Here’s some news that I know will come as a terrible shock to longtime readers: no one knows how to make fat people permanently thin. Or even less fat.
Dieting doesn’t work in the long term and often makes you fatter. WLS can kill you, in addition to other unpleasant side effects, and as with diets, there’s a good chance you’ll eventually gain it all back. “Lifestyle changes” are diets, even if you don’t like that word. Nobody sets out to lose weight temporarily, then end up fatter than ever within a few years. But that’s what happens to nearly everyone who makes a “lifestyle change” (without developing an eating disorder), because our bodies just aren’t interested in cooperating with our desire to be thin.
Despite all the billions of dollars that have been put into trying to figure this one out, still, no one knows how to make fat people permanently thin.
Wait, haven’t we covered this before? Why, yes. Yes, we have.
But in the latest fatosphere kerfuffle, I’ve seen lots of comments that essentially say one of two things:
- Not everyone who wants to lose weight wants to be thin! Not everyone’s doing it for vanity! People who have noble reasons for wanting to lose weight, or who only want to get less fat instead of thin shouldn’t be discouraged!
- Fat acceptance activists never want to acknowledge that some people are so fat it really does compromise their health! Some people need to lose weight, and dieting/WLS is right for them!
No. It just doesn’t work that way.
We don’t know how to bring about permanent weight loss safely for people who’d like to drop “the last 10 lbs.” or for people who are so fat their quality of life actually is compromised by fat itself. That was the whole point of Mariellen’s post. (Well, maybe not the whole point, but a big one.) She’s dieted and dieted and dieted. She’s had WLS, and it failed. She is still fat, and the fat is one cause of her mobility issues. In her case — as opposed to that of an average fat person, for whom being fully mobile and active is entirely possible — losing weight might theoretically alleviate some of her physical problems. But unfortunately, there is still no proven, safe way to make her — or anyone else — permanently thinner.
It is not merely a political belief that fat people, no matter how fat or how encumbered by it, will most likely not benefit in the long term from trying to lose weight. It’s reality. When it comes to extremely fat people who are suffering physically, it’s a terribly sad reality. But it’s still what’s shown by every single study (not that there are many) that follows up with dieters 5 years later, and by reams of anecdotal evidence: restricting calories and increasing exercise will not make you permanently thin. As for WLS, it seems to make some people thinner longer than dieting will, but at what price? It kills people outright, and makes others’ quality of life so horrible they commit suicide. It causes devastating permanent side effects in many people, and many others gain the weight back anyway. It absolutely does not qualify as a safe or proven method for making fat people permanently thin.
As it stands now, there is simply no such thing.
So it doesn’t matter what anyone’s reasons are for wanting to lose weight. It doesn’t matter if there’s a strong argument to be made that losing weight really would decrease someone’s suffering. It doesn’t matter if someone only wants to get down to 300 lbs. from 400, or only wants to lose enough weight to take the pressure off her knees, or only wants to lose weight because he’s been told it will lower his cholesterol/blood pressure/blood sugar. No one knows how to make it happen permanently, without the risk of grievous harm.
That’s why I am anti-WLS and anti-dieting. Because the reality is, those are not useful solutions, and in many cases, they’re harmful — even deadly — solutions.
I don’t judge individuals who resort to those options, because A) we all have a right to determine what happens with our own bodies, and B) there are no real fucking solutions for extremely fat people who are suffering.
But there’s a big difference between saying, “Yeah, I understand why you’re doing this, all things considered, and I’ve got my fingers crossed for you,” and “It’s not right for me, but it might be right for YOU!” My refusal to judge people who diet or undergo WLS is not about relativism. It is, once again, about reality: when there are no good options, you take whatever seems to be the best of a poor lot. I can understand and respect that. I can support people who make the decision to try something known to fail, even known to kill, when they have no real fucking options to improve their quality of life.
But from a political standpoint, what we need to be working toward are more and better options for suffering fat people, not quieting those who say dieting and WLS are shitty fucking options no matter how good your reasons for wanting to lose weight. Those people — and I am absolutely one of them, if you hadn’t noticed — are just acknowledging what all the evidence tells us, not trying to burst anyone’s bubble or condemn people to lifelong pain because we want to keep everyone as fat as possible. If I could wave a magic wand and take 100 lbs. off Mariellen’s arthritic joints forever, I’d do it in a heartbeat. But I can’t. And no doctor or diet can, either.
What that means is, we need to stop thinking in terms of who “needs” to lose weight and start thinking in terms of helping fat people. As I just said over at Mariellen’s place, saying “Some people need to lose weight!” is like saying, “Paralyzed people need to walk!” Yeah, if you’re paralyzed, walking would probably improve your quality of life. And if your fat causes you chronic pain and mobility issues, losing weight would probably improve your quality of life. But in both cases, wishing for a particular outcome doesn’t make it so. And yet, in only one of those cases does the medical community acknowledge that a patient deserves to be treated as-is when the ideal theoretical outcome is clearly out of reach.
If the gazillions of dollars being poured into weight loss research ever turn up something that will really help suffering fat people lose weight permanently, without the risk of death or disability — and, importantly, if it turns out that losing weight really does help those people physically — I will get right behind that. I will plug that shit every chance I get. I will still advocate as strongly and loudly as possible for fat acceptance and Health at Every Size, because for most of us, being fat is not, in itself, a health problem. But if they ever come up with a way to make people like Heidi and Mariellen feel better via weight loss? You can bet your sweet, fat ass I will amend my position to “Yes, sometimes, for some people, weight loss IS the answer.”
Problem is, gazillions of dollars and decades of research haven’t turned up a safe, reliable method for permanent weight loss. With the methods we have right now, trying to lose weight is usually counterproductive at best and lethal at worst, with a whole continuum of yucky outcomes in between — and only a tiny handful of positive outcomes, ever. That is just not fucking good enough. If a given drug only worked for less than 10% of people who took it, and in the other 90+% it A) ultimately did the opposite of what it was supposed to do, B) caused long-term damage to people’s organs, and C) oh yeah, killed people, would that drug still be on the market? Fuck no. So why, given the astonishing failure rates and side effects of the only known weight loss methods today, do doctors keep prescribing weight loss as a goddamned cure-all for fat people?
THAT is a problem for fat acceptance activists to address. And that is why many of us say that pro-dieting and pro-WLS talk has no place in fat acceptance circles. It’s not because we think being thin is a crime, or that the desire to be thinner, for any number of reasons, is at all difficult to understand. It’s because the methods we currently have for losing weight DON’T FUCKING WORK, and yet both society in general and the medical community insist that we must keep trying those things again, again, again, again — and they will acknowledge neither our human dignity nor our legitimate health problems until somehow, someday, we make this thing that works for practically NO ONE work for us.
Since finding the fat acceptance movement and learning about Health at Every Size, Mariellen’s started doing some seated exercises and some yoga. She is trying to build strength and flexibility, trying to do something to feel better in her body the way it is, because after being failed time and again by dieting, WLS, and doctors, she knows that right now, permanent weight loss is simply not a fucking option. All she can do is work with the body she’s got.
Wouldn’t it be nice if her doctors felt the same way — if, you know, they’d made some suggestions about how to exercise with a fat body and limited mobility, instead of just telling her to have WLS again, after it failed spectacularly for her AND she lost her best friend to it? Wouldn’t it be nice if all our doctors recognized our bodies as our bodies, instead of refusing to treat us properly until we go out and get entirely different bodies? Wouldn’t it be nice if they looked for any other cause of various health problems besides fat, whenever they see fat people? And if they’re not going to recognize causes other than fat, and not going to stop insisting that weight loss is the ideal, wouldn’t it be nice if they acknowledged that none of the currently available methods for weight loss WORK in the long run, and until we have one that does, maybe we need to, you know, think outside the fucking box?
I think that would be awfully nice, myself. And I think that should be a major goal of the fat acceptance movement. And I also think we should absolutely embrace those who are stuck between a rock and a hard place trying to get decent medical care as fat people.
But that doesn’t mean dieting and WLS are “right for some people,” or that there’s a better chance of them working for people in desperate circumstances than there is for those who just want to lose weight for superficial reasons. What it means is, things suck for fat people trying to get decent health care right now, and especially for very fat people who are in pain. What it means is, a lot of people end up with their fat backs against the wall, and it would be an egregious failure of both compassion and reason to treat them as if they’re simply making a free choice between a good option and a bad one.
But dieting and WLS are still not good solutions for “some people.” They are lousy fucking solutions for everyone. They don’t work, and they hurt people. Period. This is not a “what’s right for my body may not be right for yours” thing. So few people experience the desired long-term outcome from dieting or WLS that recommending them to anyone, let alone acting as if there’s a single good reason to believe they should work for everyone, ought to be considered the height of irresponsibility among medical professionals.
And among fat acceptance activists, there should be no dissent on this point. There will be, and there always has been, but there shouldn’t be. Because if you believe that in the big picture, dieting and WLS do not bring about the long-term results they’re supposed to, and are far more likely to do harm than good — as you damn well should believe, if you’re a reasonable person who’s looked at the evidence — then there is no one for whom those things are a good option. There are people for whom they’re understandable options, people for whom they seem like the only viable options. But dieting and WLS don’t magically become good options just because someone has a really outstanding reason for wanting to lose weight. The failure rate doesn’t magically drop just because someone’s extremely fat. The terrible side effects don’t disappear because someone’s in pain. The risk of death isn’t diminished because someone can’t walk across a room.
Dieting and WLS are plain lousy options for everyone, and we should be outraged that they are still the first and often only solutions fat people are offered when they seek medical attention. Embracing people who have gone those routes for one reason or another does not have to mean affirming those options as “good” or “right,” ever. They’re just not. Even if they work, they’re still not “good” or “right” in the big picture. Given the near 100% likelihood of failure and the possibility of long-term damage and death associated with them, we cannot lose sight of this simple truth: these are terrible fucking options, and we deserve better.