A Canadian panel has released new guidelines for "obesity management" that seem to be based on the adage "admit what you can't deny, deny what you can't admit," while co-opting the language of fat activism in an attempt to keep their profession profitable.
Let's start with them admitting what they can't deny. As the paper's lead author told The Guardian:
"The common medical advice to eat less and exercise more doesn't really help most patients...whenever people decrease their calories, they activate a bunch of hormones and neurochemicals within their brain, within their gut, that drive the weight to come back on. So we're failing people all the time when we say go on a diet so they can lose a little bit of weight, [because they often] regain all of it, if not more,"
This is something fat activists have been saying for literally decades, but I guess thanks to the "experts" who have been harming fat people and profiting off of this idea for those same decades for finally catching on? Still, this is a victory for fat activists.
That's the "good" news, but here's the bad news. Instead of just admitting that bodies come in lots of sizes, Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons (the group who drafted the guidelines and who, it should be pointed out, all have a tremendous financial motive to say this) are pushing the idea that being fat is "a complex chronic illness" that needs to be treated with a "variety of methods" including dangerous (and expensive!) and often completely ineffective diet drugs and surgeries.
If you want to know how absolutely ridiculous this is, take a look at their new "definition" of "obesity"
"It's not about the amount of body fat, it's not about where the body fat is. It's not about the type of body fat," said Arya Sharma, scientific director of Obesity Canada and one of the more than 60 authors. "It's just a very, very simple question. And that is: Does this person's body fat or excess body fat affect their health? If it does, we've got obesity. If it doesn't, we just have a large person with a lot of body fat."
This is anything but a very, very simple question. Since fat people get the same health issues that thin people do, the assumption that body size is what is affecting health is the root of the problem and, it must be pointed out, the root of the profit. (Especially considering the health effects of constant stigma as well as the treatment disparities caused by medical fatphobia.) But of course we are talking about a world in which being " Board Certified in Obesity Medicine" is a thing. so a LOT of people have a stake in maintaining "fatness" as a profit center.
To put this into sharper relief: if a thin person in Canada develops a health condition they are simply a thin person with a health condition. But if a fat person in Canada develops that exact same health condition, they now have two health conditions and one of them is the size of their body - which is the same size as it was the day before.
This does not smack of scientific rigor. It does sound like a desperate attempt to keep a branch of medicine (that has only succeeded in harming fat people) alive and profitable. They still seem to be recommending "counseling" interventions that have been shown to be no more effective than just giving every fat person (or, I guess now every fat person with a health issue) a pony as well as interventions that can and do kill fat people.
In fact, Dr. Sharma (who, full disclosure, has positively shared my work on a number of occasions despite our disagreements) told The Globe and Mail:
"There's this idea that if you're using medication or using surgery, then you're somehow cheating," he said. Yet he noted no one would think someone is cheating or "taking the easy way out" if they took insulin for diabetes or received a kidney transplant if they had chronic kidney disease.
It's not about the easy way out - it's about risking our lives and quality of life for no reaon. Since evidence-based interventions for the actual health conditions that fat people (and thin people) get already exist, these body size manipulation interventions are completely unnecessary and serve only to create profit for healthcare professionals and harm fat people (including not just being blamed for intervention failure, but also risking our lives and quality of life.) I imagine they'll also be using this as a loophole to sell these interventions as a solution for cultural weight stigma, but that remains to be seen.
Now, do I think every doctor who believes this is driven only by craven self-interest? Not necessarily. It's possible that they are so high on their own supply of fatphobia that this seems reasonable to them, but that doesn't make it any less harmful or wrong. The important thing here is that this will result in the continued unnecessary harm to fat people, despite good research that weight-neutral healthcare can be effective without the risks.
While there is some value here, both in finally admitting that the typical "eat less, exercise more" recommendation is, and always has been, useless, as well as at least claiming that they want to reduce the stigma fat people face, the result could actually cause more problems for fat people.
First, I note that they were not in a hurry to take responsibility and apologize for all the fat people who have been harmed by doctors' insistence - despite a complete lack of evidence- that this is a successful intervention and those fat patients who failed (which was nearly all of them) were to blame/liars/lazy/weak-willed etc.. Intead choosing to simply move forward to subjecting fat people to more dangerous (though often no more successful) interventions. The organizations behind these interventions have long been trying to increase "access" to dangerous and expensive surgeries and drugs and so they will no doubt use these guidelines to try to do that, putting more fat people's lives at risk while driving the very profitable interventions that they sell.
So how can we use this? Well, in doctor's appointments we can point out that even experts have now been honest that diets don't work, and then when they recommend these dangerous interventions we can pivot and ask for the same interventions that a thin person would be given.
In the meantime, we must keep fighting for a world where the diversity of body sizes is respected and affirmed in healthcare and the world at large.
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