Here’s an interesting, edited edited excerpt of ‘The Truth About Fat’ by Anthony Warner – The Truth About Fat: From the author of The Angry Chef
Why going on a diet and trying to lose weight could make your health worse, not better
Many experts believe we need to rethink everything we know about body size and longevity
Measures to tackle obesity have met with little success and some experts are suggesting there may be a better way. They have suggested that the pursuit of weight loss is not only incredibly difficult, it might actually be harmful and counterproductive.
So instead of wasting so much time and effort trying to find ways of making everybody thin, perhaps we should just… stop. Maybe some people are fat and we should just leave them to it.
This is a controversial approach. Let’s face it, being extremely overweight is definitely bad for your health and costs healthcare services billions of pounds. To give up on fat would be like giving up on smoking prevention back in the 1970s.
A weight-inclusive approach to healthcare
Health at Every Size (HAES) is a movement that grew out of the beliefs of feminist anti-diet and fat-acceptance campaigns. At its core is the belief that the focus on weight loss is extremely harmful and should be stopped. Now increasing numbers of informed people are adopting some of the principles of the non-diet movements.
The HAES movement encourages a weight-inclusive approach to healthcare, trying to maximise behaviours that improve physical wellbeing, without ever focusing on a patient’s weight. It rejects the notion that BMI, fat or body size is an accurate proxy for health, and this is not too far from the truth.
The movement has spawned an approach to food termed “intuitive eating”. This is based on the idea that people should be encouraged to eat whatever they desire, tuning into their natural hunger signals. Strict eating rules are abandoned in favour of understanding what your body is telling you and developing a better relationship with food.
Taking the stigma out of being fat
It encourages a world that does not stigmatise fat people. Stigma, it claims, is the greatest barrier to fat people being healthy. As a result, size-acceptance movements have been some of the most vocal critics of the “obesity epidemic” narrative. This puts them in conflict with many of the world’s large public health bodies.
But given the failure of most public health interventions to tackle obesity, perhaps a weight-inclusive approach might benefit this field, shifting the focus towards improving health, which is eminently possible, rather than reducing size, which is very difficult.
Laura Thomas PhD is a UK-based registered nutritionist who specialises in Intuitive Eating. She explains that there is great resistance to some of the HAES approaches, partly because of a lack of evidence. She told me: “There is some evidence that intuitive eating can be effective, especially in terms of improving metrics of mental health and normalising eating behaviours but there are lots of unanswered questions. We need more robust trials.”
The downside of restrictive diets
Studies have shown that restrictive weight-loss dieting is associated with binge-eating disorder, bulimia, future weight gain, negative body image, low self‑esteem and depression.
Deb Burgard, psychologist, explains: “Part of the problem is the underlying assumption that we are all meant to be one size. I don’t see the scientific basis for considering a body size a disease – we are not meant to be one size.”
The weight-inclusive movement asserts that categorising a certain range of BMIs as “normal”, is likely to create stigma. And stigma is known to cause many health inequalities, including those frequently associated with obesity and assumed to be caused by fat. People who are oppressed get sick far more frequently.
Studies have shown that the degree to which people are dissatisfied with their weight is related to their risk of developing type 2 diabetes, independent of their BMI. This raises the possibility that the stress caused by telling people they should be thinner than they are is one of the things making them sick.
Most diets don’t help people lose weight
Even for the most well-supported scientific studies, large amounts of weight loss seem hard to attain. Participants in the US Diabetes Prevention Programme (DPP), a four-year experiment to study the effects of lifestyle interventions on the risk of developing type 2 diabetes, received intensive personalised training in behavioural management strategies, physical activity and advice on dietary modification.
Participants achieved an average weight loss of 7kg in the first year, but in long-term follow‑ups, most of this weight had been regained.
The Look AHEAD study was a 10-year programme that went further, offering participants regular access to lifestyle coaches, dietitians, psychologists, doctors and physiologists. But even then, over the long term, only a third of people were able to maintain a weight loss of 5 per cent.
Focusing on wellness, not size
Both failed when it came to long-term weight loss, but they showed improvements to participants’ health. DPP focused on diabetes, pitching lifestyle against a well-known drug therapy, and proved that the lifestyle interventions were far superior. Exercise particularly seemed to have a significant effect, even if initial weight loss was not sustained at all.
The Look AHEAD study was stopped early because it failed to show enough impact on cardiovascular risk, but participants showed improvements in blood pressure, sleep apnoea, visceral fat, depression, kidney problems, physical mobility, the need for diabetes medicines, life quality, knee pain, sexual function and inflammation.
When smoking, excessive alcohol consumption, low fruit and vegetable intake and a lack of exercise are studied, it is no surprise that people doing all those things have high rates of mortality. Combine that with being fat, and the picture looks bad indeed.
Being fat and fit
Anyone fat who eats badly, drinks too much, smokes and rarely gets off the couch is far more likely to die than a thin person doing exactly the same. But research has shown that as these behaviours change, the difference between fat and thin people seems to diminish. For non-smoking, regular exercisers who only drink moderately and eat lots of vegetables, there is no difference in mortality rates between thin and fat groups.
Public health organisations exist to help us be healthy, not to become thin. Anyone who researches, campaigns, writes or works on obesity, food and health should ask themselves this: are we worried about people’s health, or about their silhouettes?
You can find the article here – I News