Why we don't prescribe weight loss

Have you ever been encouraged to lose weight for x, y, or z ailments? So often weight loss is advised as the go-to solution because our culture holds the misconception that thinness=health. Everything from joint pain to depression and anxiety (which also occur in thin people) trigger the ‘weight management’ conversation. 
But Everyone Knows That Having a Higher Body Weight Is a Problem?Every health concern tends to elicit a prescription for weight loss, and yet there’s a lot about that correlation that needs a closer look. If you’ve ever experienced this perspective, let’s explore a healthier alternative. Here are 4 misconceptions that debunk the narrative that fat is bad and causes disease. ​

You'll notice that we use terms like ‘higher body weight’, ‘people in larger bodies’, or ‘fat’ in our writing. We avoid the use of stigmatizing language (think ‘o’ words) that are associated with the BMI. 

1. Having a Higher Body Weight Is A Disease​

Higher body weight is determined by the body mass index (BMI) scale which is widely used by medical professionals today, but has a troubling history and needs to be reconsidered as a measure of health. The Quetelet index, or BMI, was developed by a Belgian astronomer in the 1830s to see if the laws of probability applied to humans at the population level. It was never meant for clinical use but instead as a statistical exercise. The equation was created using strictly white, European bodies that don’t represent ethnic size and shape diversity. Neither does it factor in age, sex, body size, fat distribution, or behaviors and lifestyle. But because insurance companies profit off charging a premium for ‘overweight’ BMI, they push the narrative that larger bodies have a higher mortality risk. In reality, more representative data samples prove that higher body weights have a lower mortality risk than ‘normal’ and ‘underweight’ individuals.
What’s more, in 1998, the National Institute of Health changed the threshold for what was considered a ‘normal’ BMI causing millions of Americans to become ‘overweight’ overnight without having gained a pound. This change was based on a report funded by pharmaceutical companies that make weight loss drugs.

​2. Higher Body Weight Causes Disease
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Higher body weight often gets blamed for conditions like cardiovascular disease and type 2 diabetes which affect people of all sizes. In fact, thin people with cardiovascular disease and type 2 diabetes have less longevity than their higher body weight counterparts. What mostly determines the likelihood of someone having these conditions are genetics and repeated weight loss and regain (called weight cycling). Just a single round of weight cyclinig has the potential to damage blood vessels and increase the risk of cardiovascular disease (independent of body weight).

Referring to diabetes, studies have shown that after 6-18 months any initial improvements attributed to weight loss deteriorate. Type 2 diabetes improvements can be pursued by changing nutrition and/or activity habits whether or not weight loss happens.

3. Weight Loss Benefits Health Outcomes

Only 15% of health outcomes are determined by diet and exercise. Other determinants include things like stress management, living with a marginalized identity, and whether someone has access to quality education and/or medical care.

Pathologizing body sizes upholds oppressive societal ideals, body hierarchy, and promotes weight stigma. Weight discrimination has powerful impacts on a person’s physical, psychological, and social wellbeing. Intentional weight loss is a stressful, slippery slope to disordered eating and eating disorders. If we consider that stress impacts our health as much as, if not more than body size, promoting weight loss is completely counterproductive.

4. Weight-Loss Treatment is Safe, Effective, and Successful

Every body functions its best within its unique range of weight, called its ‘set point’ weight. Each time the body’s biology is overridden by intentional weight loss it perceives a famine and consequently raises it’s set point weight to higher than before to prepare for the next one. Studies show that 95% of weight lost is regained within 2-5 years. This can include those who undergo bariatric surgery, which also carry Potential risks including:

• Hernias
• Bowel obstruction
• Ulcers
• Vomiting
• Malnutrition
• Low blood sugar
• Dumping syndrome, a condition that can cause nausea and dizziness
• Obstruction of stomach
• Infection
• Inability to eat certain foods
• Dilation of esophagus
• Chronic nausea and vomiting
• Anesthesia-related risks
• Acid reflux

What’s Our Responsibility?

Creating awareness of the impacts of fatphobia is the first step toward change. All bodies are deserving of dignity and respect. In the bigger picture, public health should redirect its focus to the structural systems that influence health like racism, socioeconomic, and environmental factors. The unfortunate reality is that not everyone is free from prejudice, has access to quality nutrition, or is guaranteed environmental safety. These things are privileges we need to be conscious and compassionate of. 

To learn more about this social justice issue, check out our services at Synergy Health & Wellness.