Quote of the Day: Healthcare Providers and Expectations

From an article on healthcare providers stigmatizing fat patients:

Healthcare providers also need to readjust their expectations. Getting individuals who are obese down to a normal weight isn’t realistic: Research shows that most people can’t expect to lose more than 10% of their body weight and, more important, to maintain the weight loss over time. Instead of viewing that as a treatment failure and growing discouraged with patients, doctors and nurses need to recognize that even relatively small changes in weight represent real progress and can have very important implications for health.

I’ve written before that the US National Institutes of Health (NIH) guidelines for treating obesity recommends a 10% weight loss goal.  Not to diet down to “normal weight”, or even to just “overweight”.   Ten percent.    I also noted that I never had a medical professional (or parent or teacher) be satisfied with a 10% weight loss.   I was still fat, so obviously 10% wasn’t enough.

Just to be clear? If a 10% weight loss puts you in the “normal weight” category, you weren’t in the “obese” category.

Most readers know I disagree with the emphasis on weight loss; not only are most losses not  maintained in the long term, but dieting is associated with long-term weight gain.   I do believe in bodily autonomy, though, and that those who choose to diet should use resources like the NIH guidelines and the observations of others who are maintaining losses to maximize their chances.  And I get angry that someone could work hard to lose 10% of their body weight, could work hard to maintain that loss, and still have a healthcare provider berate them for being fat.  Or refuse to treat them, just because they’re fat.

Skip the fat shaming.  It doesn’t help anyone.

(Checking out Health At Every Size doesn’t hurt either.)




13 responses to “Quote of the Day: Healthcare Providers and Expectations”

  1. Patsy Nevins Avatar
    Patsy Nevins

    There have also been other studies which have indicated that the 10% weight loss also is not easy to maintain for most people, particularly since weight gain with aging is virtually inevitable for most of us, that dieting has very negative effects on health, which increase with age, so that by the time you are my age, weight loss increases mortality risks by several hundred percent, & also some studies which show that the 10% weight loss does not necessarily bring any improvement in health & can do the opposite. Yes, we own our bodies, & if people insist on trying to lose weight, they will keep trying to do so, & they & their healthcare providers will continue to see them as defective & failures if they do not. I much prefer accepting, loving, & living comfortably with the body I have. They tend to conveniently ‘forgot’ that the health risks of ‘obesity’ are greatly exaggerated & often fabricated & that actually fat people, at least moderately fat people, tend to live longer than thin ones (which has certainly been true in my family almost without exception…I have had many fat relatives live well into their 80’s & 90’s & currrently have two brothers who are well into their 70’s who have been fat all their lives & have ranged between 250-270 pounds for many years. Many studies have also shown that the differences in health atttributed to fat can be pretty much tracked to the effects of stress, abuse, discrimination, & poor medical care/fear of seeking medical care until illness is advanced.

    I guess I am fat liberation radical, but I do not believe in weight loss at all, other than what may naturally occur with changes in exercise, etc., & I do not believe any of the hype about fat being such a terrible killer. Even in the case of those who weigh 400 pounds or more, early death is not inevitable. I have heard of instances of people that large who have lived well into their 80s, often, significantly enough, in cultures where fat is not demonized & in some cases even celebrated.

    But, then, I am stubbornly independent, determined to own my own body & life, & I have little use for the medical establishment, the media, or anyone in the weight loss industry. So I will live…& die…on my own terms & no one will ever get away with telling me that any health issues I may have are caused by the size of my body.

    1. Living 400lbs Avatar

      Let me get this straight: I write that I disagree with weight loss, that most intentional losses are not maintained, that dieting is associated with weight loss in the long term …. and you figured that meant I am promoting dieting?

  2. Megan Avatar

    Hells yeah! As I read your last paragraph, I almost jumped up in my chair, cheering… except I’m at work, and I doubt that would be terribly appropriate. :)

  3. Patsy Nevins Avatar
    Patsy Nevins

    No, no, I didn’t read that you were promoting dieting. Quite the contrary..I said that those who push ‘just lose 10% of your weight’ are still pushing dieting & that it is no easier to maintain a 10% loss over the long term than a 50% loss. I am sorry if I was unclear; I wasn’t disagreeing with you but I guess that I didn’t state what I believe & feel clearly enough. I am upset with the number of people who will tell you, “Oh, I don’t believe in dieting, but just do this or that & you will lose weight” & that, no matter what the evidence is, that at least SOME weight loss is ALWAYS desirable & necessary & that we can attain it if we REALLY try. No, I had no quarrel with what YOU said or what YOU believe. And I do agree that it is especially maddening if someone meekly goes along & does work hard to try to lose 10% of his/her weight according to orders, lives a life of deprivation in order to try to maintain it, & is STILL berated for being fat. I was only trying to make the point that the evidence does not even show that what they are telling is to do is good for us. I guess they don’t need evidence; they just need a fat person in front of them to bully.

  4. jaed Avatar

    For me, the difference between eating poorly and being a couch potato on the one hand, and eating well (for me this is low-carb with lots of veggies) and doing some exercise on the other, is in fact just about ten percent. That seems anecdotally like an average for people who start practicing HAES.

    I think they’re looking at a side effect (the ten percent weight loss) of improving one’s health practices and making it a goal, but losing ten percent by unhealthy means such as restricting won’t make you healthier the way eating well and exercising will. And, of course, someone who starts eating well and exercising has improved their health even if they’re one of those who don’t lose or gain a pound no matter what they do.

    It’s encouraging in that it’s a more realistic expectation, but discouraging in that they still seem hyperfocused on weight rather than health.

    1. Living 400lbs Avatar

      I am kind of “yes and no” on this. I mean, yes, a lot of people who implement HAES end up losing a small amount of weight, and 10% isn’t all that crazy. If they stick with the changes, the loss can be lasting. But as you note, the loss is a possible side effect, not the reason for the changes.

      But, you can also get a 10% weight loss through exercise and/or food restriction; if the change is mostly from exercise and you maintain the exercise, then the loss is more maintainable.

      Then there’s the folks to who crash diet, lose 40%, regain a bunch, but still are “maintaining” a 10% loss through exercise, caffeine, fasting, cigs….

      So yeah, I’m all for being more realistic about how diets [don’t] work. (It’s interesting how people tell me that dieting would only be worth it if they’d become thin — “a 10% loss isn’t worth the hassle”.) Also that the health benefits usually ascribed to weight loss can often be attained through HAES. But it’s important to remember that the studies tell us what happens in general, and specific individuals are sometimes another thing entirely ;)

  5. DebraSY Avatar

    I agree with Jaed, though I call the 10% loss that may result from HAES a “bonus” instead of a “side effect,” but that’s probably just semantics. I only disagree with one thing that Patsy says: that maintaining a 10% loss is as hard as a 50% loss. Simply, it isn’t. Not that I have a ton of evidence to back me up, but I don’t think she does either. There are many people who report that they float along at roughly 10% under their highest established weight when they practice HAES, as Jaed does here, and I take them at their word. Sadly, no one cares to quantify these people and take them seriously. The National Weight Control Registry requires a minimum 30 lbs to sign on, which only equals 10% for people who start at 300 lbs and up. Many of us started lower than that.

    Living, got a question. I generally ask permission before I put a blog on my roll. I know I don’t fit neatly in a group. Some maintainers may be put off by my grumpiness, and size acceptance folks can easily see me as a hypocrite. But since you’ve put me in a post, I’m thinking you might be okay with my blog. Would you allow me to put you on my blogroll? I’d probably put you among the “Other Observers of Weight and Life,” unless, per chance, you’re one of those HAES people maintaining a roughly 10% loss, and you’d like to be put in the Maintainer group.

    1. Living 400lbs Avatar

      I agree with Jaed, though I call the 10% loss that may result from HAES a “bonus” instead of a “side effect,” but that’s probably just semantics.

      Mostly. It’s also about values. I had so much pressure to lose weight growing up, and so many battles with parents / doctors over my inability to lose enough to make them happy, that as an adult I would DENY any weight loss, because the response my parents trained me to expect (and which I roughly translated to “Well, if you lose enough to be thin you might not be totally worthless”) would just send me spiraling into anger, hatred, plunging self-worth, and depression. Thinking of it as a “side effect” helps me to keep the weight change value-neutral, which is as I want it to be. Different people, different experiences.

      (To be clear, usually it was my parents asking if I’ve lost weight that bothered me. I had years where my parents would ask me every time we talked if I’d lost weight. In retrospect I’m sometimes surprised I didn’t actually get violent. It’s down to once every 5 years or so now.)

      There are many people who report that they float along at roughly 10% under their highest established weight when they practice HAES, as Jaed does here, and I take them at their word.

      So do I. I do think that it being a result of HAES and not single-minded focus on weight may help, but I’m probably biased there. It may also have to do with dieting history. Again this is anecdotal, but the more I yo-yo’d the harder weight loss and maintenance became — and the less I found that HAES-like changes (taking the bus, exercising more regularly) would be accompanied by weight loss. I sometimes joke that everyone only gets so many weight-loss chits a lifetime and I’ve used up my pass….

      Would you allow me to put you on my blogroll?

      Certainly! “Other Observers of Weight and Life” is probably the best fit.

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