I think this highlights well a core problem with "Healthy at any Size." It is true that doctors will point to reducing weight first when they probably shouldn't, and many definitely don't even...
But around the same time, she was also coming to terms with health issues related to her weight. “I was experiencing the physical effects of being in a heavier body,” she says. First there were pain and mobility issues: Her back was regularly going out, and she was frequently rolling over her ankles.
I think this highlights well a core problem with "Healthy at any Size." It is true that doctors will point to reducing weight first when they probably shouldn't, and many definitely don't even consider how other health (and societal) problems manifest as obesity (thyroid issues come to mind). And this is a massive problem.
However, our bodies just aren't built to handle heavier weights. You will encounter more health problems due to being heavier, they just manifest as early knee replacements and back surgeries. Things that are much more expensive and harder to treat than high cholesterol.
I'm OK with some form of social stigma on being overweight for this reason (speaking as an overweight person myself). For similar reasons that we place a social stigma on smokers. Or people who ride motorcycles without helmets. However, that stigma should not interfere with medical treatment. And the cause/effect of obesity (especially if able to rule out obvious overeating problems) needs to be explored more objectively.
Edit: I would like to add this stigma is not intended to be inclusive of treating overweight people like subhuman garbage as too many places online tend to. There needs to be a delicate balance of social pressure and empathy, which the internet tends not to handle well.
I disagree with you. The HAES movement is just the crystallization of the greater desire for dignity, and stigmatizing people is the exact opposite of what they need; it's the problem that people...
I disagree with you. The HAES movement is just the crystallization of the greater desire for dignity, and stigmatizing people is the exact opposite of what they need; it's the problem that people are already dealing with right now.
HAES is problematic for exactly the reason you presented, but keep in mind that doctors focusing on a person's weight is often a reason why people tend to avoid going to see them until there's a medical emergency.
Speaking as someone who is far more than a little overweight, I have a long history of doctors just telling me to lose weight even when I didn't have any medical problems whatsoever. It made me feel like shit every single time; it gave me the impression that they just saw me as a piece of meat. None of them even gave me any significant resources to help lose weight either.
The reasons why people are gaining this weight and the processes of getting rid of it are complex so I'm not going to go into the weeds right now, but telling people they are bad because they are overweight is not the way to fix the problem.
I have sleep apnea. It's a disorder largely linked to obesity but I was diagnosed when I was a teenager, a regular sized, perfectly healthy teenager. It's just a genetic thing for my family...
I have sleep apnea. It's a disorder largely linked to obesity but I was diagnosed when I was a teenager, a regular sized, perfectly healthy teenager. It's just a genetic thing for my family because we have that fleshy bit in our throats that causes it.
Do you know how many times I've heard doctors hyperfocus on weight loss as a treatment? Again, I am not obese or significantly overweight. My BMI is in the overweight category but that's because I can toss giant sacks of beans like few else can. It's plain to see in person. And yet I have sat through so many doctors appointments where they put me on a scale, crunch some simple numbers, and tell me the solution is weight loss.
Of course "lose weight" is a perfectly viable medical suggestion. The problem is that it's frequently a lazy medical suggestion from disinterested medical professionals who are eyeing the clock and the invoice more than the person in front of them. I've never been upset during any medical appointment except for those related to my sleep apnea where the medical professionals seem overtrained to blame weight. If someone like me experienced this frequently despite not being obviously overweight at all, then I can only imagine the frequency and additional flags (visual, behavioural, etc.) that overweight people receive.
One of the most recent success stories from a bigger person in my life has been after a decade of failure with exercise and diet. The most recent failure? A specialized clinic dedicated to weight loss. Two years of tests, checks, appointments, that went nowhere all to result in "We can prep you for a major surgery that will have a significant impact on the rest of your life, or we can discharge you." What's finally working? They finally got a job that has insurance that allows them to afford psychotherapy and physiotherapy, and now it's finally happening for them because they can now exercise without setting their joints on fire and they're getting their mental attitude in check.
This is what people are really asking for. It's not that they want to be healthy at every size, it's that they don't want to be regarded like lepers just for being overweight and clearly aren't doing This One Simple Thing. Obviously the weight is a problem, I'm sure all but the most delusional are aware, but they need more help to address it than they are really getting from medical professionals.
I can't help but think of how women's medical health is only being more widely understood in recent years, and how much trouble many have had getting diagnosed with endometriosis for so long just because medical professionals weren't trained for that but were also somehow infallible with their diagnoses. As much as we should trust science, medical professionals, and doctors, we should also be more than aware that they do not have a full picture of human health just yet and the overweight are probably one of the remaining underserved groups.
There's a culture problem in medicine around authority. I work in medicine and I've seen it time and time again. There are places in which the system has fought back and authority isn't inherent -...
also somehow infallible with their diagnoses
There's a culture problem in medicine around authority. I work in medicine and I've seen it time and time again. There are places in which the system has fought back and authority isn't inherent - the classic example of this is doctors which trust and listen intently to their nurses. Often times, the nurse has a much better idea of what's going on with a patient than the doctor does.
But when a patient comes to a doctor and brings education with them- when a patient comes with research papers and asks questions and suggests what might be wrong with them, this is often written off by doctors as WebMD syndrome. They don't take the patient's seriously because they don't have the same grueling training. What they aren't taking into consideration is the patient's lived experiences and the fact that the patient is the only expert about their own body and their own feelings/experience.
While it's all the rage to ensure that physicians are trained on recognizing and mitigating personal biases, this is often presented through the lens of minority populations. Thinking about how a black person may have contempt for a medical system which makes it more difficult for them to access care, for doctors to listen to them, and for them to interact in a culturally appropriate way is incredibly important, but it also ignores a vital axis to consider - their inclusion in the very structure or basis of western medicine as we know it. There's been a highlight on this issue when it comes to women's health, and the overwhelming majority of medical literature being based on the health of young white men, we're still struggling with understanding how this more broadly affects everyone in healthcare. There's also huge issues with general racial and ethnic diversity but we don't spend enough time teaching doctors to think about how this might affect how they listen to and interpret findings in everyone who isn't a young white man. This gets even more complicated when you deal with individuals who have disability or specific medical conditions and how their medication regimen or their disease state might give them vastly different reference ranges for important clinical indicators. Gender diverse individuals often experience some of the worst health care, because providers don't consider that the assigned sex often has close to no clinical relevance to their lab values whereas their circulating hormones are of much more importance. Combine this with the typical systemic sexist issues of medical misogyny (sadly applicable to all kinds of transgender individuals, whether through the present or past lens) with the fact that transgender individuals are almost never included in studies, and you end up with a population that is more often dismissed and ignored being treated by doctors who have less of an understanding about how a person's clinical findings indicate their state of health than the very person they are treating.
Studies show that, while yes, you should feel proud of hour weight loss, because it took hard work and determination, it's clear that you were lucky. Maybe genetically, maybe in your childhood,...
Studies show that, while yes, you should feel proud of hour weight loss, because it took hard work and determination, it's clear that you were lucky. Maybe genetically, maybe in your childhood, maybe in environmental toxins, maybe in a million other ways. Millions of people have taken exactly those simple steps, and been unable to find your success. Maybe they lack willpower, or determination, or discipline, or whatever. Now what, though? If they keep trying that way, and it isn't working, what good is your advice to just do it?
Just to reiterate, luck doesn't take away from the massive amount of work you did. You're lucky that you were able to do that work though. That's all I meant.
Just to reiterate, luck doesn't take away from the massive amount of work you did. You're lucky that you were able to do that work though. That's all I meant.
I think it's important to acknowledge that CICO is the reality of weight loss, but that there are factors outside of that that can make weight loss via diet/exercise ineffective. Diet and exercise...
While important, diet and exercise alone don't lead to significant outcomes of weight reduction for enough people.
Unfortunately, a lot of people try to reduce weight loss down to "calories in calories out" (CICO), "thermodynamics", and "willpower", but that ignores the reality of obesity.
I think it's important to acknowledge that CICO is the reality of weight loss, but that there are factors outside of that that can make weight loss via diet/exercise ineffective.
Diet and exercise themselves are effective ways of weight control in the same way that not smoking cigarettes is an effective method of not further increasing your lung cancer risks. Perhaps it's not useful advice to everyone, but it's also not wrong to state clearly.
I feel like this is a situation that is best explained through a series of case studies. Case studies where millions of dollars are poured into individual's biological and psychological analysis...
I feel like this is a situation that is best explained through a series of case studies. Case studies where millions of dollars are poured into individual's biological and psychological analysis until we can understand, for that person, all of the nitty gritty painfully interconnected systems that lead to their personal obesity. Because for most people "it's not as simple" as CICO. I was never obese but I did lose a lot of weight that I gained from poor eating habits and can imagine a number of ways I could have fallen off of the success track. This isn't really a situation where aggregate studies will help to show anyone why "git gud at willpower" is not going to work. I think a dozen deeply humanizing stories of everything it can take and all of the changes just one person needs to make to switch to a long-term healthy lifestyle would do far more than a population study of millions.
I think in general we understand that the post-industrial lifestyle of humanity with unlimited access to cheap carbs and high cost to healthy food and onerous cost of (American) healthcare generally leads to obesity or being overweight. But it would be amazing to understand how a particular person, when attempting to cut back on sugar, goes through withdrawal that causes extra cortisol in their system when they're already red-lined on stress, quickly leading to failure to change their diet because they have no budget left for discomfort.
In Stephen King's The Drawing of the Three, the main character Roland is not of our world, and ends up drinking a soda. After learning it is sugar that makes it so sweet, he ponders if this sugar...
But it would be amazing to understand how a particular person, when attempting to cut back on sugar, goes through withdrawal
In Stephen King's The Drawing of the Three, the main character Roland is not of our world, and ends up drinking a soda. After learning it is sugar that makes it so sweet, he ponders if this sugar is what is called 'cocaine' in his world.
I find this to be a great bit of social commentary.
Here's one that found 1/5 of their cohort lost 10% of their weight and maintained that loss for a year. Others, as far as I'm aware, show even lower success rates. Many weight loss studies even go...
Here's one that found 1/5 of their cohort lost 10% of their weight and maintained that loss for a year. Others, as far as I'm aware, show even lower success rates. Many weight loss studies even go so far as to call people who don't succeed at weight loss in the initial phase as dropouts rather than participants.
I'm nowhere near as fatalistic as the people who proclaim that significant weight loss is impossible to maintain, but, clearly, just telling people to count calories and work out is not a successful tactic for our society.
No one said it did. I'll respond here by copying my other comment(s) that was being written while you typed out your two and then I'm done here as the comments here have become increasingly circular:
Yes, because the causes of a person's obesity usually do not just "turn off" like a light switch once they reach a healthy weight.
No one said it did.
I'll respond here by copying my other comment(s) that was being written while you typed out your two and then I'm done here as the comments here have become increasingly circular:
Except that it's well established that CICO is the only way to lose weight and maintain such. CICO is the only way to lose weight because that's how weight loss works. It's not advice, it's physics. The only way to have less of something is to remove more than is put in. Rez didn't say "eat less, move more", they said...
try to find a way to eat less (and better) while exercising more, wherever, whenever you can.
That "way" may be therapy, drugs, surgery, coaching, groups, or any other number of things that help someone find their way to lose weight. Rez stated there's no silver bullet, that weight loss methodology needs to be tailored to the individual, and shared how Rez tailored theirs. All of which is true.
Yes. Very few people want to be obese, so it isn't a stretch to assume that the directives of common sense that Rez shared only "work" as advice for a small number of people we cannot readily...
Yes. Very few people want to be obese, so it isn't a stretch to assume that the directives of common sense that Rez shared only "work" as advice for a small number of people we cannot readily identify in advance. Luck by demographic.
Except that it's well established that CICO is the only way to lose weight and maintain such. Rez didn't say "eat less, move more", they said... That "way" may be therapy, drugs, surgery,...
Except that it's well established that CICO is the only way to lose weight and maintain such. Rez didn't say "eat less, move more", they said...
try to find a way to eat less (and better) while exercising more, wherever, whenever you can.
That "way" may be therapy, drugs, surgery, coaching, groups, or any other number of things that help someone find their way to lose weight. Rez stated there's no silver bullet, that weight loss methodology needs to be tailored to the individual, and shared how Rez tailored theirs. All of which is true.
CICO is the only way to lose weight in the same way that the only way to cure cancer is to kill the tumours. There are thousands of interpretations of that "advice", and very few of them seem to...
CICO is the only way to lose weight in the same way that the only way to cure cancer is to kill the tumours. There are thousands of interpretations of that "advice", and very few of them seem to work. Rez didn't say anything wrong, they just didn't help anyone either.
Again a comment that points out that there are several ways to reach a goal is cherry picked to only address the point that someone can disagree with by ignoring all else. CICO is the only way to...
Again a comment that points out that there are several ways to reach a goal is cherry picked to only address the point that someone can disagree with by ignoring all else.
CICO is the only way to lose weight because that's how weight loss works. It's not advice, it's physics. The only way to have less of something is to remove more than is put in. Rez not only didn't say anything wrong, they did try to help by asking what others have done, and sharing their experience. Only to be met with vitriol by the same cherry picked arguments focusing on some word or phrase that triggered them.
I say this to you and others in this thread: If you can't address the entirety of a comment, please refrain from responding in the first place as all you're doing is a thinly veiled bad faith song and dance that is not only wrong, but also doesn't help anyone either.
Do you really think your prior summary of Rez's comment is accurate? They basically defended the well-documented phenomenon of doctors withholding treatment in lieu of prescribing weight loss by...
Again a comment that points out that there are several ways to reach a goal is cherry picked to only address the point that someone can disagree with by ignoring all else.
Do you really think your prior summary of Rez's comment is accurate? They basically defended the well-documented phenomenon of doctors withholding treatment in lieu of prescribing weight loss by saying "should doctors not tell smokers to quit?", then implied that it's your fault if your doctor doesn't actually give you resources to achieve that goal because you should demonstrate faith in them before you should expect them to do their job, and then described how they lost weight by taking accountability. That is not "sharing how [they] tailored theirs", in my book. That's just implying that everyone who doesn't lose weight isn't taking care of themselves.
CICO is the only way to lose weight because that's how weight loss works. It's not advice, it's physics.
So why is it so important to parrot?
Only to be met with vitriol by the same cherry picked arguments focusing on some word or phrase that triggered them.
These arguments are not cherrypicked, they're recognizing the subtext of the statement and expressing distaste or disagreement. Where did they ask others to share their experience? I don't see that at all.
If you can't address the entirety of a comment, please refrain from responding in the first place as all you're doing is a thinly veiled bad faith song and dance that is not only wrong, but also doesn't help anyone either.
And all you're doing by insisting that anyone who talks on this site complies with a set of arbitrary internet-debate rules rather than recognizing that conversation is a matter of nuanced back-and-forth with no way to tell who's right in the end is driving off people who don't conform to your worldview. Discourse should be more like song and dance than point-scoring and fallacy-checking.
I have not operated in bad faith here. You have decided I am wrong, and are justifying why you're right.
Y’all are both technically correct. While weight loss ultimately does boil down to CICO, the factors can dramatically influence them. Take gut microbes. A hypothetical baseline gut flora might...
Y’all are both technically correct. While weight loss ultimately does boil down to CICO, the factors can dramatically influence them. Take gut microbes. A hypothetical baseline gut flora might help you extract 2000 out of 2500 calories ingested. An obesogenic one might extract 2400 calories. That’s a 20% increase in your calorie count, and cutting your food intake by 20% (or more, to be able to lose weight and not just maintain it) can be very difficult to do. What’s worse is that some studies show the microbes can influence what we want to eat or are craving, which makes weight loss even more difficult.
I know that your post is compassionate and you're trying to be helpful. But do you want to know what I wanted most to do as soon as I started reading it? I wanted to tell you to fuck off on the...
I know that your post is compassionate and you're trying to be helpful. But do you want to know what I wanted most to do as soon as I started reading it? I wanted to tell you to fuck off on the high horse you rode in on. Both you and the doctors I am referring to are making one critical mistake; you are assuming that I haven't heard all of this a million times before, that I haven't done anything to improve myself, and/or that telling me again is going to have any kind of positive effect. All of those are catastrophically wrong. If you really were obese in the past then you should already know that there is no way that the world isn't constantly giving overweight people these messages.
I'm in my 30s. I've been through more diets than I care to count. I've never had anything more than temporary success, and those were very fleeting. As @wervenyt has pointed out, you're incredibly lucky to have been able to succeed with nothing more than "common sense". You're practically a lottery winner from my perspective. But honestly that just makes your message come across as that much more cruel.
Now do you understand why I say that these messages are unhelpful?
For the record, I am lucky enough to be a part of a highly vertically-integrated healthcare system, which means they actually do have resources. I am taking advantage of them now. But that wasn't always there. The kind of help I'm getting is based on much newer research; many of the papers I see cited are within the last decade and there's nothing more than 20 years old. The specific program that I'm in is also a pilot; it's so new it hasn't even been widely implemented, and I'm just fortunate enough to live in the service area where they're trying it out. And while it's too early to know how well I'll hold up long term, I have enough support that I'm confident that things are going to work out for a change. And this is even without diet pills of any sort.
Edit: the sibling post by @TheJorro made me realize that I didn't actually tell you what the major difference is between the program I'm taking now and the resources available to me in the past. This program approaches the problem from the perspective of Lifestyle Medicine; in other words it's a holistic health program. It means that I have access to medical doctors, nutritionists, physical therapists, social workers, as well as the support of the group that I'm doing this program with. And then in addition to that I have optional support from over-the-phone counseling with a life coach and access to phone apps where I can get one-on-one counseling or pre recorded guided meditations. I could also get a therapist if I needed, but that crosses into the line where I'd have to start paying coinsurance. It's far different than saying "lose weight" and maybe giving a pamphlet.
Advice for someone overweight: try losing weight Advice for someone depressed: try being happy Advice for someone addicted to drugs: try not doing drugs This kind of mindset unfortunately still...
Advice for someone overweight: try losing weight
Advice for someone depressed: try being happy
Advice for someone addicted to drugs: try not doing drugs
This kind of mindset unfortunately still finds purchase quite often, because there are some individuals which don't take it seriously. It's why we see in the literature that many diets simply don't work, especially in the long term. But you bring up an extremely important point here that we shouldn't focus on promoting this kind of feedback because it's harmful to people who have done everything and aren't finding purchase. It's erasing their experience and minimizing their importance. Thank you for sharing this.
As @stu2b50 pointed out, there's a lot of bad fat-acceptance stuff out there, and a lot of bad readings of good stuff. And it paints HAES (and results in supporters that are) as a movement to...
telling people they are bad because they are overweight is not the way to fix the problem.
As @stu2b50 pointed out, there's a lot of bad fat-acceptance stuff out there, and a lot of bad readings of good stuff. And it paints HAES (and results in supporters that are) as a movement to embrace obesity as a completely neutral, or even good, thing. From both the inside and outside.
When I say a delicate social stigma, I'm thinking more like "Obesity should be treated socially the way we treat cancer." It's not healthy to have it. It's still desirable to rid yourself of it, but you're not a failure of a human being if you're unable to. Its also roughly how I stigmatize a smoking addiction (as a former one myself).
I will say my "motorcyclist without helmet" was a bad example in this case, because I do think of people who don't wear one as being at least somewhat brain-damaged. I don't feel that way about the obese or smokers.
I would not characterize having cancer as having a delicate social stigma in "western cultures". A stigma almost necessarily implies shame and moral failure, whereas cancer is treated as an...
I would not characterize having cancer as having a delicate social stigma in "western cultures". A stigma almost necessarily implies shame and moral failure, whereas cancer is treated as an invading menace and people with it are viewed as fighters and survivors. Plenty of people would turn their nose up at making friends with smokers and fat people, almost nobody avoids those darn carcinogen-magnets.
Comparisons are not perfect. Cancer is generally not something that is self-inflicted (lung and skin cancer possible exceptions), which is part of why the fighters/survivors dynamic exists. Though...
Comparisons are not perfect. Cancer is generally not something that is self-inflicted (lung and skin cancer possible exceptions), which is part of why the fighters/survivors dynamic exists. Though obesity (or even addiction) aren't necessarily either. It's complicated.
And I'll agree that stigma is probably not the best word.
Thank you; you put my thoughts into words in a much better way than I could have. I would like to add that I know that the HAES people can go too far; I admitted that in my earlier response....
Thank you; you put my thoughts into words in a much better way than I could have.
I would like to add that I know that the HAES people can go too far; I admitted that in my earlier response.
Nutrition is complicated. The reasons why people are getting overweight are multifaceted. Saying "you should lose weight" helps nobody. Saying "eat less" helps nobody. Saying "calories in, calories out" helps nobody. If you really want to help someone lose weight, then you need to know what they are eating, when they are eating, how they are eating it, why they are eating it, and how their individual bodies react to specific foods before you can reasonably understand why someone is at the weight they are. There is no way giving them the metaphorical stick is going to help anyone.
Yeah, the HAES angle did not come off very well in the article. Uh While not necessarily a complete contradiction, I mean, c'mon. There's a kernel of truth in there, but just from a point A to...
Yeah, the HAES angle did not come off very well in the article.
The fat acceptance literature she’d been studying opposed weight loss as a means to health.
Uh
“You can be healthy at every size,” Juneja summed up. But “I was not healthy at the size that I was.”
While not necessarily a complete contradiction, I mean, c'mon.
“The idea of other health issues being ‘obesity-associated’ is scientifically questionable, since weight cycling [also known as yo-yo dieting], weight stigma, and health care inequalities are all correlated with the same health issues to which being higher weight is correlated,” explained Ragen Chastain, a patient advocate and writer focused on weight stigma and weight-neutral health, who, like many of her peers, believes weight loss should not be used as a medical intervention.
There's a kernel of truth in there, but just from a point A to point B logic point of view, stigma and healthcare inequality does not give you type 2 diabetes, or high cholesterol leading to heart failures, or joint pain. To attribute all, or even just a majority, of the commonly cited obesity-linked health risks to things like weight stigma is just sticking your head in the sand.
In the end, one of the subjects of the article put it well
“It feels like you have to be like, ‘I love being fat, this is my fat body,’ or, ‘Fat people are evil,’” Juneja told me.
Everything tends to the extremes. It's not that strange, humans are naturally defensive (also why you should never argue with someone you actually want to convince of something - it'll never work), so pokes and prods from the other extreme causes something like HAES to move from something quite reasonable to head-in-the-sand quite quickly.
It's a bit ironic that Juneja had to overcome the stigma of "treating" obesity to start using GLP-1 medications, from being in a movement that sought to eliminate a different stigma.
There was a recent study that suggests we might even be understating the risks of obesity: https://www.colorado.edu/today/2023/02/23/excess-weight-obesity-more-deadly-previously-believed The...
The premise is, according to the article at least, that looking at BMI at the time of death is not enough as many illnesses brought on by obesity can lead to rapid weight loss, skewing the data.
Interesting. I'll try reading the linked paper later. https://www.tandfonline.com/doi/full/10.1080/00324728.2023.2168035 Remember Sci-Hub if you need it.
Interesting. I'll try reading the linked paper later.
Exactly. Something can have a stigma without requiring people be assholes to others about it. There's a lot of toxicity around obesity online and IRL, and that has never felt productive to me....
Edit: I would like to add this stigma is not intended to be inclusive of treating overweight people like subhuman garbage as too many places online tend to. There needs to be a delicate balance of social pressure and empathy, which the internet tends not to handle well.
Exactly. Something can have a stigma without requiring people be assholes to others about it. There's a lot of toxicity around obesity online and IRL, and that has never felt productive to me. Just alienating.
When I was morbidly obese it really sucked to move around. I would walk really slowly, but also my knees and my hips were starting to give out a lot. When I lost the weight I ended up getting...
When I was morbidly obese it really sucked to move around. I would walk really slowly, but also my knees and my hips were starting to give out a lot. When I lost the weight I ended up getting X-Rayed and going to physical therapy. Luckily there was no structural problems, no arthritis as I originally thought. But rather there was issue with the muscle surrounding it. When the PT was massaging my kneecaps she said she could feel abrasions around it. So I was definitely damaging my body and if I let it go on for longer it would have eventually led to joint issues.
I have a couple of very large friends who have had this happen. One got a RSI that caused a nerve pinch in her shoulder, and the other destroyed his ankle at work (size contributed to the force of...
I have a couple of very large friends who have had this happen.
One got a RSI that caused a nerve pinch in her shoulder, and the other destroyed his ankle at work (size contributed to the force of the impact, but not the issues he was having related to surgery). Both had to fight to get anything done because just being fat, while stressful on the joints, doesnt cause nerve pinches where she had one or a doctor to repair an ankle in such a way as to put a tendon across a sharp bone, but both were told to lose weight as a first solution.
This is a tough one for me, and I second guess even posting a comment. I'm really not interested in debates or "just try X" advice or the ad nauseam repetition of talk about calories, those are...
This is a tough one for me, and I second guess even posting a comment. I'm really not interested in debates or "just try X" advice or the ad nauseam repetition of talk about calories, those are all quite useless to me. Just from my personal experience, I know that I can count calories to lose weight, it's all the other compounding factors (cravings, sleep, self-control, etc.) that I find tough to manage- and that makes all "count calories" advice absolutely unhelpful. Also, my experience is only my own. While I may have medical conditions that contribute to my weight, others may have medical issues that make tackling it nearly impossible or have a more direct effect on weight- and certainly promoting acceptance and removal of stigma/shame and promotion of self-esteem seems wholly beneficial in that case.
With all that said, I find that sometimes the fat-acceptance discussion omits necessary nuances. The way I thought made most sense to me was ending the stigma around obesity and trying to address its social acceptance and self-acceptance from a self-esteem point of view. Because it can be an insidious thing that some of us struggle with all our lives without being able to overcome it- and shame, stigma, etc only make things worse. So, in those terms I've typically considered fat-acceptance a good thing.
However, in some cases I feel pushed to accept my current weight as healthy or some generalized nuance-free form of okay- and this doesn't help me either. Trying to fool myself into thinking my weight is having no ill effects on me is harmful and I do not appreciate that rhetoric.
But for me personally, as someone who is more than overweight, it needs to be okay for me, at least for myself, to acknowledge the truth that I know that my current size is making me unhealthy. Not only that, it is making me uncomfortable. Not only that, it affects my joints. From a social perspective, it can affect what clothes I can wear, what places I can comfortably sit/lay/stand, forces considerations about different things that people of lesser size do not deal with on a daily basis.
Overall my obesity is still mild compared to some- so I can't even imagine how it has to be for someone experience the issues I experience but at a much higher scale. I completely understand trying to help someone remove the shame, stigma, and other negativity that sometimes only reinforces the weight - and not thinking we're helping by constantly giving them condescending advice (that they've probably heard 1000 times) about how to tackle their problem. People need resources and understanding in addition to acceptance- so that they can take an informed path- whatever that ends up looking like for them. Ignoring a weight level that is dangerous to health as if it is no problem at all helps no one.
Thanks for posting the comment! I can’t see any downside to anyone loving themselves more. I think the nuanced mindset of “I’m not going to hate my weight, but I’m also not going to lie to myself...
Thanks for posting the comment! I can’t see any downside to anyone loving themselves more. I think the nuanced mindset of “I’m not going to hate my weight, but I’m also not going to lie to myself about it” sounds very healthy.
I think this highlights well a core problem with "Healthy at any Size." It is true that doctors will point to reducing weight first when they probably shouldn't, and many definitely don't even consider how other health (and societal) problems manifest as obesity (thyroid issues come to mind). And this is a massive problem.
However, our bodies just aren't built to handle heavier weights. You will encounter more health problems due to being heavier, they just manifest as early knee replacements and back surgeries. Things that are much more expensive and harder to treat than high cholesterol.
I'm OK with some form of social stigma on being overweight for this reason (speaking as an overweight person myself). For similar reasons that we place a social stigma on smokers. Or people who ride motorcycles without helmets. However, that stigma should not interfere with medical treatment. And the cause/effect of obesity (especially if able to rule out obvious overeating problems) needs to be explored more objectively.
Edit: I would like to add this stigma is not intended to be inclusive of treating overweight people like subhuman garbage as too many places online tend to. There needs to be a delicate balance of social pressure and empathy, which the internet tends not to handle well.
I disagree with you. The HAES movement is just the crystallization of the greater desire for dignity, and stigmatizing people is the exact opposite of what they need; it's the problem that people are already dealing with right now.
HAES is problematic for exactly the reason you presented, but keep in mind that doctors focusing on a person's weight is often a reason why people tend to avoid going to see them until there's a medical emergency.
Speaking as someone who is far more than a little overweight, I have a long history of doctors just telling me to lose weight even when I didn't have any medical problems whatsoever. It made me feel like shit every single time; it gave me the impression that they just saw me as a piece of meat. None of them even gave me any significant resources to help lose weight either.
The reasons why people are gaining this weight and the processes of getting rid of it are complex so I'm not going to go into the weeds right now, but telling people they are bad because they are overweight is not the way to fix the problem.
I have sleep apnea. It's a disorder largely linked to obesity but I was diagnosed when I was a teenager, a regular sized, perfectly healthy teenager. It's just a genetic thing for my family because we have that fleshy bit in our throats that causes it.
Do you know how many times I've heard doctors hyperfocus on weight loss as a treatment? Again, I am not obese or significantly overweight. My BMI is in the overweight category but that's because I can toss giant sacks of beans like few else can. It's plain to see in person. And yet I have sat through so many doctors appointments where they put me on a scale, crunch some simple numbers, and tell me the solution is weight loss.
Of course "lose weight" is a perfectly viable medical suggestion. The problem is that it's frequently a lazy medical suggestion from disinterested medical professionals who are eyeing the clock and the invoice more than the person in front of them. I've never been upset during any medical appointment except for those related to my sleep apnea where the medical professionals seem overtrained to blame weight. If someone like me experienced this frequently despite not being obviously overweight at all, then I can only imagine the frequency and additional flags (visual, behavioural, etc.) that overweight people receive.
One of the most recent success stories from a bigger person in my life has been after a decade of failure with exercise and diet. The most recent failure? A specialized clinic dedicated to weight loss. Two years of tests, checks, appointments, that went nowhere all to result in "We can prep you for a major surgery that will have a significant impact on the rest of your life, or we can discharge you." What's finally working? They finally got a job that has insurance that allows them to afford psychotherapy and physiotherapy, and now it's finally happening for them because they can now exercise without setting their joints on fire and they're getting their mental attitude in check.
This is what people are really asking for. It's not that they want to be healthy at every size, it's that they don't want to be regarded like lepers just for being overweight and clearly aren't doing This One Simple Thing. Obviously the weight is a problem, I'm sure all but the most delusional are aware, but they need more help to address it than they are really getting from medical professionals.
I can't help but think of how women's medical health is only being more widely understood in recent years, and how much trouble many have had getting diagnosed with endometriosis for so long just because medical professionals weren't trained for that but were also somehow infallible with their diagnoses. As much as we should trust science, medical professionals, and doctors, we should also be more than aware that they do not have a full picture of human health just yet and the overweight are probably one of the remaining underserved groups.
There's a culture problem in medicine around authority. I work in medicine and I've seen it time and time again. There are places in which the system has fought back and authority isn't inherent - the classic example of this is doctors which trust and listen intently to their nurses. Often times, the nurse has a much better idea of what's going on with a patient than the doctor does.
But when a patient comes to a doctor and brings education with them- when a patient comes with research papers and asks questions and suggests what might be wrong with them, this is often written off by doctors as WebMD syndrome. They don't take the patient's seriously because they don't have the same grueling training. What they aren't taking into consideration is the patient's lived experiences and the fact that the patient is the only expert about their own body and their own feelings/experience.
While it's all the rage to ensure that physicians are trained on recognizing and mitigating personal biases, this is often presented through the lens of minority populations. Thinking about how a black person may have contempt for a medical system which makes it more difficult for them to access care, for doctors to listen to them, and for them to interact in a culturally appropriate way is incredibly important, but it also ignores a vital axis to consider - their inclusion in the very structure or basis of western medicine as we know it. There's been a highlight on this issue when it comes to women's health, and the overwhelming majority of medical literature being based on the health of young white men, we're still struggling with understanding how this more broadly affects everyone in healthcare. There's also huge issues with general racial and ethnic diversity but we don't spend enough time teaching doctors to think about how this might affect how they listen to and interpret findings in everyone who isn't a young white man. This gets even more complicated when you deal with individuals who have disability or specific medical conditions and how their medication regimen or their disease state might give them vastly different reference ranges for important clinical indicators. Gender diverse individuals often experience some of the worst health care, because providers don't consider that the assigned sex often has close to no clinical relevance to their lab values whereas their circulating hormones are of much more importance. Combine this with the typical systemic sexist issues of medical misogyny (sadly applicable to all kinds of transgender individuals, whether through the present or past lens) with the fact that transgender individuals are almost never included in studies, and you end up with a population that is more often dismissed and ignored being treated by doctors who have less of an understanding about how a person's clinical findings indicate their state of health than the very person they are treating.
Studies show that, while yes, you should feel proud of hour weight loss, because it took hard work and determination, it's clear that you were lucky. Maybe genetically, maybe in your childhood, maybe in environmental toxins, maybe in a million other ways. Millions of people have taken exactly those simple steps, and been unable to find your success. Maybe they lack willpower, or determination, or discipline, or whatever. Now what, though? If they keep trying that way, and it isn't working, what good is your advice to just do it?
Just to reiterate, luck doesn't take away from the massive amount of work you did. You're lucky that you were able to do that work though. That's all I meant.
What studies?
I think it's important to acknowledge that CICO is the reality of weight loss, but that there are factors outside of that that can make weight loss via diet/exercise ineffective.
Diet and exercise themselves are effective ways of weight control in the same way that not smoking cigarettes is an effective method of not further increasing your lung cancer risks. Perhaps it's not useful advice to everyone, but it's also not wrong to state clearly.
I feel like this is a situation that is best explained through a series of case studies. Case studies where millions of dollars are poured into individual's biological and psychological analysis until we can understand, for that person, all of the nitty gritty painfully interconnected systems that lead to their personal obesity. Because for most people "it's not as simple" as CICO. I was never obese but I did lose a lot of weight that I gained from poor eating habits and can imagine a number of ways I could have fallen off of the success track. This isn't really a situation where aggregate studies will help to show anyone why "git gud at willpower" is not going to work. I think a dozen deeply humanizing stories of everything it can take and all of the changes just one person needs to make to switch to a long-term healthy lifestyle would do far more than a population study of millions.
I think in general we understand that the post-industrial lifestyle of humanity with unlimited access to cheap carbs and high cost to healthy food and onerous cost of (American) healthcare generally leads to obesity or being overweight. But it would be amazing to understand how a particular person, when attempting to cut back on sugar, goes through withdrawal that causes extra cortisol in their system when they're already red-lined on stress, quickly leading to failure to change their diet because they have no budget left for discomfort.
In Stephen King's The Drawing of the Three, the main character Roland is not of our world, and ends up drinking a soda. After learning it is sugar that makes it so sweet, he ponders if this sugar is what is called 'cocaine' in his world.
I find this to be a great bit of social commentary.
Here's one that found 1/5 of their cohort lost 10% of their weight and maintained that loss for a year. Others, as far as I'm aware, show even lower success rates. Many weight loss studies even go so far as to call people who don't succeed at weight loss in the initial phase as dropouts rather than participants.
I'm nowhere near as fatalistic as the people who proclaim that significant weight loss is impossible to maintain, but, clearly, just telling people to count calories and work out is not a successful tactic for our society.
So how do those studies show that Rez "was lucky"? Because Rez has kept themselves fit after being obese while others didn't?
No one said it did.
I'll respond here by copying my other comment(s) that was being written while you typed out your two and then I'm done here as the comments here have become increasingly circular:
Yes. Very few people want to be obese, so it isn't a stretch to assume that the directives of common sense that Rez shared only "work" as advice for a small number of people we cannot readily identify in advance. Luck by demographic.
Except that it's well established that CICO is the only way to lose weight and maintain such. Rez didn't say "eat less, move more", they said...
That "way" may be therapy, drugs, surgery, coaching, groups, or any other number of things that help someone find their way to lose weight. Rez stated there's no silver bullet, that weight loss methodology needs to be tailored to the individual, and shared how Rez tailored theirs. All of which is true.
CICO is the only way to lose weight in the same way that the only way to cure cancer is to kill the tumours. There are thousands of interpretations of that "advice", and very few of them seem to work. Rez didn't say anything wrong, they just didn't help anyone either.
Again a comment that points out that there are several ways to reach a goal is cherry picked to only address the point that someone can disagree with by ignoring all else.
CICO is the only way to lose weight because that's how weight loss works. It's not advice, it's physics. The only way to have less of something is to remove more than is put in. Rez not only didn't say anything wrong, they did try to help by asking what others have done, and sharing their experience. Only to be met with vitriol by the same cherry picked arguments focusing on some word or phrase that triggered them.
I say this to you and others in this thread: If you can't address the entirety of a comment, please refrain from responding in the first place as all you're doing is a thinly veiled bad faith song and dance that is not only wrong, but also doesn't help anyone either.
Do you really think your prior summary of Rez's comment is accurate? They basically defended the well-documented phenomenon of doctors withholding treatment in lieu of prescribing weight loss by saying "should doctors not tell smokers to quit?", then implied that it's your fault if your doctor doesn't actually give you resources to achieve that goal because you should demonstrate faith in them before you should expect them to do their job, and then described how they lost weight by taking accountability. That is not "sharing how [they] tailored theirs", in my book. That's just implying that everyone who doesn't lose weight isn't taking care of themselves.
So why is it so important to parrot?
These arguments are not cherrypicked, they're recognizing the subtext of the statement and expressing distaste or disagreement. Where did they ask others to share their experience? I don't see that at all.
And all you're doing by insisting that anyone who talks on this site complies with a set of arbitrary internet-debate rules rather than recognizing that conversation is a matter of nuanced back-and-forth with no way to tell who's right in the end is driving off people who don't conform to your worldview. Discourse should be more like song and dance than point-scoring and fallacy-checking.
I have not operated in bad faith here. You have decided I am wrong, and are justifying why you're right.
Y’all are both technically correct. While weight loss ultimately does boil down to CICO, the factors can dramatically influence them. Take gut microbes. A hypothetical baseline gut flora might help you extract 2000 out of 2500 calories ingested. An obesogenic one might extract 2400 calories. That’s a 20% increase in your calorie count, and cutting your food intake by 20% (or more, to be able to lose weight and not just maintain it) can be very difficult to do. What’s worse is that some studies show the microbes can influence what we want to eat or are craving, which makes weight loss even more difficult.
I know that your post is compassionate and you're trying to be helpful. But do you want to know what I wanted most to do as soon as I started reading it? I wanted to tell you to fuck off on the high horse you rode in on. Both you and the doctors I am referring to are making one critical mistake; you are assuming that I haven't heard all of this a million times before, that I haven't done anything to improve myself, and/or that telling me again is going to have any kind of positive effect. All of those are catastrophically wrong. If you really were obese in the past then you should already know that there is no way that the world isn't constantly giving overweight people these messages.
I'm in my 30s. I've been through more diets than I care to count. I've never had anything more than temporary success, and those were very fleeting. As @wervenyt has pointed out, you're incredibly lucky to have been able to succeed with nothing more than "common sense". You're practically a lottery winner from my perspective. But honestly that just makes your message come across as that much more cruel.
Now do you understand why I say that these messages are unhelpful?
For the record, I am lucky enough to be a part of a highly vertically-integrated healthcare system, which means they actually do have resources. I am taking advantage of them now. But that wasn't always there. The kind of help I'm getting is based on much newer research; many of the papers I see cited are within the last decade and there's nothing more than 20 years old. The specific program that I'm in is also a pilot; it's so new it hasn't even been widely implemented, and I'm just fortunate enough to live in the service area where they're trying it out. And while it's too early to know how well I'll hold up long term, I have enough support that I'm confident that things are going to work out for a change. And this is even without diet pills of any sort.
Edit: the sibling post by @TheJorro made me realize that I didn't actually tell you what the major difference is between the program I'm taking now and the resources available to me in the past. This program approaches the problem from the perspective of Lifestyle Medicine; in other words it's a holistic health program. It means that I have access to medical doctors, nutritionists, physical therapists, social workers, as well as the support of the group that I'm doing this program with. And then in addition to that I have optional support from over-the-phone counseling with a life coach and access to phone apps where I can get one-on-one counseling or pre recorded guided meditations. I could also get a therapist if I needed, but that crosses into the line where I'd have to start paying coinsurance. It's far different than saying "lose weight" and maybe giving a pamphlet.
Advice for someone overweight: try losing weight
Advice for someone depressed: try being happy
Advice for someone addicted to drugs: try not doing drugs
This kind of mindset unfortunately still finds purchase quite often, because there are some individuals which don't take it seriously. It's why we see in the literature that many diets simply don't work, especially in the long term. But you bring up an extremely important point here that we shouldn't focus on promoting this kind of feedback because it's harmful to people who have done everything and aren't finding purchase. It's erasing their experience and minimizing their importance. Thank you for sharing this.
Sincerely, thank you for your acknowledgement. I was honestly starting to think my point was not getting across for a minute.
As @stu2b50 pointed out, there's a lot of bad fat-acceptance stuff out there, and a lot of bad readings of good stuff. And it paints HAES (and results in supporters that are) as a movement to embrace obesity as a completely neutral, or even good, thing. From both the inside and outside.
When I say a delicate social stigma, I'm thinking more like "Obesity should be treated socially the way we treat cancer." It's not healthy to have it. It's still desirable to rid yourself of it, but you're not a failure of a human being if you're unable to. Its also roughly how I stigmatize a smoking addiction (as a former one myself).
I will say my "motorcyclist without helmet" was a bad example in this case, because I do think of people who don't wear one as being at least somewhat brain-damaged. I don't feel that way about the obese or smokers.
I would not characterize having cancer as having a delicate social stigma in "western cultures". A stigma almost necessarily implies shame and moral failure, whereas cancer is treated as an invading menace and people with it are viewed as fighters and survivors. Plenty of people would turn their nose up at making friends with smokers and fat people, almost nobody avoids those darn carcinogen-magnets.
Comparisons are not perfect. Cancer is generally not something that is self-inflicted (lung and skin cancer possible exceptions), which is part of why the fighters/survivors dynamic exists. Though obesity (or even addiction) aren't necessarily either. It's complicated.
And I'll agree that stigma is probably not the best word.
I was just talking about the choice of "stigma", the condescension wasn't necessary.
Thank you; you put my thoughts into words in a much better way than I could have.
I would like to add that I know that the HAES people can go too far; I admitted that in my earlier response.
Nutrition is complicated. The reasons why people are getting overweight are multifaceted. Saying "you should lose weight" helps nobody. Saying "eat less" helps nobody. Saying "calories in, calories out" helps nobody. If you really want to help someone lose weight, then you need to know what they are eating, when they are eating, how they are eating it, why they are eating it, and how their individual bodies react to specific foods before you can reasonably understand why someone is at the weight they are. There is no way giving them the metaphorical stick is going to help anyone.
Society doesn’t shame having cancer, but it shames most of the ways you get it.
Yeah, the HAES angle did not come off very well in the article.
Uh
While not necessarily a complete contradiction, I mean, c'mon.
There's a kernel of truth in there, but just from a point A to point B logic point of view, stigma and healthcare inequality does not give you type 2 diabetes, or high cholesterol leading to heart failures, or joint pain. To attribute all, or even just a majority, of the commonly cited obesity-linked health risks to things like weight stigma is just sticking your head in the sand.
In the end, one of the subjects of the article put it well
Everything tends to the extremes. It's not that strange, humans are naturally defensive (also why you should never argue with someone you actually want to convince of something - it'll never work), so pokes and prods from the other extreme causes something like HAES to move from something quite reasonable to head-in-the-sand quite quickly.
It's a bit ironic that Juneja had to overcome the stigma of "treating" obesity to start using GLP-1 medications, from being in a movement that sought to eliminate a different stigma.
There was a recent study that suggests we might even be understating the risks of obesity: https://www.colorado.edu/today/2023/02/23/excess-weight-obesity-more-deadly-previously-believed
The premise is, according to the article at least, that looking at BMI at the time of death is not enough as many illnesses brought on by obesity can lead to rapid weight loss, skewing the data.
Interesting. I'll try reading the linked paper later.
https://www.tandfonline.com/doi/full/10.1080/00324728.2023.2168035
Remember Sci-Hub if you need it.
Exactly. Something can have a stigma without requiring people be assholes to others about it. There's a lot of toxicity around obesity online and IRL, and that has never felt productive to me. Just alienating.
When I was morbidly obese it really sucked to move around. I would walk really slowly, but also my knees and my hips were starting to give out a lot. When I lost the weight I ended up getting X-Rayed and going to physical therapy. Luckily there was no structural problems, no arthritis as I originally thought. But rather there was issue with the muscle surrounding it. When the PT was massaging my kneecaps she said she could feel abrasions around it. So I was definitely damaging my body and if I let it go on for longer it would have eventually led to joint issues.
Why do you say that? Are doctors ignoring more glaring issues?
I have a couple of very large friends who have had this happen.
One got a RSI that caused a nerve pinch in her shoulder, and the other destroyed his ankle at work (size contributed to the force of the impact, but not the issues he was having related to surgery). Both had to fight to get anything done because just being fat, while stressful on the joints, doesnt cause nerve pinches where she had one or a doctor to repair an ankle in such a way as to put a tendon across a sharp bone, but both were told to lose weight as a first solution.
This is a tough one for me, and I second guess even posting a comment. I'm really not interested in debates or "just try X" advice or the ad nauseam repetition of talk about calories, those are all quite useless to me. Just from my personal experience, I know that I can count calories to lose weight, it's all the other compounding factors (cravings, sleep, self-control, etc.) that I find tough to manage- and that makes all "count calories" advice absolutely unhelpful. Also, my experience is only my own. While I may have medical conditions that contribute to my weight, others may have medical issues that make tackling it nearly impossible or have a more direct effect on weight- and certainly promoting acceptance and removal of stigma/shame and promotion of self-esteem seems wholly beneficial in that case.
With all that said, I find that sometimes the fat-acceptance discussion omits necessary nuances. The way I thought made most sense to me was ending the stigma around obesity and trying to address its social acceptance and self-acceptance from a self-esteem point of view. Because it can be an insidious thing that some of us struggle with all our lives without being able to overcome it- and shame, stigma, etc only make things worse. So, in those terms I've typically considered fat-acceptance a good thing.
However, in some cases I feel pushed to accept my current weight as healthy or some generalized nuance-free form of okay- and this doesn't help me either. Trying to fool myself into thinking my weight is having no ill effects on me is harmful and I do not appreciate that rhetoric.
But for me personally, as someone who is more than overweight, it needs to be okay for me, at least for myself, to acknowledge the truth that I know that my current size is making me unhealthy. Not only that, it is making me uncomfortable. Not only that, it affects my joints. From a social perspective, it can affect what clothes I can wear, what places I can comfortably sit/lay/stand, forces considerations about different things that people of lesser size do not deal with on a daily basis.
Overall my obesity is still mild compared to some- so I can't even imagine how it has to be for someone experience the issues I experience but at a much higher scale. I completely understand trying to help someone remove the shame, stigma, and other negativity that sometimes only reinforces the weight - and not thinking we're helping by constantly giving them condescending advice (that they've probably heard 1000 times) about how to tackle their problem. People need resources and understanding in addition to acceptance- so that they can take an informed path- whatever that ends up looking like for them. Ignoring a weight level that is dangerous to health as if it is no problem at all helps no one.
Thanks for posting the comment! I can’t see any downside to anyone loving themselves more. I think the nuanced mindset of “I’m not going to hate my weight, but I’m also not going to lie to myself about it” sounds very healthy.