the short term, but full regain, sometimes with harmful side effects, within five years for the vast majority of participants. Is there five-year data that shows that this intervention is likely to have different results?
Almost certainly there won’t be five years of follow-up, at which point you can make your decision. If they claim that there is five years of follow-up, or if you want to look into the research that does exist more fully, I recommend asking for the research, and you can use this tool to evaluate it. Also remember that the burden of proof should be on the person who is recommending the weight loss intervention, not on the person to whom it is being recommended.
If the suggested intervention is a drug, then we can also ask what the side effects are, and if any were life-threatening. The answer to this also gives you valuable information about the person speaking to you, including if they think it’s worth risking your health, life, and/or quality of life to make you thinner.
If a healthcare practitioner blows your question off with “every drug has side effects” then, at least from my perspective, that is not a healthcare practitioner who can be trusted and they are utterly failing at their duty of informed consent.
Ideally, instead of pouring good money after bad trying to figure out how to make fat people thin, we should instead invest in more studies of promising weight-neutral interventions, where health is supported directly, rather than trying to make people thin and hoping health will follow (there’s a list of some of the research supporting the paradigm here if it’s helpful.)
For now, in terms of harm reduction, some suggestions I have are:
Eradicate the notion that the “ob*sity epidemic”* is so terrible that we have to try anything and everything.
Stop using the argument that there is a “paucity of long-term data” about weight loss interventions as an excuse to foist more poorly/briefly studied interventions on fat people. Even if someone believes there’s not enough data to be conclusive, that doesn’t mean they can ignore the data that does exist.
The claim that there isn’t enough money for long-term studies should not be considered a good reason to foist poorly/briefly studied interventions on fat people (especially without true informed consent.)
Studies should not be written as sales and marketing tools. Study authors should seek to be honest and transparent in their discussions and conclusions, never writing with the intention of making the intervention seem more successful or safe than it truly was. (There is a tool to evaluate research here.)
Peer reviewers must rise above their own weight bias and do their jobs. At the very least, they should make sure that the conclusions match the data, information about dropout rates and limitations is clear. They should also not allow sweeping statements about weight and health that mislead readers into believing that being fat causes health issues and weight loss will solve them, when the research only shows a correlation between weight and health issues.
In intervention approval processes that weigh risks against benefits, a mountain of poorly contrived, poorly executed research that correlates higher-weight and health issues should not be uncritically used to approve dangerous weight loss interventions (ie: using the spurious argument a dangerous weight loss drug should be approved because it’s so risky to be fat that it’s reasonable to risk fat people’s lives and quality of life of they might use a little weight.)
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For a full bank of research, check out 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 Harrisons Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
I have had fatty liver for over a decade, and in that time, based on the research that I now know only followed participants for less than two years, multiple health care providers have advised me to lose *just* 7-10 percent of my weight as a way to manage my fatty liver. I tried, multiple times, but unsurprisingly (now) after a lifetime of dieting and weight cycling, any weight loss was quickly followed by weight regain plus a few pounds.
I'm scheduled to see my latest HCP who follows my fatty liver in January. She has already advised me to lose weight several times, even though I have tried telling her about my personal history that makes that recommendation inappropriate. I've been working with IE dietitians and even the dietitian who works with this HCP applauds my IE, weight neutral approach.
If the HCP again recommends weight loss for me, in addition to the questions about how long the research that supports that recommendation followed participants, I will have pointed questions about whether the study accounted for patients with histories of chronic dieting and weight cycling, as I'm confident they did not.
I am not an "uncompliant" patient. I eat a healthy diet and exercise as much as my various chronic conditions allow, which, as I have pointed out to my doctors, are actual behaviors I can control (unlike my weight!). I do all that I can to support my health. But my genetics and personal health history mean that among other things, no matter what I do my liver's going to accumulate fat.
Your column and the IE dietitians I've been working with have provided invaluable support for me to advocate for appropriate healthcare. Each visit I have with my healthcare providers, I am better at declining to get irrelevant weigh-ins and advocating for weight neutral care. Thank you.
I wanted to send this to my cousin, an X-Ray tech. But The Share link goes to a different article.