Dear Family Member,
I understand your fears. I get it. You want the best for your loved one. You want him or her to have the best and healthiest and fullest life possible. I do too.
You believe that helping your loved one to lose weight will help achieve these goals. Here, I disagree—I will explain below.
You believe that weight loss will lead to better health. You have heard the scary information about the dangers of obesity and know there is an all-out war on obesity. Or you have seen or heard your loved one ridiculed or judged negatively by peers because they didn’t conform to a certain size.
However, did you know that:
- The war on obesity is driven by political and financial interests?
- Weight loss from dieting is unsustainable for most people?
- Calorie deprivation leads to decreased satiety hormones and increased hunger hormones?
- Calorie restriction also leads to changes in thinking and attention that causes dieters to become preferentially focused on food?
- Dieting contributes to eating disorders, weight cycling, and weight gain more often than it succeeds?
- Many of the medical problems attributed to obesity are correlational at best, and might be better explained instead by weight stigma and the social pressures experienced by people in larger bodies?
I have been working in the field of eating disorders since my training at a bulimia research lab in 1991. When I first learned to treat binge-eating disorder, a course of cognitive behavioral therapy (CBT) for binge eating was expected to be followed by a course of behavioral weight loss. However, since that time we have learned that behavioral weight loss doesn’t work. And while CBT for binge-eating disorder can be successful, it rarely leads to significant weight loss, even among those considered to be in an “overweight” weight category. However, CBT does lead to cessation of binge eating and prevention of further weight gain.
I firmly believe that bodies are meant to come in a variety of shapes and sizes. We are not all meant to be Size 0 or 2 or 4.
Take shoe size: while the average woman today has an 8 shoe size, most do not—some will have size 5 and others will have size 10. Shoe size has a normal distribution within the population.
Just as with shoe size, so it is with body weight. Every body appears to have a set point, a weight at which it functions optimally. This set point is not destined to be at the 50th percentile for every person—some will be heavier and some will lighter. Repeated attempts at dieting seem to increase a body’s setpoint, which is the opposite of what most dieters are trying to achieve.
I no longer support attempts at deliberate weight loss because I have come to believe it is not only fruitless but in fact harmful. Every day in my practice I witness the destruction left by the war on obesity and failed diet attempts. I see the carnage of past dieting, weight regain, shame and self-loathing in the form of disordered eating and intractable eating disorders. Against this backdrop, I believe that above all else, my duty to your family member is to not harm them.
There is no magic solution. Failing to fit the thin mold can be a burden. I wish I could wave a magic wand and have your loved one’s body transform into one that would not be stigmatized, would be celebrated, and would fit into all spaces. But I can’t change your loved one’s genetic body destiny, just as I can’t change any person’s ethnic background or skin color to conform to the privileged group. And I believe the solution is not to change your loved one’s body to conform—the solution is to fight to end weight stigma and the oppression of larger bodies.
Here’s what I can do:
- I can help your loved one recover from an eating disorder, using evidence-based treatments backed by scientific research.
- I can help your loved one work on accepting and appreciating their body and all its capabilities.
- I can help your loved one unfetter themselves from self-imposed rules and restrictions and live a fuller life.
- I can help your loved unburden themselves from shame and self-loathing.
- I can help your loved one to advocate for themselves if he or she needs accommodations from a world that was not built to accommodate his or her body.
- I can help your loved one learn to stand up to weight stigma and bullying.
- I can help your loved one request and receive respectful health care.
- I can help your loved one improve their relationship with food so that eating and social situations are enjoyable.
- I can help your loved one achieve peace.
If you want these things for your loved one, please let me do what I was hired to do—guide your loved one to healthiest, best, and fullest life possible. Please examine the basis of your own hope that your loved one will conform to the thin standard. While I know this comes from a good place, it’s not pointing to the right destination. There are happier places to land. There is much work to be done. We all have weight stigma.
To learn more, I suggest reading the following articles: