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Today I’ll start with a few scenarios. Note that they include weight loss talk so feel free to skip the bullets.
A doctor tells a fat patient to eat less and exercise more.
A doctor recommends that a fat patient swallow a balloon to take up room in their stomach
A doctor prescribes Wegovy for weight loss because it helps disrupt the body’s hunger signals.
A doctor prescribes an appetite suppressant to a fat patient for weight loss
A doctor prescribed (when it was still available) the FDA-approved AspireAssist, in which a tube was placed in the patient’s stomach connected to a port on the outside. After each meal the patient used the tube and a handheld device to pump the food directly out of their stomach and into the toilet prior to digestion.
These are some of many so-called healthcare interventions that stem from the debunked calories in/calories out model of weight loss, based on the idea that if someone eats less fuel than their body needs, it will consume itself and become permanently smaller.
Now, there is about a century of research showing that the most common outcome will be that people lose weight short-term and then regain it long-term as their bodies adjust to food restriction and change physiologically in order to become weight maintaining, weight regaining machines. Then there is deeply flawed research (often funded and/or conducted by the weight loss industry) that uses a number of methods to try to obfuscate the abject failure of these weight loss interventions.
In all of this, there is a question that is almost never even asked, certainly not by the weight loss industry:
Are the people following these weight loss interventions getting enough actual nutrition?
Almost all of the weight loss interventions based on calories in/out and appetite suppression just assume that fat people should eat less food than they need/less food than they are eating now. Not only is this unscientific, it can be dangerous. It can lead to a failure to identify (or even screen for and, sadly, in some cases even believe that there are) eating disorders in higher weight people. It can also lead people to believe that somehow weight loss by any means necessary is more important than fat people actually being nourished. Interventions like the AspireAssist literally assume (without evidence) that fat people don’t need (a recommended 30% of) the food that they eat and can be removed without discernment. This gets even more concerning when we talk about (the scourge of) “very low calorie” diets where people can get 800 or even fewer calories a day.
This “thin by any means necessary” belief means that whether or not fat people who are put on these interventions are actually getting adequate nutrition is not tracked. Follow-up appointments typically consist of nothing more than a weigh-in. With drugs like Wegovy, people report “forgetting to eat” or never wanting to eat and believing that’s a “normal” relationship with food. Pro-tip – it’s not. Our bodies have hunger signals for a reason, and assuming that fat people don’t need to be able to perceive them is, again, unscientific and incredibly harmful.
The belief that thinner people should have access to the nutrition they need to survive and thrive, but fat people just need enough calories not to die is pure weight stigma, incredibly common, and can be fatal.
Testing (or, hey, even caring about) nutritional deficiencies during weight loss interventions would be better, but the true solution is to move to a weight-neutral paradigm where, understanding that health is not an obligation, barometer of worthiness, or entirely within our control, the focus of healthcare is on supporting the health of people of all sizes, not on health for thin people but thinness by any means or method, however dangerous, unscientific, or ill-advised for fat people.
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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Thank you for talking about this. I am so, so, so tired of doctors assuming they know anything about what I actually eat or don’t eat. They never even ASK about my food intake before telling me to stop eating in one way or another.
My iron stores got so low before I figured out I have celiac, they worried I had some kind of rare cancer… I had to go through a (traumatic) bone marrow biopsy. Only to find out that because I was eating so little (because everything made me sick— which doctors didn’t believe, because a fat person could NEVER go without eating!), I had a ton of nutritional deficiencies. But the iron was the lowest and most dangerously low.
I say “I figured out I have celiac” because I did. No help from doctors. Out of desperation, I requested testing twice and was refused because of my size. (People my size can’t have celiac!) It would be years before I could find someone to take my request seriously, and I was RIGHT.
Years of poor nutrition, poor concentration, brittle bones, and menstrual issues… and no one even asked about my nutrition. If I talked to them about my food intake, they didn’t believe me. No matter how much I did or didn’t eat, it was always too much.
I don’t understand “treatments” like Wegovy. It just tells your body not to release hunger cues, so you don’t eat, but your body still needs food, right? I know on busy days at work or when I’m doing something really fun (like going to Disneyland) I WILL get dizzy and possibly even nauseous if I don’t eat. Are these folks not feeling those symptoms or are they just supposed to go on tired and dizzy?