When One Size Fits All, Truth Suffers

“You should be ashamed.” That message flies in every direction when the subject is weight and health and obesity. Shame is a potent tool, but it’s a sloppy one. And for health, it’s never helpful. Truth suffers when people start thinking they have an exclusive claim on the truth. And on weight, health, and obesity, one size will never fit all.

Angry About Weight Management

Writing in the New York Times, Jennifer Weiner is furious with Weight Watchers. She’s angry about a news release from the company:

The news release talks up “wellness” and “healthy habits for real life.” Stacie Sherer, senior vice president for corporate communications at Weight Watchers, told me in an interview that the company’s mission was to “make wellness accessible to all,” to talk not calories but mind-set, to help clients manage their weight over a lifetime and to give teenagers “a framework to make healthier decisions” about food and activity.

Weiner, author of Hungry Heart, goes on to explain why Weight Watchers infuriates her. “The pernicious, pervasive idea that thin equals happy” hooked her at an early age. She doesn’t want others to spend their 20s on a diet. Her concerns are totally legitimate.

One Size for Weight and Health Is Never Right for All

However, the trouble is that when it comes to a person’s weight and health and relationship with food, you can be sure that one size does not fit all. Some people have legitimate needs to think about healthy ways to manage their weight. Some find good results – not miracles – with Weight Watchers or other self-help programs. Others find better health through medical weight management or bariatric surgery.

Speaking of her own experience with surgery, Weiner said in 2016, “for me, it wasn’t a choice I made to get thin. That was not going to be a possibility.” For herself, the goal was to return to a happier, healthier state of being at a size 16.

But folks in the Health at Every Size® movement vilify surgery, saying it “intentionally damages healthy organs” and warning that it causes “death and malnutrition.” The truth suffers when you are convinced you know the one and only righteous path.

Angry About Shaming

People who live in larger bodies suffer constant insults and shaming. Meanness lives in a dark corner of the human soul and weight bias gives many people permission to express that meanness. Weight bias compounds the harm of obesity and stands in the way of more constructive solutions.

But demeaning people who think differently from you about weight and health is hardly better. “Shame on you,” said a HAES® promoter to us recently. We weren’t toeing his line. Dispensing shame easily becomes a bad habit. Beware the power of the dark side.

Truth, painting by Mikalojus Konstantinas Ciurlionis / WikiArt

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March 5, 2018

4 Responses to “When One Size Fits All, Truth Suffers”

  1. March 05, 2018 at 8:35 am, John DiTraglia said:

    Low-fat vs low-carbs for weight loss – it doesn’t matter

    A study (1) from Stanford reported this week in The Journal of the American Medical Association is going to dismay many loud speaking people on the low-carb band wagon. Also this study contradicts an ad I saw on TV today for “23 and me.” That ad says that weight loss schemes designed to match your genes work better.
    In this project called DIETFITS, about 600 overweight and obese people were given either a “healthy” low-fat diet or low-carb diet and watched for a year. They were not instructed try to eat fewer overall calories but they all did eat about 550 fewer calories per day. This observation means that when you can’t eat every kind of food you might want, you wind up eating less. So both groups lost between 5-6% of their baseline weight on average. This is the secret of all diets – eating special means it is going to be less appetizing. That is also the reason all diets fail – when you lose weight you get hungry, especially for the stuff you not supposed to eat.
    They also looked at some genetic patterns and insulin responses that seemed to make a difference to the response to different diets in prior studies. But they could not find any diet-gene type interactions. Weght and weight loss patterns must be somehow genetic, though, because in both groups some people lost as much as 66 pounds and some gained as much as 22 pounds. We just don’t know which genes yet. It’s complicated.
    The only statistically significant differences between the groups were that in the low-fat diet group the low-density lipoprotein (LDL-bad) cholesterol was lower and in the low-carb group the high-density lipoprotein (HDL-good) cholesterol and triglycerides were higher. So maybe that’s a small vote in favor of the low-fat group since LDL probably beats HDL and triglycerides as heart risk factors.
    They also instructed the low-carb group to eat less added sugar and refined flour and the low fat group to not eat trans fats and everybody was instructed to eat more vegetables less processed foods and eat at home as much as possible. That was the “healthy” part. So I guess we’ve already agreed to that much of the diet gospel.
    I can hardly wait to see the outcry of letters to the editor on this one.

    1. Gardner CD et l. Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion JAMA. 2018;319(7):667-79.

    John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- or phone-354-6605.

  2. March 05, 2018 at 9:26 am, Allen Browne said:

    “Mindset” and “healthy decisions” are concepts that lead down a slippery slope. They assume a control that most people with obesity do not have. They ignore the physiology of the energy regulatory system (ERS). The ERS drives most behavior. The ERS controls intake of energy and use of energy in ways that are out of conscious control – GI tract absorption, brown fat energy consumption, etc. For those who are helped by programs such as Weight Watchers, great. But the fact that most will need more and supporting that without blame or bias is an ongoing challenge.

  3. March 05, 2018 at 11:22 am, Susan Dimick said:

    Another wonderful and thoughtful contribution. Thank you.

  4. March 14, 2018 at 2:51 pm, M. said:

    As a supporter of HAES… I am cautiously positive about Weight Watchers. Of all the weight loss companies, I find them least objectionable.

    My first encounters with WW were back in the 1970s when they publicly weighed you, announced your weight, and how much it had changed. Rounds of applause for those who lost even a single pound; words of shame for those who didn’t lose or, worse, gained.

    Eventually WW wised up and realized public ridicule doesn’t work. They are getting better as time goes on, but they still make money by counting on the low rate of long-term success and the rate of people willing to try again.

    Re: WLS: You cannot argue that weight loss surgery cuts into otherwise healthy organs, or that it -can- cause death (unlikely) or malnutrition (far more likely). Dr Arya Sharma has said that at extremely high BMIs, the rate of complications from WLS is 100%. Of course, that could be minor or deadly.

    When it comes to the dangers of WLS I always recommend reading this release form by a weight loss surgeon (a link to his website is at the bottom):

    I’m sure its information is nothing new to you, but it’s an eye-opener to those who think WLS is a quick fix to automatic health and happiness, something that TV shows promote as the truth.

    Informed decisions require having all the information, not just the positive stuff.