This Orgy of Fatphobia and Shit Science Is Literally Killing People

“Diet” by mahmoud99725 is licensed under CC BY-SA 2.0

A few days ago, Forbes published a quick little commentary on a Journal of the American Medical Association study on that topic that never dies (although its participants sometimes do), weight loss. A bit different from the norm, this study from last year aimed to analyze what it takes to to keep young adults from gaining weight. What could go wrong, right?

Plenty.

I mean, I’m delighted that a magazine dedicated primarily to finance and investing is delving into these deep issues (see what I did there?), but there are better ways to look at this. Ways that don’t suck worse than a day-old donut.

This article showed me how fatphobia and shit science pervades basically every level of reporting this particular study. It’s blindingly obvious to me how the delicate dance around the study’s results indicates a reticence to admit the following:

  • Diets don’t work
  • Scaring people about gaining weight doesn’t work
  • Harder dieting has a shorter payoff and a bigger long-term risk
  • Researchers and reporters need a lesson in medical ethics

A Study of Pain and Suffering

Under the hashtag #livelong (cue the creepy foreshadowing music), author Peter Ubel goes through the basic function of the study. Researchers divided up participants (all adults under age 35) into three groups. The first group was the control group, given little direction in changing their patterns of diet and exercise. The second group, the “small changes” group, was provided a series of lessons to encourage them to adopt a minor decrease in calorie consumption, and a little more exercise. The third group, the “large changes” group, was instructed to focus on cutting a significant amount of calories and exercising much more. They were told to set a goal of losing about 5–10 lbs, to “buffer against expected weight gain.” Both of these latter groups were strongly encouraged to participate in regular self-weighings.

Ah yes, the “lose weight before you gain it” play. It works so well for everyone. Except perhaps the people in the study. And literally everyone else.

If you look at JAMA’s own reporting of the study, the “large changes” group had the best outcome. That group had an average loss of about 5 lbs. over a “mean follow-up of 3 years.”

Anyone who has tried to lose weight and keep it off knows that it would be a mean three years, indeed.

JAMA concludes that this group had the greatest success, and that both intervention groups “significantly reduced incidence of obesity relative to control.”

You could look at this as a scientific breakthrough or more of the same old trash science, depending how many diet and weight-loss related studies you have read in your lifetime. For another perspective, take a look at the graph Forbes published along with Ubel’s commentary.

Wow! Now that, my friends, is telling an entirely different story. And perhaps this is why JAMA indicated the follow-up had average times. Let’s pull a few relevant points out of this graph:

  • Even the control group lost a little weight at first.
  • The “large changes” group lost the most weight, but began to rapidly regain it within a year.
  • Although the control group had the highest net weight gain of about a kilogram (2.2 lbs) by the end date three years after the study began, the “large changes’ group had the largest total weight gain.
  • The “small changes” group gained about twice the amount of the control group, and the “large changes” group gained over 3.5 times as much.

Now, I’m not so daft as to say that the researchers have a moral imperative to make recommendations that are only tangentially related to their results. That is not a hallmark of good science. However, intellectual honesty seems to be missing from JAMA’s report. Unless this graph is a gross misrepresentation of the detailed specifics of the results (which are behind a pay wall, for my purposes), the conclusions are disingenuous.

Yes, the group with the highest amount of intervention lost the most weight and had the lowest weight at the conclusion of the study. But the spread of net weight gain between the three groups is only about a kilogram, which does not paint a compelling picture of the success of greater interventions.

But even this isn’t the worst part.

Rapid Weight Loss = Rapid Weight Regain

Researchers have an obligation to be medically responsible with their study participants’ lives, and honestly I can’t conclude that this was achieved during this study.

I have to introduce a third source into this equation, so that you can understand the cruelty of this study. UNC’s School of Public Health published a report around the same time as the study, about a year ago. In this, you see how the “large changes” group was able to lose weight so rapidly, and how they regained it so easily.

This report details the instructions this group was given, to cut consumption by 500–1000 calories a day (!!!!) for eight weeks and increase exercise to 250 minutes per week. Participants were told to maintain the exercise levels throughout the study.

Let’s think about this for a minute. Take at least a moderate (and possibly a severe) cutback to your calories for eight weeks. Simultaneously, increase exercise. For sure, you’ll lose some weight. And then the very moment you stop that crazy diet pattern, it comes crashing back.

This explains why the graph doesn’t show a plateau or even a period of maintaining the weight loss before the point starts rising again. These people in the “large changes” group had no chance here. They were put on a short-term crash diet and their bodies responded accordingly.

Where is the sense of medical ethics here?

The Big Yo-Yo in the Room

In the world of fatphobia (a.k.a. “our society”), being at or above a certain weight is the worst thing ever. Whatever you have to do, do not cross this line. Else you will be eaten by monsters. Or heavily judged by literally everyone, everywhere you go.

Since fatphobia only recognizes the end product and not the process, there is no discussion of the health outcomes that are produced when you pressure people to lose weight in a manner that they cannot hope to maintain over any period of time.

As an increasing number of researchers and experts are starting to find out, rapidly losing weight and regaining it actually matters for health outcomes, and not in a good way.

I have trouble enough with the researchers, who apparently saw no need to mention the fact that while the group they encouraged (tortured) into losing weight lost the most weight and had the lowest weight compared to baseline at the end of the study, they also gained the most weight as a result of those instructions.

As an increasing number of researchers and experts are starting to find out, this little side-note actually matters for health outcomes.

For years, people have been claiming that obesity contributes to an increased risk of diabetes, heart disease, stroke, etc. The list is long and keeps getting longer. In fact, this stereotype has become so pervasive that many fat people find themselves in a double-bind as they seek health treatment for any condition. If it is a health concern that is “linked to obesity,” they are blamed for it. But even if it is not related to weight at all (e.g. an injury from a car accident), doctors too-often dismiss symptoms and side-effects as something related to weight.

Through this cloud of (let’s be honest) idiocy, it has been difficult for anyone fighting fatphobia to persuade others that weighing more isn’t necessarily a health care problem, much less a drain on the economy. But the evidence is growing.

See, the more people look into this, the more they realize one crushing fact: Weight is not the problem.

Diets are the problem.

Here’s a lit review from the International Journal of Exercise Science in 2009 that points to yo-yo dieting as a possible or likely cause of increased risk of diabetes and heart disease.

Here’s a summary of a study from April of 2017 in the New England Journal of Medicine showing that people with heart disease were noticeably more likely to have a stroke, heart attack or die if they had lost and gained more weight during the period of the study.

And the Icing on This Shit Sundae Is…

Of course, the conclusion of this exploration in human suffering takes me back to the Forbes commentary. Given the graph that shows how fundamentally unsuccessful crash dieting is, you might think that Ubel would argue that there has to be a better way.

He does. And it’s not pretty.

Since the weight gain picked up pretty quickly less than two years after the lowest point of weight loss, he suggested that people who want to avoid becoming obese just pick a different kind of diet to engage in every couple of years.

He thought this was so clever that he posted it in Twitter links at the top of the commentary, so that I could share his thoughts myself, if I wanted:

“The best way to help people avoid #obesity is probably to try a new weight loss approach every couple years or so.”

Let’s read that again, shall we?

“The best way to help people avoid obesity is probably to try a new weight loss approach every couple years or so.” — Peter Ubel

I see the disclaimer, and I’m not buying it for a second. I’m sorry, but you don’t get to speculate and then make recommendations that are literally killing people. To say nothing of the damage to the psyche caused by this self-destructive process.

You don’t get to look at the damage diets cause and conclude that it would be better if people just did them more often.

You don’t get to take the mounting weight of evidence against yo-yo dieting and pretend it doesn’t exist. People’s fucking lives are at stake.

You don’t get to use a large forum to share your prejudiced and ill-informed views, expecting that a quick disclaimer exempts you from criticism.

This is bullshit privilege cloaked in pseudo-science. This is a story about a flawed study with biased conclusions that ignores systemic issues, and a series of reports on that study that re-entrench a damaging mindset instead of calling it out.

Like what you read? Give Holly Smith a round of applause.

From a quick cheer to a standing ovation, clap to show how much you enjoyed this story.