Hey, you all should check out the interview with the awesome Health at Every Size advocate Linda Bacon over at Med Journal Watch. (And let’s all take a moment to appreciate the blog’s author, Christian Bachmann, for being willing to examine his own biases and change his mind about obesity.)
I particularly liked this bit of the interview:
CB: If people are fat and sick and if they lose weight and get cured, this could be a proof that fatness causes disease. Has there been any such outcome in a study?
LB: That seems like an impossible study to conduct. You would have to control to make sure that nothing changed other than their weight. They would have to be doing something differently to lose weight. For example, suppose they exercised more – you couldn’t attribute the health improvement to the weight loss as it might have come from the activity changes.
Bacon goes on to say that although gastric by-pass surgery has been shown to cause an immediate reversal of diabetes, the fact that it’s immediate suggests weight loss is not the cause of that reversal; furthermore, a study that examined the effects of liposuction on diabetic women showed that, shockingly enough, sucking out the fat did not improve their metabolic profiles.
I think these are such important points, and I need to remember to make them more often. I actually wasn’t aware that there was a liposuction study, but I know I’ve wondered many times why doctors don’t advocate liposuction for health reasons — it’s a hell of a lot less invasive than gastric by-pass surgery — if they really believe fat is the problem. If being “overweight” is the big health risk, and liposuction is a reasonably efficient way of removing fat, why isn’t it being touted as a cure-all? Why don’t insurance companies cover it for anyone with a BMI over 25? Wouldn’t it save money in the long run, by removing the scourge of fat, which we all know is going to leave our health care system in tatters? (Insert big huge eyeroll.) Wouldn’t it be cost-effective, according to the Fat Is the Enemy belief system, even if it had to be repeated frequently — since regain is a problem with lipo, just like with dieting and bariatric surgery? How come I’ve had doctors hand me Weight Watchers pamphlets, but they’ve never once recommended liposuction?
Well, there are two reasons I can think of off the top of my head. One is that, as that study showed and anyone who’s read a bit about Health at Every Size could easily guess, lipo won’t cure jack. Because most of the health problems traditionally associated with fat can be prevented and/or improved by increasing exercise and getting more fruits and veggies and fiber and whatnot, regardless of whether weight loss occurs. It ain’t the fat causing the health problems, it’s the sedentary lifestyle and lousy diet that sometimes but not always go hand in hand with fat.
The other reason, of course, is that if you believe fat is a moral issue, then liposuction seems like a cop-out. Where’s the punishment? Where’s the atonement? Where’s the humiliation?
Sadly, I’m not at all sure that the first reason is the primary influence on doctors’ deciding not to recommend lipo to their fat patients.
Now read that first line of Bacon’s again. That seems like an impossible study to conduct. Ding ding ding! Weight loss is sometimes a side effect of other intervening factors — diet changes, exercise changes, surgery, illness, going on or off a particular medication — but it is not an intervention in itself. You can’t just decide to lose weight and magically do it, without making some other specific changes in your lifestyle.
Which means there is no real way to measure whether weight loss itself has health benefits. You can prove that eating a balanced diet and exercising have health benefits, or even that bariatric surgery does (though I don’t believe for a second those benefits come close to outweighing the risks), but any weight loss in those cases might very well be incidental — and the one thing we do know is that, even with the surgery, any weight loss is likely to be temporary. The fat will probably come back, but must the health risks?
No, not necessarily. As I’ve said a kabillion times, the Health at Every Size approach has shown terrific results in terms of improving health, but not in terms of keeping weight off of people who are predisposed to be fat. In light of that, and the fact that liposuction doesn‘t improve health, WHY THE FUCK ARE WE STILL BLAMING THE FAT?