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 2005, the moral panic about “obesity” was ramping up, and there was big money at stake, all resting on the idea that fat kills. 

Well, Flegal’s research pulled the rug out from under those views, not only showing that fatness was associated with only 1/3 the associated deaths that previous research estimated (and even that smaller estimate can be critiqued), but also showing that being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories. 

The reaction to these results -- which have been verified over and over again in the years since and in decades of prior research -- was swift and vicious. Powerful people launched a smear campaign against Flegal and her work:

Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work.

Flegal’s first-hand account of her experience illustrates how power and stigma pervade and bias weight science. This can have a chilling effect:

One of the effects of the public insults may also have been to deter or intimidate other investigators. An anonymous researcher was quoted elsewhere as saying if character assassination is the price for publishing data that contradicts established beliefs, fewer academics will be willing to stick out their necks and offer up fresh thinking.

I read a lot of studies around digestive illnesses, which in turn are bound to mention weight sometimes and the explanations these researchers come up with for some findings are bonkers. I've seen correlations of higher weight and heartburn explained as these individuals must eat more/more often to avoid the heartburn and are therefore gaining weight (an incredibly facile explanation of weight gain that's based on a far too basic idea of calories in, calories out). Basically whenever a correlation between higher weight and an illness comes up (correlation = both have been observed at the same time), without question the high weight must cause the illness and never the other way around. How do these people expect to arrive at the truth, if the very start of their hypothesis is a rigid assumption? There is a whole term and repeated research around the fact that people in the "overweight" category of the BMI are the healthiest and live the longest, the so-called "obesity paradox". This term is 1984-level word-bending to account for the fact that people have started with a biased opinion (fat is bad and fat makes you unhealthy) and the reality they've encountered through actual scientific research (fat seems to have a protective function and thinner doesn't mean healthier by default) shows the fucking opposite. In fact what this research tells us is that weight as a single indicator for health is meaningless and should be discarded.

Of approximately 60+ studies I've read TWO pay mind to the fact that disordered eating and exercize patterns exist and clinicians need to be careful not to encourage them, while I would say at least 30 of these studies have included the implication that being fat is unhealthy. Their sources again going back to correlations between weight and illness, nothing else.

One is that fat people live longer in spite of our invisibility to the medical system

The other is that fat people live longer because of our invisibility to the medical system.

The more I read about the increasing prevalence of iatrogenic illness, the more I think the latter is the case. How many times have I been prescribed a medication that I ultimately did not need, where the side affects were worse than the condition it was prescribed to treat?

Pre-diabetes was rejected as a diagnosis by the World Health Organization (although it is used by the US and UK) - the correct term for the condition is impaired glucose tolerance. Approximately 2% of people with "pre-diabetes" go on to develop diabetes per year. You heard that right - TWO PERCENT. Most diabetics actually skip the pre-diabetic phase.

There are currently no treatments for pre-diabetes besides intentional weight loss. (Hmm, that's convenient, right?) There has yet to be evidence that losing weight prevents progression from pre-diabetes to T2DM beyond a year. Interestingly, drug companies are trying to persuade the medical world to start treating patients earlier and earlier. They are using the term “pre-diabetes” to sell their drugs (including Wegovy, a weight-loss drug). Surgeons are using it to sell weight loss surgery. Everyone’s a winner, right? Not patients. Especially fat patients.

Check out these articles:

Prediabetes: The epidemic that never was, and shouldn’t be

The war on ‘prediabetes' could be a boon for pharma—but is it good medicine?

Also - I love what Dr. Asher Larmie @fatdoctorUK has to say about T2DM and insulin resistance, so here's one of their threads I pulled from Twitter:

1️⃣ You can't prevent insulin resistance. It's coded in your DNA. It may be impacted by your environment. Studies have shown it has nothing to do with your BMI.

2️⃣ The term "pre-diabetes" is a PR stunt. The correct term is impaired glucose tolerance (or impaired fasting glucose) which is sometimes referred to as intermittent hyperglycemia. It does not predict T2DM. It is best ignored and tested for every 3-5yrs.

3️⃣ there is no evidence that losing weight prevents diabetes. That's because you can't reverse insulin resistance. You can possibly postpone it by 2yrs? Furthermore there is evidence that those who are fat at the time of diagnosis fair much better than those who are thin.

4️⃣ Weight loss does not reverse diabetes in the VAST majority of people. Those that do reverse it are usually thinner with recent onset T2DM and a low A1c. Only a tiny minority can sustain that over 2yrs. Weight loss does not improve A1c levels beyond 2 yrs either.

5️⃣ Weight loss in T2DM does not improve macrovascular or microvascular health outcomes beyond 2 years. In fact, weight loss in diabetics is associated with increased mortality and morbidity (although it is not clear why). Weight cycling is known to impacts A1c levels.

6️⃣ Weight GAIN does NOT increase the risk of cardiovascular OR all causes mortality in diabetics. In fact, one might even go so far as to say that it's better to be fat and diabetic than to be thin and diabetic.

Dr. Larmie cites 18 peer reviewed journal articles (most from the last decade) that are included in their webinar on the subject, linked below.

Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records by Fields, et al (2015):

(apologies in advance for the stigmatizing language used in the study)

Methods: We drew a sample of individuals aged 20 years and older from the United Kingdom's Clinical Practice Research Datalink from 2004 to 2014. We analyzed data for 76,704 obese men and 99,791 obese women. We excluded participants who received bariatric surgery. We estimated the probability of attaining normal weight or 5% reduction in body weight. Results: During a maximum of 9 years' follow-up, 1283 men and 2245 women attained normal body weight. In simple obesity (body mass index = 30.0-34.9 kg/m(2)), the annual probability of attaining normal weight was 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1290 for men and 1 in 677 for women with morbid obesity (body mass index = 40.0-44.9 kg/m(2)).

I ran the numbers. For smaller fat people, that is 0.5% for men and 0.8% for women. For larger fat people, it's 0.08% and 0.1%. That's 1 in 1,000. It is practically impossible for the average person.

In the post below, I include 9 different peer-reviewed studies on why long-term weight loss is impossible, including an overview of a journal where UCLA researchers Traci Mann, Janet Tomiyama, and Britt Ahlstrom conducted the most comprehensive and rigorous analysis of diet studies, analyzing 31 long-term studies.