Thursday, 30 January 2020

Jennifer Kuk, PhD Kind Of Almost Gets It Right About Dieting

the best obesity treatmentAn article about an interview with Jennifer Kuk, PhD (kinesiology) is making the rounds (I’m not linking because it is chock full of fatphobic links and ads, so you’ll have to google if you want to read it all.) Dr. Kuk studies “metabolically healthy [fat] people” and she does a decent job of explaining why dieting almost never works, including:

I think the largest is that if you eat less and move more you can lose all the weight that you want. The people who are able to do that are equivalent to people who have won the lottery. I think that we all know that there are people that win the lottery but not everybody does. And the people who win the lottery and are able to lose weight through diet and exercise are screaming at everybody else saying, “Why can’t you do it? I did it.” But it would be the same as the lottery winner saying, “I won the lottery. Why didn’t you win the lottery?” We see the absurdity of that, but we don’t see it when it comes to weight loss.

as well as

I think that probably the best way is to pick the right parents. If you have the right genetic makeup, it defends against weight gain. There’s a study that had many people eat a thousand calories extra, which is about a third more than what they normally ate, and there are some individuals in that study who gained nothing, despite not exercising more.

and

I don’t know if weight loss should be the ultimate goal. I think that the question is wrong. So the right question is, “How do you get healthier?” You should not equate weight with health. They’re not the same thing.

This is a huge step, and I appreciate her being clear and honest about this. Of course, it should be made clear that this is the right question with the understanding that health is not an obligation, barometer of worthiness, entirely within their control, or anyone else’s business unless they are specifically asked to make it their business. It’s also important to notice that this concern trolling around fat people needing to “prioritize our health” (and the assumption that we’re not) is often massively hypocritical when we look at how other groups are treated. 

Still, there are serious problems with this interview that are rooted in the ways that Dr. Kuk is still stuck in a weight = health paradigm.

First, she gives credence to some seriously scientifically questionable ideas around weight (including that hanging around fat people can make you fat.) But that’s not the worst of it. To me her most dangerous errors are:

People First Language

Her advocacy for “People First Language,” which perpetuates weight stigma, and lets us know that she is coming from a place of weight stigma.

The notion of a small bit of weight loss causing health improvements

You can lose a very small amount of weight and get significant health benefits…in order for you to improve your health, the amount of weight that you need to lose is very small. Most [fat people,] if they lost five per cent, they would get healthier, they’d feel better they’d have more energy.

This doesn’t even pass the smell test – the idea that, regardless of your starting weight, losing 5% would mean every fat person would be “healthier,” feel “better,” and have “more energy” is utterly ridiculous.

Also, the notion of 5% weight loss causing health benefits was reached by attrition, not research – as Tomiyama, Mann et. al point out, 5% is “arbitrary and non-medical”  The number started out much higher but they kept being lowered because of the near-complete failure of weight-loss interventions to achieve weight loss. They started with the exacting height/weight tables of the Metropolitan Insurance Company, then were moved to 20%, then to 10%, and finally to 5%. Again, it’s not the result of good research.

It also ignores the fact that even those who lose 5% of their weight will likely gain it back (with many gaining back more) meaning that, even if one believes that body size is the problem, then they are prescribing a “solution” that has the opposite of the intended effect the majority of the time.

Finally, it assumes (in a manner that can only be characterized and non-scientific) that the very small amount of weight loss itself caused any health benefits, rather than asking if the behavioral changes that led to the (likely temporary) weight loss also caused the health benefits. This allows weight loss to be a credit thief which is an even bigger mistake you realize that

  • the weight loss and the health benefits are typically concurrent
  • Research like Matheson et. al. and Wei et. al. found the health benefits happen without the weight loss
  • People who lose small amounts of weight through other means (like liposuction for example) don’t typically experience these supposed “health benefits of weight loss”

Perhaps her most dangerous misstatement is:

Bariatric surgery is the best obesity treatment that we have…

She admits that even after surgery most people remain fat, but that doesn’t even scratch the surface of the issue here. The real problem is that these surgeries are not “the best” anything unless you are talking about very profitable ways to risk fat people’s lives and quality of life in a barbaric surgery that is a total crapshoot. You see, some people are happy with the results, some people have horrific lifelong side effects and would give anything to take the surgery back, and some people are killed – and there is absolutely no way to predict which group someone will be in until they are in it. And we rarely if ever hear from the victims.

In truth the best “obesity treatment” we have is to stop focusing on body size and give ethical, evidence-based healthcare to people of all sizes – including a focus on eliminating oppression and increasing access to the foods, movement, and healthcare that people choose. For a thoroughly cited review of the science around this I highly recommend this piece.

I appreciate Jennifer Kuk making these statements about the massive failure rate of dieting, especially considering the fact that she is likely to get a ton of pushback from a fatphobic society where people have been duped into believing that thinness is necessary for health, that dieting can lead to thinness for almost everybody, and that health is an obligation.  I just hope that she makes it the rest of the way out of the weight= health paradigm.

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