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HAES® Matters: Dieting, Disease, and Weight (part 1)

From time to time the Health At Every Size® Blog will be sharing HAES Matters “roundtable” posts with our readers. The questions that appear in the HAES Matters posts are based on questions generated by participants at ASDAH’s 2011 Educational Conference.  The participants were asked to list the most common questions they heard with respect to health, weight, dieting, and the Health At Every Size approach to promoting wellness.  We have compiled responses from some of ASDAH’s HAES experts to these commonly asked questions. We hope you will comment below with your own questions, answers, and reflections on these HAES matters.

Q: Aren’t health interventions the only reasons fat people live as long or longer than people who weigh less?

A: Sandy Andreson
Many fat people avoid seeking health care because of misdiagnoses, and the shaming and blaming of health care professionals.

Health care interventions are the reason why some people of any size have greater longevity. Health care interventions are also the reason why some people live longer but can experience a decrease in their quality of life. The outcome of health care interventions is very individual. Genetics and resiliency have a lot to do with individual health intervention outcomes.

A: Deb Burgard
The tone of this question is confusing to me.  There are genuine misunderstandings of the health risks of the overweight to moderately obese BMI ranges, such that I would first answer that no, it is not all driven by medical interventions.  People are living longer than we expect and that is driven by the fact that what we expect is based on stereotypes and weight bias.

But another way to answer this is to look at the improvements that have helped peoples’ health.  So if things like blood pressure treatment or better control of diabetes allow people to live longer, isn’t this a good thing?

Exactly how is a medical success story a problem when it comes to fat people?  Why aren’t we happy about the ways fat people can be fat and not doomed to live out the negative stereotypes?

A: Fall Ferguson
This question contains a critical false assumption.  The most recent data indicates that people whose BMI falls in the “overweight” category tend to live longer than those with “normal” BMI.  And, most individuals with a BMI in the lower “obese” categories have a similar life expectancy as someone with a BMI in the “normal” category.  People whose BMI falls into the categories at the extreme ends of the continuum (“underweight” and higher levels of “obese”) have the lowest life expectancy.

Moreover, a growing body of evidence on the so-called “obesity paradox” shows that for certain serious health conditions, higher BMIs and/or higher levels of body fat appear to serve a protective function.  For example, studies have found that fatter cardiac patients are more likely to survive heart attacks, invasive procedures, and hospitalization.

In short, there is every reason to believe that the vast majority of fat people – in medical terms, the people we think of as “overweight” or “obese” – live as long and often longer than thin people.

Q: What about people who are dieting for their health?

A: Deb Burgard
Trying to lose weight “for health reasons” can be an earnest attempt to follow doctors’ orders.  It can also be a way to bargain with the universe for some people who wonder if the reason they have failed before is that they somehow don’t deserve to be thinner if they only want it for their looks.  And it can also be the case that people who are at lower weights have better health in some specific way, and the idea is that if one achieves that weight one will achieve that health benefit – even though there is little evidence that weight-suppressed people reduce their risks to that of never-fat people, because there are so few people who permanently change their weight.

It is understandable in our very fat-stigmatizing culture that people would want to be thinner for all kinds of reasons. Fortunately, no one needs to sit in judgment of anyone’s reasons. Unfortunately, a person’s reasons don’t matter to the success of the project of permanently changing one’s weight.

Our bodies don’t know the difference between food restriction to follow a doctor’s orders, restriction to fit into your bridesmaid dress, restriction in a time of famine and war, or restriction to give you a feeling of control over your life. To our bodies, it is just a problem that needs to be solved as quickly as possible – i.e., those fat cells need to be refilled and so thinking about food will take priority, and metabolic rate – “unnecessary spending” from the body’s point of view – will slow.

Until there is any kind of data that people who try to lose weight for any reason are still maintaining that weight loss 2-5 years later, what we are really doing when we embark upon pursuing weight loss is actually a round of weight cycling. Weight cycling is a problem for health because it can cause hypertension and redistribution of body fat to the abdomen. For most people there is a loss of muscle mass, a net increase in fat, and possibly a higher weight in the long run.  People feel defeated, their bodies have become even more efficient with fuel, and they have less muscle mass to support their joints, move with ease, and burn fuel.  It will take less and less food to support any given weight, setting up an ever-widening gulf between how they would eat to maintain their weight and how others eat.

Weight cycling is not the answer. Instead, the same things that improve health for a thin person improve health for a fat person – so whatever is possible and sustainable for a given person, the health benefits will last whether weight changes or stays the same.

The problem that isn’t solvable this way is the stigma fat people face that damages our health, including the willingness of healthcare providers to prescribe the pursuit of weight loss when the overwhelmingly likely outcome is weight cycling.  To change weight stigma we need to take collective action. We need to prescribe hate loss.

A: Fall Ferguson
I applaud anyone’s efforts to improve their health. However, the idea of “dieting for health” is not a straightforward concept; I would seek to understand the individual’s real objectives, whether more energy, reducing symptoms, or something else, and then I would talk to the person about ways to work towards those objectives.

For some people, health professionals have recommended following a specific nutritional regimen or avoiding certain foods. As a health educator, I would work with a client to find ways to make that regimen sustainable for the client. If the real purpose of the “diet” is weight loss, however, there is a lot of evidence that for many people, even people with chronic diseases, restrictive eating for the purpose of weight loss does not improve health and can actually harm health over the long term.

Based on the research and my own experience, what does work to improve health for most people may not be easy, but it is not complicated. There are no fad diets or secret ingredients: healthy eating and healthy movement (both of which should be defined in an individualized way), stress reduction, sleep management, and finding ways to have meaning, connection, and joy in life. Of course, corporations can’t make large profits from any of that.

A: Deb Lemire
“Dieting” in the traditional way we understand it – reducing caloric intake in order to lose weight – is intrinsically not healthy. When you “diet” you purposely deprive your body of enough food to function optimally. So in essence no one can actually “diet” for his or her health. When someone says they are “dieting for their health” they unfortunately have bought into the misinformation that abounds from the diet industry rhetoric. And sometimes it is a way to say to the world “see I am trying to lose weight. I am trying to look how you say I should look. Don’t hate me.” Eating a variety of foods in sufficient amounts and being physically active are the primary keys to good health.

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