Thursday, 17 October 2019

The Tricky Argument That Dieting Makes People Fatter

Dieting and SuccessAs the whole Kurbo disaster has unfolded (in case you missed it, Weight Watchers – aka WW [insert eye roll here] decided that their best move was to harm children with a diet app which may or may not have anything to do with the fact that their shareholders filed a class-action lawsuit based in large part around their decrease in adult subscribers.)

Of the many, many (OMG so many) arguments that were made against the catastrophic atrocity, one that I saw a lot was that dieting is likely to make kids fatter than they would be otherwise. This is a tricky argument and I want to get into that today.

Now, when I talk about “dieting” I mean any intentional attempt to alter food intake and/or movement in order to decrease body size. Yes it counts as a diet even if someone calls it a “lifestyle change” (sure it is  – you change to a lifestyle where you diet all the time.)

First of all, based on the research it’s absolutely true. It turns out that one of the many negative effects of giving a body less food than it needs to survive in the hopes that it will eat itself and become smaller, is that the body’s famine defenses kick in and alter it to become a weight gaining, weight-maintaining machine.

Would the victims of diet culture have been smaller without their history of dieting? Maybe. What’s important is that a smaller body is not a better body – bodies come in lots of sizes for lots of reasons, and people of all sizes are fully worthy of respect.

And that’s the issue with this argument. Though it’s true that dieting is likely to leave people fatter than they were when they started, using that as an argument against dieting is inherently fatphobic since its core premise is still that we want to avoid people becoming fat/fatter.

That said, we live in a fatphobic society and dieting and the diet culture it creates have real negative consequences to physical and mental health, and so this argument can also be considered a harm reduction strategy. It can be seen as a drop of fatphbobia in the fatphobia bucket, but if it keeps a parent from putting their child on a diet for example, it may be worth it in a cost-benefit analysis.

There are things that we can do to improve this argument by the way that we frame it.

After I explain statistics around dieting and weight gain I’ll often say something like “so even if you believe that fat people would be healthier if we were thinner – and I don’t agree – dieting is still the worst possible advice you could give us.”

The truth is that there are actual health risks to dieting which I think are important to point out, saying something like “It’s not that weight gain is, in and of itself, the problem. The problem is that dieting changes a person’s physical and mental response to food and movement and can lead to health issues including everything from weight cycling to prompting an eating disorder,”

I most often use this argument when I’m speaking to healthcare providers about whether or not dieting meets the requirements of ethical, evidence-based medicine (spoiler alert – it doesn’t.) When I make this point, I try to always counter any fatphobia inherent in the argument by saying something like – “there’s nothing wrong with people being fat, but there is something wrong with giving a supposed medical intervention that has the opposite of the intended effect the majority of the time.” Or “I don’t think the evidence suggests that a larger body is a medical problem to be solved, but as long as HCPs are trying to treat weight loss as if it’s a medical intervention, then we have to talk about whether or not it meets the basic requirements of ethical, evidence-based medicine.” 

If we are using the argument as a harm-reduction strategy, we can try to remove some of the fatphboia by saying something like “The Kurbo app creates physical and mental health risks and, even if you believe that kids would be healthier if they were thinner, there’s no evidence that this app will any kid thinner or healthier. In fact, experts from multiple fields agree that this app will do great harm.

The fact that diets don’t work is an important thing to talk about – especially since they are sold to us a healthcare intervention (of course, being thinner and being healthier are two different things  and dieting almost never results in either.) Still, there are plenty of reasons to eschew dieting besides the fact that the most common outcome is weight gain, and the fact that this argument can add to fatphobia is something we can try to mitigate when we make it.

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