Fat Liberation

[ID: an infographic that reads, “Did you know? Set point is a predetermined weight range that your body is ‘meant to be in’ given your life circumstances. What happens when we diet and try to go below our set point?” A graph shows both set point and weight loss goals gradually increasing. As new set points rise, the person creates a new weight loss goal. The text continues to read, “Each time we try to lose weight, it becomes harder, and the weight comes back faster; we can’t fight biology. Things that can impact set point: stress, genetics, socioeconomic status, food access, food variety, level of movement, age, culture, our jobs, sleep, medications, medical diagnoses. Your weight will fluctuate through life. Welcome that. Stop trying to control your weight and start living your life.” End ID.]

Must I go through this again? Fine. FINE. You guys are working my nerves today. You want to talk about facing the facts? Let's face the fucking facts.

In 2022, the US market cap of the weight loss industry was $75 billion [1, 3]. In 2021, the global market cap of the weight loss industry was estimated at $224.27 billion [2]. 

In 2020, the market shrunk by about 25%, but rebounded and then some since then [1, 3] By 2030, the global weight loss industry is expected to be valued at $405.4 billion [2]. If diets really worked, this industry would fall overnight. 

1. LaRosa, J. March 10, 2022. "U.S. Weight Loss Market Shrinks by 25% in 2020 with Pandemic, but Rebounds in 2021." Market Research Blog. 2. Staff. February 09, 2023. "[Latest] Global Weight Loss and Weight Management Market Size/Share Worth." Facts and Factors Research. 3. LaRosa, J. March 27, 2023. "U.S. Weight Loss Market Partially Recovers from the Pandemic." Market Research Blog.

Over 50 years of research conclusively demonstrates that virtually everyone who intentionally loses weight by manipulating their eating and exercise habits will regain the weight they lost within 3-5 years. And 75% will actually regain more weight than they lost [4].

4. Mann, T., Tomiyama, A.J., Westling, E., Lew, A.M., Samuels, B., Chatman, J. (2007). "Medicare’s Search For Effective Obesity Treatments: Diets Are Not The Answer." The American Psychologist, 62, 220-233. U.S. National Library of Medicine, Apr. 2007.

The annual odds of a fat person attaining a so-called “normal” weight and maintaining that for 5 years is approximately 1 in 1000 [5].

5. Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A.T., & Gulliford, M.C. (2015). “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” American Journal of Public Health, July 16, 2015: e1–e6.

Doctors became so desperate that they resorted to amputating parts of the digestive tract (bariatric surgery) in the hopes that it might finally result in long-term weight-loss. Except that doesn’t work either. [6] And it turns out it causes death [7],  addiction [8], malnutrition [9], and suicide [7].

6. Magro, Daniéla Oliviera, et al. “Long-Term Weight Regain after Gastric Bypass: A 5-Year Prospective Study - Obesity Surgery.” SpringerLink, 8 Apr. 2008. 7. Omalu, Bennet I, et al. “Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004.” Jama Network, 1 Oct. 2007.  8. King, Wendy C., et al. “Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery.” Jama Network, 20 June 2012.  9. Gletsu-Miller, Nana, and Breanne N. Wright. “Mineral Malnutrition Following Bariatric Surgery.” Advances In Nutrition: An International Review Journal, Sept. 2013.

Evidence suggests that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function [10].

10. Tomiyama, A Janet, et al. “Long‐term Effects of Dieting: Is Weight Loss Related to Health?” Social and Personality Psychology Compass, 6 July 2017.

Prescribed weight loss is the leading predictor of eating disorders [11].

11. Patton, GC, et al. “Onset of Adolescent Eating Disorders: Population Based Cohort Study over 3 Years.” BMJ (Clinical Research Ed.), 20 Mar. 1999.

The idea that “obesity” is unhealthy and can cause or exacerbate illnesses is a biased misrepresentation of the scientific literature that is informed more by bigotry than credible science [12]. 

12. Medvedyuk, Stella, et al. “Ideology, Obesity and the Social Determinants of Health: A Critical Analysis of the Obesity and Health Relationship” Taylor & Francis Online, 7 June 2017.

“Obesity” has no proven causative role in the onset of any chronic condition [13, 14] and its appearance may be a protective response to the onset of numerous chronic conditions generated from currently unknown causes [15, 16, 17, 18].

13. Kahn, BB, and JS Flier. “Obesity and Insulin Resistance.” The Journal of Clinical Investigation, Aug. 2000. 14. Cofield, Stacey S, et al. “Use of Causal Language in Observational Studies of Obesity and Nutrition.” Obesity Facts, 3 Dec. 2010.  15. Lavie, Carl J, et al. “Obesity and Cardiovascular Disease: Risk Factor, Paradox, and Impact of Weight Loss.” Journal of the American College of Cardiology, 26 May 2009.  16. Uretsky, Seth, et al. “Obesity Paradox in Patients with Hypertension and Coronary Artery Disease.” The American Journal of Medicine, Oct. 2007.  17. Mullen, John T, et al. “The Obesity Paradox: Body Mass Index and Outcomes in Patients Undergoing Nonbariatric General Surgery.” Annals of Surgery, July 2005. 18. Tseng, Chin-Hsiao. “Obesity Paradox: Differential Effects on Cancer and Noncancer Mortality in Patients with Type 2 Diabetes Mellitus.” Atherosclerosis, Jan. 2013.

Fatness was associated with only 1/3 the associated deaths that previous research estimated and being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories [19].

19. Flegal, Katherine M. “The Obesity Wars and the Education of a Researcher: A Personal Account.” Progress in Cardiovascular Diseases, 15 June 2021.

Studies have observed that about 30% of so-called “normal weight” people are “unhealthy” whereas about 50% of so-called “overweight” people are “healthy”. Thus, using the BMI as an indicator of health results in the misclassification of some 75 million people in the United States alone [20]. 

20. Rey-López, JP, et al. “The Prevalence of Metabolically Healthy Obesity: A Systematic Review and Critical Evaluation of the Definitions Used.” Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 15 Oct. 2014.

While epidemiologists use BMI to calculate national obesity rates (nearly 35% for adults and 18% for kids), the distinctions can be arbitrary. In 1998, the National Institutes of Health lowered the overweight threshold from 27.8 to 25—branding roughly 29 million Americans as fat overnight—to match international guidelines. But critics noted that those guidelines were drafted in part by the International Obesity Task Force, whose two principal funders were companies making weight loss drugs [21].

21. Butler, Kiera. “Why BMI Is a Big Fat Scam.” Mother Jones, 25 Aug. 2014. 

Body size is largely determined by genetics [22].

22. Wardle, J. Carnell, C. Haworth, R. Plomin. “Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment” American Journal of Clinical Nutrition Vol. 87, No. 2, Pages 398-404, February 2008.

Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index [23].  

23. Matheson, Eric M, et al. “Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals.” Journal of the American Board of Family Medicine : JABFM, U.S. National Library of Medicine, 25 Feb. 2012.

Weight stigma itself is deadly. Research shows that weight-based discrimination increases risk of death by 60% [24].

24. Sutin, Angela R., et al. “Weight Discrimination and Risk of Mortality .” Association for Psychological Science, 25 Sept. 2015.

Fat stigma in the medical establishment [25] and society at large arguably [26] kills more fat people than fat does [27, 28, 29].

25. Puhl, Rebecca, and Kelly D. Bronwell. “Bias, Discrimination, and Obesity.” Obesity Research, 6 Sept. 2012. 26. Engber, Daniel. “Glutton Intolerance: What If a War on Obesity Only Makes the Problem Worse?” Slate, 5 Oct. 2009.  27. Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22(1), 68–78. 28. Chastain, Ragen. “So My Doctor Tried to Kill Me.” Dances With Fat, 15 Dec. 2009. 29. Sutin, Angelina R, Yannick Stephan, and Antonio Terraciano. “Weight Discrimination and Risk of Mortality.” Psychological Science, 26 Nov. 2015.

In 2011 or so, I started having intense pain in my legs and feet. I was sent to an orthopedic surgeon. He said, "This pain is because you are fat. Go on this diet and lose weight."

I went on the diet. I ate 1300 calories a day. I exercised until I literally couldn't stand up.

1300 calories a day is what a healthy toddler should eat. I was 34 years old. I was starving, in excruciating pain. I was angry and hungry and hurting. I really don't envy anyone who had to deal with me.

Oh yeah: and I didn't lose any real weight, no matter how hard I worked and how scrupulously I followed the diet.

By 2013, when - shockingly - I had ruined my muscle tone and was still in incredible pain, I got to a point where I couldn't walk to the bathroom at work without help. I missed my kid's chorus concerts bc I couldn't sit in uncomfortable chairs after suffering all day. And I still hadn't lost any real weight.

"Isn't there anything else this could be?" I asked.

He refused to run other tests. "You just need to lose the weight."

Two years this had gone on, and I was still in pain. Still missing out on my life. Still missing out on Cat's life, on moments I couldn't ever get back.

My partner finally got fed up and dragged me to another doctor. Dragged me back to our family doctor and told her what was going on.

She took one look at me - literally, she touched my feet once - and said, "This guy is an idiot."

Two days later, an MRI found a 2.5 cm mass adhered to the sheath of my spinal cord, compressing my spinal cord against the inside of my spine. Three days after that, I was told it was most likely malignant.

It wasn't. I was lucky. It was a benign mass, removed May 9th, 2013.

Since then, I've been diagnosed with diabetes and celiac disease, both of which my doctors think come from the bodily trauma that this all put me through - that genetic predisposition got kicked into overdrive by either the trauma of starving myself for two years or surgery. We can't be sure if it's the starvation or the surgery that did it.

We can, however, be very, very sure that the disordered eating that I have struggled with for the last 12 years comes directly from a doctor who looked at me and said, "You should starve yourself," and only saw fat, not a person.

I'm very, very lucky that it wasn't actually cancer. I know more than one person who wasn't that lucky. Some of them (z''l) have died.