Why recommending weight loss, even when a person’s BMI is very high, is often unhelpful and misguided.

A personal trainer tagged me in a post showing the image of a fat person and how this fat/weight was damaging to their body and therefore, why weight loss was necessary.

I am going to to attempt to break this down as simply as possible to explain why such attitudes are misguided and damaging to a person’s health. This is actually a very complex topic and I hope those with much greater understanding of social justice issues will forgive me for only mentioning them as a factor without going into depth.

Let’s say this fat person – described as “obese” in the mainstream culture – does have issues with some organs and joints, let’s say they have diabetes and knee pain. And let’s agree for a moment that their high body weight is exacerbating these conditions.

The mainstream assumption is losing weight will help this person. Now if this personal trainer was to help this individual lose weight, I am going to assume they are not going to suggest liposuction, therefore if the person changes their health behaviours, how do we know if any improvements to health are due to weight loss or the change in diet and exercise? 

We don’t, but either way, if this PT encourages the client into calorie deficit to achieve weight loss, the client will almost certainly regain the weight at some point. If there are PTs reading this who feel strongly that they have helped the majority of their clients lose weight (through diet and exercise) and keep it off  for life, we need your evidence of this please – at present we have none. What we do have though, is evidence that shows many people end up heavier through pursuing weight loss.

This brings us to vital and often overlooked factors that affect a person’s health and which may explain why this person ended up at this weight. While these factors may influence current eating and/or exercise habits, they can affect health independent of diet and exercise.

To assume diet and exercise are the key, or only factors to address when helping someone manage their health is misguided and in most cases highly insufficient. I want to pause for a moment here and acknowledge that this is more or less what I was trained to do and what I did for the first part of my career. I’m not saying that I ignored, or that other practitioners who still work this way ignore a person’s psychology or life circumstances, I certainly didn’t, but I did not address them adequately, particularly with regard to body image and impact of weight stigma, and I did not understand the implications of continuing to place focus on body weight.

 

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Some of the reasons people end up with a higher body weight

  • Concern about weight from a young age, be that underweight or “overweight” as per growth charts. There is evidence that parents who worry about their kids weight, end up with fatter children. 
  • Medication
  • Hormonal disturbances
  • Mental health issues with or without medication
  • Economic and social circumstances
  • Adverse childhood events, including trauma
    ….
    .
    and the most common reason I see with my clients…

    .
  • Through the pursuit of weight loss – a large number of my clients have dieted themselves to a heavier weight, research shows that up to 2/3 of people end up heavier through dieting in an attempt to lose weight.

Regardless of the reasons, placing the focus on weight and encouraging people to pursue weight loss is more likely to lead to the following, than it is to improve a person’s health long-term…

  • Weight loss followed by regain (weight cycling/yoyo dieting), often to a higher weight.
  • Engaging in diet behaviours that are generally not sustainable and may lead to a poor relationship with food over-time, disordered eating behaviours such as restricting and bingeing.
  • Engaging in exercise behaviours that are generally not sustainable and may lead to a poor relationship with exercise over-time, injury or a general dislike of exercise.
  • An increased sense of shame over body size and perceived “failure” to control their weight, eating behaviours and maintain a certain level of exercise. Shame has been identified as an independent risk factor for health.
  • Perpetuating our cultures weight bias (that thinner people are more worthy, healthy, attractive etc) and the social stigma that accompanies this.

To state this person is unhealthy because of their high body weight or to keep this as the focus for their health issues, is at best misguided and very simplistic, and at worst, serves to further damage the individuals health through the continued pursuit of weight loss, weight cycling and weight stigma. Those of us who work in the Health At Every Size paradigm work to take the focus off body weight and instead focus on addressing health behaviours and the various factors that influence these. 

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