This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! The idea that people can gain “clinically meaningful health benefits” by losing 5-10% of their body weight is ubiquitous and ridiculous. Sometimes it is recommended as a way to improve general health, to reduce cardiometabolic risk factors, or to improve a specific health condition. This piece is, essentially, the third in a series about this phenomenon. You can find the other two pieces, in which I wrote in depth about ideas, and a study that tested it,
The two years of my adult life when I had a “normal” BMI I had an ED. Initially when I started restricting my eating, I had in my mind I should lose 20 lbs to reach the normal BMI range. After losing 25 lbs, I still wasn’t small enough, my mental health was very bad and it took another 2 years to stop restricting my food with calorie counting apps when I started to regain weight.
My labs 10 years later show better health parameters, I was anemic throughout my 20s and my blood pressure remained borderline high when I was a lower weight. When I began TTC about 8 years ago, my dr put me on blood pressure meds and 2 kids later I am still on that dose. It irritates me that weight loss is still recommended to me for my chronic high blood pressure. No I don’t think it will go away if I lost 20 pounds, no I don’t think it’s helpful to try to lose weight. Thank you for your work!
I love it when you "bring it home" and lay down some cold hard facts. This will go in my "Ragen favorites" folder, which is getting awfully full, btw. 😉
Thank you for this. I'm dealing with a healthcare provider who believes in recommending weight loss, although she says she'll respect my decision to not pursue it (argh.)
Would you please refresh my recollection of any evidence that a weight loss of 5 - 10% is *not* due to the weight loss itself, and therefore is likely to be due to behavioral changes that preceded the weight loss?
Oh, I think I just recalled what the argument is: that people who make lifestyle improvements experience improvements in measures of health even if they don't lose weight.
Would you link me to any of your or other's articles listing the health risks of pursuing weight loss, please? It's so I can share them with my provider and clinic. I go to a Federally Qualified Health Center, which I've read is the type of clinic where the government tests their weight loss strategies, or at least promotes them the most.
This is always fascinating. I've gotten this recommendation for the past, oh, five years, but what happened is that I started a new job with less stress and more movement, and at the exact same weight, my A1C went down two points. Huh. Imagine that.
Thank you for this, I keep thinking about this. Once upon a time I weighed about 80 pounds less than I do now. I had problems with chronic headaches, heartburn, acne, and depression. I briefly lost a bunch of weight through horribly restrictive eating (which was medically sanctioned) and I still had all these problems. Arguably the ED made my depression worse because losing weight didn’t make my problems go away. Anyway long story short I got on SSRIs, and felt better than I did in years (to the sacrifice of my appetite). I weigh more now than I ever have but I also stopped caring, my self esteem is better than it was when I was much, much thinner. But I still have some of those health problems, and after getting blood tests done, I’m doing fine. So like, why do we assume weight gain causes all illnesses when so many of us had them when we weighed less? Us fat folks shouldn’t have to lose weight just to be taken seriously but that’s the sad reality. As far as I know, there isn’t a single disease or illness that only fat people get.
I also had a copy of my comments for future reference, so will paste here, and lesson learned not to try to do this on my phone!
_____________
After a lifetime of weight cycling and bullshit "advice" from doctors, I just stopped listening to all the junk science. I'm healthier now than ever, surprising my doctor.
It's like the hate-eggs campaign in the 80s...people gave up nutrition-packed eggs on the "medical" advice that eggs yolks, because they contained cholesterol, would raise their cholesterol. That is so simplistic it's positively Medieval! Back then, it was called the "Doctrine of Signatures," and meant that if a plant looked like a body part, it must be good medicine to treat it. To say that because a food has cholesterol it must raise a person's is laughable. In fact, that was before it was discovered that there are different kinds of cholesterol, which have different effects, and interact in different ways. Yup.
I did my own research and decided to keep eating eggs. Of course, there is a new "study" every so often either praising or vilifying eggs, which just proves my point: no one really knows wtf they're talking about.
It is arrogant beyond belief to think that our human knowledge can approach complete understanding on any health or disease process, as we find out every day with new knowledge that debunks old treatments. I believe that the insane way our culture operates in a current state of high anxiety and chronic stress is behind much of the malaise we suffer, from sleep to heart disease, to diabetes. Not saying that if a person is on a medication for these they should not take them if they are working well; just that I will not be shocked when the causation finally surfaces. But of course, there is no money to be made on walking back the people-as-products-and-productivity-machines narrative that makes shareholders wealthy. Meanwhile, we will continue to get new "diet drugs," because, well, they're making a lot of money.
I decided long ago that if I were to pivot every time another "report" dropped about whether or not to eat this or that food based on this or that study, would be a crazy-making path that I refused to follow. Moreover, the money and power behind these fads are not a reason to override one's own instincts about what and how to feed our bodies. Our bodies are wise beyond measure, with millions of years of evolution letting us know what does and does not suit each of our particular bodies, so I say we listen to them and cancel out all stupid the noise.
"Bother!" said Kate, as she accidentally deleted her comment while using the app and touched just the wrong place. I had intended to share a link to a post about the Barbie movie in reply to @Janelle leaving such a kind comment about liking my writing style. Here is the link for "No Barbie for Me": https://verbihundcafe.substack.com/p/no-barbie-for-me
I went down this (really stupid) road with my former physician. Fortunately, my current PA is willing to treat me using a weight-neutral paradigm, which is why I'm willing to drive 100 plus miles to keep seeing her. It's sad that it's so rare to find medical professionals who will extend the most common of courtesy to their patients.
I do discuss weight and BMI in this comment. Even though I'm ridiculing the idea postulated, if you would find such a discussion triggering, give the comment a miss.
Anyway, here's how it went with my old doctor.
I have endocrine problems. My thyroid immolated itself when I hit puberty. I have PCOS. I was unsurprised when I developed diabetes at 49, since the rest of my endocrine system is a trash fire. I also became bulimic at 12 years old and spent decades living with food insecurity, both voluntary (dieting) and involuntary (didn't have enough money to buy adequate food.) So, one might think the man would have the sense to realize he was dealing with a person who had tried and "failed" at dieting numerous times. No such luck. Our conversations went a little bit something like this:
Him: "If you could just lose 30 pounds. That's only 10 percent of your weight. Surely you can do that!"
Me: "I'm not dieting again. Every time I diet, the weight comes back with friends. That's not why I'm here."
Him: "But it's such a small amount of weight!"
Me: "I'm done with yo-yo dieting. I'm not doing this!"
I did the math. If, according to the BMI (remember, the B stands for bullshit) my weight "should" be between 114 and 154 pounds.
If I were to lose 30 pounds from my approximate current weight of 300, I'd be at 270. But I still wouldn't be an "acceptable" size. So then the old doc would prompt me to lose another 10 percent. That would be 27 pounds, but I want to keep the math easy, so we'll just do 30 again, which would put me at 240 pounds. Nope, still not good enough. He'd want me to lose another 10 percent, which would be 24 pounds. I'll do 25, which would put me at 215. Guess what, once again I still haven't measured up to the BMI, so I'd lose another 21 pounds. We'll just go with 20 because the math is easier. This would put me at 195. But that's still not acceptable. I'll lose another 20 pounds, which would put me at 175. Nope, we aren't there yet. I'll lose 15 pounds, putting me at 160. Nope, I still haven't achieved the almighty goal. Let's lose another 15.
This puts me at 145. That's within the "acceptable" range according to the BMI. But guess what? My proclivity for thinking more weight loss is better has returned full force. I'm going to keep dieting until I plateau and start hating myself because I can't lose more weight. Really, that phase would have happened far sooner. Never mind my endocrine problems, I'm one of those people who has dieted so much over the years that I no longer lose weight when I diet. I only did the mathematical exercise above to illustrate how ridiculous and obsessive this idiot idea is and how it just results in a shame spiral. I'm not the only one who has this reaction to being prescribed weight loss. Doctors don't give a good god damn, though.
The two years of my adult life when I had a “normal” BMI I had an ED. Initially when I started restricting my eating, I had in my mind I should lose 20 lbs to reach the normal BMI range. After losing 25 lbs, I still wasn’t small enough, my mental health was very bad and it took another 2 years to stop restricting my food with calorie counting apps when I started to regain weight.
My labs 10 years later show better health parameters, I was anemic throughout my 20s and my blood pressure remained borderline high when I was a lower weight. When I began TTC about 8 years ago, my dr put me on blood pressure meds and 2 kids later I am still on that dose. It irritates me that weight loss is still recommended to me for my chronic high blood pressure. No I don’t think it will go away if I lost 20 pounds, no I don’t think it’s helpful to try to lose weight. Thank you for your work!
I love it when you "bring it home" and lay down some cold hard facts. This will go in my "Ragen favorites" folder, which is getting awfully full, btw. 😉
For “joint health” (aka my knee arthritis) I was told losing 5-10 *lbs* would help. Like…what!?
Thank you for this. I'm dealing with a healthcare provider who believes in recommending weight loss, although she says she'll respect my decision to not pursue it (argh.)
Would you please refresh my recollection of any evidence that a weight loss of 5 - 10% is *not* due to the weight loss itself, and therefore is likely to be due to behavioral changes that preceded the weight loss?
Oh, I think I just recalled what the argument is: that people who make lifestyle improvements experience improvements in measures of health even if they don't lose weight.
Would you link me to any of your or other's articles listing the health risks of pursuing weight loss, please? It's so I can share them with my provider and clinic. I go to a Federally Qualified Health Center, which I've read is the type of clinic where the government tests their weight loss strategies, or at least promotes them the most.
Thank you again.
MIC drop! Yes!
Amazing article! Love it!
This is always fascinating. I've gotten this recommendation for the past, oh, five years, but what happened is that I started a new job with less stress and more movement, and at the exact same weight, my A1C went down two points. Huh. Imagine that.
Thank you for this, I keep thinking about this. Once upon a time I weighed about 80 pounds less than I do now. I had problems with chronic headaches, heartburn, acne, and depression. I briefly lost a bunch of weight through horribly restrictive eating (which was medically sanctioned) and I still had all these problems. Arguably the ED made my depression worse because losing weight didn’t make my problems go away. Anyway long story short I got on SSRIs, and felt better than I did in years (to the sacrifice of my appetite). I weigh more now than I ever have but I also stopped caring, my self esteem is better than it was when I was much, much thinner. But I still have some of those health problems, and after getting blood tests done, I’m doing fine. So like, why do we assume weight gain causes all illnesses when so many of us had them when we weighed less? Us fat folks shouldn’t have to lose weight just to be taken seriously but that’s the sad reality. As far as I know, there isn’t a single disease or illness that only fat people get.
I also had a copy of my comments for future reference, so will paste here, and lesson learned not to try to do this on my phone!
_____________
After a lifetime of weight cycling and bullshit "advice" from doctors, I just stopped listening to all the junk science. I'm healthier now than ever, surprising my doctor.
It's like the hate-eggs campaign in the 80s...people gave up nutrition-packed eggs on the "medical" advice that eggs yolks, because they contained cholesterol, would raise their cholesterol. That is so simplistic it's positively Medieval! Back then, it was called the "Doctrine of Signatures," and meant that if a plant looked like a body part, it must be good medicine to treat it. To say that because a food has cholesterol it must raise a person's is laughable. In fact, that was before it was discovered that there are different kinds of cholesterol, which have different effects, and interact in different ways. Yup.
I did my own research and decided to keep eating eggs. Of course, there is a new "study" every so often either praising or vilifying eggs, which just proves my point: no one really knows wtf they're talking about.
It is arrogant beyond belief to think that our human knowledge can approach complete understanding on any health or disease process, as we find out every day with new knowledge that debunks old treatments. I believe that the insane way our culture operates in a current state of high anxiety and chronic stress is behind much of the malaise we suffer, from sleep to heart disease, to diabetes. Not saying that if a person is on a medication for these they should not take them if they are working well; just that I will not be shocked when the causation finally surfaces. But of course, there is no money to be made on walking back the people-as-products-and-productivity-machines narrative that makes shareholders wealthy. Meanwhile, we will continue to get new "diet drugs," because, well, they're making a lot of money.
I decided long ago that if I were to pivot every time another "report" dropped about whether or not to eat this or that food based on this or that study, would be a crazy-making path that I refused to follow. Moreover, the money and power behind these fads are not a reason to override one's own instincts about what and how to feed our bodies. Our bodies are wise beyond measure, with millions of years of evolution letting us know what does and does not suit each of our particular bodies, so I say we listen to them and cancel out all stupid the noise.
"Bother!" said Kate, as she accidentally deleted her comment while using the app and touched just the wrong place. I had intended to share a link to a post about the Barbie movie in reply to @Janelle leaving such a kind comment about liking my writing style. Here is the link for "No Barbie for Me": https://verbihundcafe.substack.com/p/no-barbie-for-me
Nailed it! You make the perfect argument here, and I love your writing style.
I know I'm tardy to the party.
I went down this (really stupid) road with my former physician. Fortunately, my current PA is willing to treat me using a weight-neutral paradigm, which is why I'm willing to drive 100 plus miles to keep seeing her. It's sad that it's so rare to find medical professionals who will extend the most common of courtesy to their patients.
I do discuss weight and BMI in this comment. Even though I'm ridiculing the idea postulated, if you would find such a discussion triggering, give the comment a miss.
Anyway, here's how it went with my old doctor.
I have endocrine problems. My thyroid immolated itself when I hit puberty. I have PCOS. I was unsurprised when I developed diabetes at 49, since the rest of my endocrine system is a trash fire. I also became bulimic at 12 years old and spent decades living with food insecurity, both voluntary (dieting) and involuntary (didn't have enough money to buy adequate food.) So, one might think the man would have the sense to realize he was dealing with a person who had tried and "failed" at dieting numerous times. No such luck. Our conversations went a little bit something like this:
Him: "If you could just lose 30 pounds. That's only 10 percent of your weight. Surely you can do that!"
Me: "I'm not dieting again. Every time I diet, the weight comes back with friends. That's not why I'm here."
Him: "But it's such a small amount of weight!"
Me: "I'm done with yo-yo dieting. I'm not doing this!"
I did the math. If, according to the BMI (remember, the B stands for bullshit) my weight "should" be between 114 and 154 pounds.
If I were to lose 30 pounds from my approximate current weight of 300, I'd be at 270. But I still wouldn't be an "acceptable" size. So then the old doc would prompt me to lose another 10 percent. That would be 27 pounds, but I want to keep the math easy, so we'll just do 30 again, which would put me at 240 pounds. Nope, still not good enough. He'd want me to lose another 10 percent, which would be 24 pounds. I'll do 25, which would put me at 215. Guess what, once again I still haven't measured up to the BMI, so I'd lose another 21 pounds. We'll just go with 20 because the math is easier. This would put me at 195. But that's still not acceptable. I'll lose another 20 pounds, which would put me at 175. Nope, we aren't there yet. I'll lose 15 pounds, putting me at 160. Nope, I still haven't achieved the almighty goal. Let's lose another 15.
This puts me at 145. That's within the "acceptable" range according to the BMI. But guess what? My proclivity for thinking more weight loss is better has returned full force. I'm going to keep dieting until I plateau and start hating myself because I can't lose more weight. Really, that phase would have happened far sooner. Never mind my endocrine problems, I'm one of those people who has dieted so much over the years that I no longer lose weight when I diet. I only did the mathematical exercise above to illustrate how ridiculous and obsessive this idiot idea is and how it just results in a shame spiral. I'm not the only one who has this reaction to being prescribed weight loss. Doctors don't give a good god damn, though.
Love this piece! 💜