So we’ve all heard that weight loss succeeds for only a tiny fraction of people long term, but today I want to talk about what we even mean by success. As dieting interventions have failed over and over again, the people researching them have continued to change the definition of success – from specific weights, to 20% of body weight, then to 10% of body weight, then to 5% of body weight (all of which were, at one time, accompanied by the phrase “an amount that is known to have a strong impact on health” thought it is actually completely arbitrary and without medical rationale.)
Often weight loss studies simply move the goal post and declare victory. Weight Watchers own research showed that participants were able to maintain a 5 pound loss after 2 years (which means that participants paid about $254 per pound in meeting fees alone – not counting WW branded food, cookbooks, diet scales etc.). Commenting on this in the media, Weight Watchers’ chief scientist said “It’s nice to see this validation of what we’ve been doing.” This word, validation? I do not think it means what she thinks it means.
So is weight loss “success” achieving a specific weight? Is it a loss of 20% of body weight? 10%? 5%? Five pounds of weight loss over 2 years (a thing I could likely accomplish through regular exfoliation and without even a single spoonful of Weight Watchers 0 Points soup)?
It seems to me that if medical science truly believes in the idea of a “healthy weight” then success would be moving participants to whatever that weight is – so if they are talking Body Mass Index then success would be moving participants into the “normal” BMI category and keeping them there long term. And if we’re miles away from finding a weight loss intervention that works for more than a tiny fraction of people, we are LIGHT YEARS away from a study where an intervention moved those considered “overweight” and “obese” into the “normal” category over the long term.
When someone, whether it’s a doctor or random person on Facebook, feels the need to suggest weight loss to me, this is were I start. I ask if they feel that weight loss constitutes evidence based medicine. When they say yes, I ask them to produce evidence that would lead them to believe that I could reach and maintain the amount of weight loss that they are recommending.
Disturbingly often, medical professionals answer this question by suggesting that I try to lose less weight than they originally suggested, with absolutely no mention of the evidence I asked for. So I ask them to produce evidence that would lead them to believe that I could reach the new amount of weight loss they are suggesting and maintain it, and I also ask why my question about evidence caused them to immediately change the measure of success, rather than provide me with, you know, research.
Typically this is met with something like “any weight loss is better than no weight loss” which typically isn’t remotely in integrity with their original recommendation. So I asked them to produce evidence backing that claim. Recently my partner was at the doctor and when she challenged his suggestion that she should lose weight by saying that only a tiny fraction of people succeed he agreed that it was between 2% and 5%, and then reiterated his recommendation for weight loss. This does not smack of stringent science.
So let’s recap:
The amount of weight loss that medical science claims is necessary to create “significant health benefits” has been changed repeatedly and arbitrarily based on the utter failure of weight loss interventions over the last half century, and not based on science regarding weight and health.
Success by the definition of the people running the studies about weight loss is not the measure of success that they use in their marketing, and both goals are all but impossible based on their own research.
We have the right to health interventions that are evidence based and that have measures of success based one some kind of actual medical rationale.
NEW FAT ANTHOLOGY!
Praeger Publishing (an imprint of ABC/CLIO) has asked me to edit a multi-volume anthology “The Politics of Size: Perspectives from the Fat-Acceptance Movement”
My goal is to create a work with diverse perspectives including people of many races, ethnicities, dis/abilities, ages, sizes, genders, sexual orientations, those from an academic background, and those who do not normally write from an academic perspective. I am especially interested in those who write about intersectionalities and those who don’t feel that they are represented in my personal work and/or in the Size Acceptance work that typically gets attention. If you are interested in submitting a chapter please e-mail me at ragen at danceswithfat dot org.
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