The problem is that weight loss hardly ever works in the long term so even if it would help, it still doesn’t meet the criteria for evidence based medicine. It’s like telling people with knee pain that they should learn to fly. Maybe it would help but we have no reason to believe it’s possible so we don’t tell people to jump off their roof and flap their arms as hard as they can. Weight loss only has about a 5% better chance of working than flying, yet doctors send people home with diet sheets every day. That’s not just poor medicine, it’s actually incredibly harmful because while fat people are basically jumping off their roofs and flapping their arms really hard, their actual issues are completely ignored and untreated.
If we, including the medical establishment, accept the simple fact that weight loss almost never works, then we could actually start treating people’s health issues.
Knee pain? Here are some strength and flexibility exercises and movement pattern correction that improve knee function (like we give thin people with knee pain.)
High blood glucose? Here are some interventions that are shown to help control blood glucose (like we give thin people with high blood glucose.)
Strep Throat? Here are some antibiotics (like we give thin people with strep throat)
Hit by a van? Here is medical care that directly addresses your injuries (like we give thin people who get hit by vans.)
It’s not that complicated. We have to quit giving people a “prescription” that has the opposite of the intended effect almost all the time. It’s not just bad medicine, it’s remarkably stupid. If Aspirin made your headache worse 95% of the time, but the doctor kept prescribing it, would you keep taking it? If Viagra gave guys more erections in year one but resulted in impotence from year two on would doctors still prescribe it?
This has got to stop. I’ve written before in detail about ways to talk to your doctor, but one basic thing that you can do is ask for the evidence basis of their treatment- is there research in which a majority of people have successfully lost the amount of weight that your doctor wants you to lose, and is there evidence that the weight loss had the health benefit that the doctor is looking for.
If the answer is no (and it will be no) then consider asking them how they feel weight loss meets the criteria of evidence based medicine.
Or, simply insist that you be given a treatment plan for which there is a basis in evidence – sometimes a simple way to do this is to ask what treatment protocol you would be given if you were thin and presenting with the same issues.
The fact that every day fat people’s actual health issues go untreated as we walk away with a prescription that hasn’t worked in 50 years of studies, almost always producing the opposite of the intended effect should be considered medical malpractice. If we let go of the idea of weight loss fixes everything, imagine all the things we could actually fix.
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