How to Handle Weightloss Recommendations

(from doctors, loved ones, etc.)

You’ve just received a weightloss recommendation. Whether you are already on the journey of letting go of dieting and making peace with your body (at any size) or this is something that you have considered (or not considered) but are scared to do, it can be disheartening to hear from your doctor that you need to lose weight. So often weight loss is advised as the go-to solution because our culture, particularly the medical community, holds the misconception that thinness=health. Everything from joint pain to depression and anxiety to general statements like “to be healthier” trigger the ‘weight management’ conversation. This often means that root causes go undiagnosed, especially among people living with marginalized identities. This reality has devastating consequences, sometimes resulting in death. To fully grasp why the traditional weight-normative approach to healthcare is poor medical practice, it helps to debunk common myths associated with higher weight bodies.  

The bottom line is, health is more nuanced than the number on the scale. You can still pursue healthy behaviors regardless of your current weight or body shape. Also known as weight-inclusive, or a Health At Every Size (HAES) approach, possible outcomes include improved blood pressure, cholesterol, and cortisol levels, as well as improved dietary quality, reduced body dissatisfaction, and sustained physical activity. 

Since navigating our fatphobic medical system can be tricky, here are some ways you can ensure your healthcare is ethical, evidence-based, and aligned with your goals.

Prepare for Weightloss Recommendations

Considering medicine is big business, remember you are the CEO of your body. If you can, find a health care provider (HCP)  who is HAES-aligned. This, however, does require privilege. If your options are limited due to insurance, there are still steps you can take to get the care you’d like to receive. Take the stance that your healthcare will be a dialogue between you and your healthcare provider (HCP) as opposed to you being subservient and succumbing to the typical power imbalance. Don’t be too afraid to ask questions, challenge advice, or request to be treated based on your values. Let them know ahead of time that you practice HAES and ask if that’s something they can respect and work with. Request not to be weighed, or weighed blindly, unless necessary for rare medical indications such as weight-based medication dosing. While it’s easy to get defensive about this sensitive subject, take care with the tone you use. The unfortunate truth is that being labeled noncompliant, problematic, or difficult could risk compromising the quality of care you’ll receive.

Advocate Against Weightloss Recommendations

A HCP’s number one priority should be to do no harm. They may need to be reminded that shame is not health-promoting and that you’re there to focus on symptoms concerning you in the here and now. The most powerful question you can ask when experiencing weight stigma is, ‘Do people with smaller bodies than mine experience X condition?’. When they reply, ‘Yes’, because ALL bodies experience adverse symptoms and conditions, you can ask, ‘What would you suggest for them? Can we try that?’. 

Educate About the Dangers of Weightloss

Whether you use this information for your personal affirmation or choose to educate others, here are some statistics that defend weight-inclusive healthcare:

On weight and health: 

• The lowest mortality rates occur among people with a BMI in the ‘overweight’ category, while those with BMI’s in the ‘normal’ and ‘obese’  categories have equal mortality risks
• Relying on BMI as an indicator of metabolic health results in 24% misdiagnosis of ‘normal’ weight people, 51% of ‘overweight’ people, and 32% of ‘obese’ people
• Correlation between higher weight and certain health conditions does not guarantee causation
  • Causal factors include genetic predisposition, medical conditions, weight cycling, weight stigma, and cardiovascular fitness

On dieting: 

• Within 1-5 years, 95-98% of weight lost is regained
  • 2/3rds of people will regain more weight than they lost
• Diets are the number one contributor to the development of eating disorders 

On weight cycling: 

• Weight cycling (or yo-yo dieting) has been proven to increase mortality risk, and to raise the risk of hypertension, diabetes, hyperlipidemia, heart disease, gallbladder disease, and osteoporosis

On weight stigma: 

• Weight stigma, or internalized negative opinions about body size, elevates the risk of hypertension, diabetes, hyperlipidemia, metabolic syndrome, eating disorders, and depression

Considerations

There may be moments when you don’t have the emotional bandwidth to educate and advocate. Some days you’ll feel prepared for the challenge and other days you’ll feel too vulnerable. That’s okay. If you need to protect your energy by taking a more passive approach, honor that.

Weight-inclusive, affirming healthcare should be the norm. Given that it’s not, the onus should be on HCP’s to change. Undersized waiting room chairs, waiting rooms full of fatphobic magazines and pamphlets, and ‘one-size-fits-all’ equipment will one day be a thing of the past. Until then, use what you can from this guide to best get your needs met. If you’d like further support in navigating our thin-obsessed society, I’ll invite you to book a free discovery call for 1:1 nutrition counseling. I’ll help you find freedom with food, peace with your body, and joy in your life.