I’m often called upon to debate the research around Weight Loss and Health at Every Size – sometimes it’s as a professional speaker in an organized panel or debate, sometimes it’s at the doctor’s office when I’m insisting on evidence-based treatment, sometimes it’s when someone has posted some weight loss thing on my social media and I feel like engaging them.
Before we get too far into this, people are allowed to do whatever they want with their bodies, for whatever reason they want – that includes weight loss or practicing Health at Every Size, or something else – regardless of the evidence. And no evidence is needed for the fact that fat people have the right to exist in fat bodies (there’s a full discussion about that here.) This post is about those who choose to discuss and debate the research around weight loss and Health at Every Size
When I started at this, my first instinct was to lead with a ton of research that supports a Health at Every Size approach, and then state the fact that there isn’t a single study where more than a tiny fraction of people are able to maintain weight loss for five years for more, and that no study exists that compares the health of fat people who have suppressed their weight long term to fat people who have stayed fat and/or fat people who practice Health at Every Size to show that they actually have better health.
But there were some issues that made this approach ineffective: By far the most common was that a combination of scientific illiteracy and hubris leads many people to believe that “common knowledge” (ie: “Everybody knows that people who regain weight just went back to their old habits” or “Everybody knows that being fat is unhealthy.” etc.) is actually the same thing as fact.
So I would provide multiple studies, and they would simply state that those studies must be flawed because “everybody knows” that their (completely unsupported by evidence) beliefs are true, and then claim to have won the debate. To paraphrase an old saying, arguing with “everybody knows” is like playing chess with a pigeon, no matter how good your research is, the bird is going to shit on the board and strut around like it won.
When I then brought up the lack of evidence to support their point, people would insist the pervasiveness of their beliefs proved their that they are true, and that I had to prove that no study exists. Of course it’s basically impossible to prove that a study doesn’t exist so there would be more shitting and more strutting.
This is irritating in debates, but not unexpected. Those who aren’t on “team everybody knows” are always at a disadvantage in these situations because we have the same amount of time to introduce and prove an entire paradigm, as the person who is saying “everything you already is true.” I knew that’s what challenging paradigms is about when I took on the challenge.
Where this started to create a serious issue for me was in the doctor’s office when it was standing in the way of good, evidence-based medical care. A doctor would prescribe weight loss (for a condition that thin people also get.) I would talk about HAES and go through the shitting/strutting situation I just described, and leave without the care I needed, or with the care but completed exhausted and possibly in need of blood pressure medication!
I’ve found it’s much more successful to flip the strategy. When people want to debate weight loss with me, I put the burden of proof on them – if they think that people are able to lose weight long term, and that doing so will make them healthier, then they ought to be able to produce some evidence for that – especially if they are a doctor who has an ethical responsibility to provide me with evidence-based medicine and informed consent, and I’ll be happy to discuss that evidence. This is often pesky for them as no such evidence exists – and fair warning, if you are telling me about a study where 70% of people dropped out and the rest lost 2 pounds you’ve not made your point.
I’m happy to produce and discuss research to support Health at Every Size, but I now realize that it’s not my job to provide the evidence for both sides of the debate, and it’s not acceptable to me for people to bring “Everybody Knows” to a research fight.
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