The Truth About That New "Fat But Fit" Study

I got an email this morning from a reporter at The Daily Meal, asking me to give my thoughts on a new study. News outlets are claiming this new research is evidence that "fat but fit is a myth" and "there's no such thing as metabolically healthy obesity." 

I won't link to the study or those articles here because they reinforce weight stigma, which is bad for your health (more on that below). But the study is called "Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women," and it just came out this week in the Journal of the American College of Cardiology (after being widely covered in the media before publication).

The Daily Meal reporter, Holly Van Hare, did a lovely job with the story, so be sure to check it out (trigger warning for this and all the study links below). But of course I have a lot more to say about this issue than could fit there, so here are my unabridged thoughts: 

First of all, the study didn’t control for two likely risk factors for heart disease, independent of body size: weight stigma and weight cycling.

People in larger bodies are more likely to be stigmatized for their size—bullied and shamed in school, at home, walking down the street, and in the doctor’s office, and paid lower salaries than their thin peers in the working world—and when people internalize weight stigma, it has profoundly negative effects on their mental health.

Experiencing this stigma also raises people’s risk of chronic diseases including heart disease—regardless of actual body size. What's more, weight stigma results in people delaying or avoiding going to the doctor, which can lead to poorer health outcomes down the line. 

People in larger bodies are also more likely to have weight cycled or “yo-yo dieted” in the past, and weight cycling has also been associated with a greater risk of heart disease.

Weight cycling tends to drive people’s weight up over time; up to 2/3 of people who embark on intentional weight loss actually end up heavier than when they started. (For more on these underreported aspects of weight science, see Linda Bacon and Lucy Aphramor’s great paper “Weight Science: Evaluating the Evidence for a Paradigm Shift.”) 

Until weight science can control for weight cycling and weight stigma, we can't say that being at the higher end of the BMI spectrum causes any health conditions—even if higher weights are associated with these health conditions. Correlation does not equal causation, y'all.

Moreover, *even if* weight did have some causal effect on people’s health (which is possible, but again we can’t actually know until we control for weight stigma and weight cycling), we DON’T HAVE a known way for more than a tiny fraction of people to lose weight and keep it off permanently.

The success rate of intentional weight-loss efforts is 5% or less, by most researchers’ accounts. So for 95% or more of people, ALL diets are yo-yo diets.

And we know yo-yo diets negatively affect people’s health outcomes from the research I mentioned above!

So EVEN IF weight itself were partially to blame for the heart disease outcomes, medicine doesn’t actually have a known way for people to lose weight and keep it off. Prescribing weight loss just is NOT ethical healthcare. 

There has to be a better way. 

That’s where Health at Every Size® (HAES) comes in. HAES is about engaging in health-promoting behaviors without pursuing weight loss, as well as working to change society to reduce weight stigma and other forms of social injustice that harm people's health. HAES approaches have been shown to have better health outcomes than the traditional weight paradigm. 

That's what I mean by ethical healthcare.

BTW, the new study also doesn’t say what the larger-bodied participants were doing or not doing to support their health during the follow-up period. The researchers only controlled for the potential confounding variables of "age, sex, self-reported smoking status, and social deprivation" (a measure of socioeconomic status, education, and employment).

The researchers didn’t determine whether the study participants were restricting their food intake and experiencing rebound bingeing during the study period, versus eating intuitively.

They didn’t determine whether participants were engaging in (and enjoying) physical activity, versus having lack of access to accommodating and welcoming spaces for movement. 

The researchers also didn’t control for whether the participants had access to compassionate healthcare providers who supported their *actual health* instead of focusing on their weight and reinforcing weight stigma.

And all three of those things can affect people’s health outcomes, again *independently of body size.*

A few other thoughts: study subjects who were in the underweight category with zero metabolic abnormalities also had greater heart-related risks (e.g. elevated risk of heart failure) than the people in the "normal-weight" BMI category. Why don’t those results get reported by the media? Why aren’t newspapers and websites trumpeting “the risks of underweight for cerebrovascular disease"? Weight bias much?!? 

The vast majority of media don’t report the nuances of these scientific studies because most reporters don’t actually know how to parse them—and I was one of them before I got a master’s in public health, so I know how it goes. Many reporters just use the press release or the abstract to report scientific studies, and others might give a cursory glance at the actual study but are just looking for confirmation of what they already believe it says.

I don’t know the exact stats, but I’m willing to bet a very small percentage of reporters who covered this story even SAW the study’s finding that people in the “underweight" category have a higher risk of heart failure than people in the “overweight” category, or that the study didn’t control for nutritional intake, physical activity level, weight stigma, or weight cycling. (I know Van Hare was one of this small percentage who did see the full study, which is awesome.) 

Mainstream health media needs to do better. But that's a story for another time. 

The Washington Post on Why Emotional Eating Isn't the Real Problem

Many people self-identify as emotional eaters, when really the root of the problem isn't emotional at all. 

The problem is dieting, and the feelings of deprivation that it creates.

Dieters are more likely to report turning to food for comfort, whereas non-dieters are more likely to turn away from food in times of stress.

And when people are deprived of food—whether physically, psychologically, or both—they're more likely to blame emotions for their eating.    

To learn why, check out this great Washington Post article about why we're putting too much blame on emotional eating. I'm thrilled to be quoted as the expert in the piece, and I hope it'll help you feel more compassionate toward yourself for eating in ways you've deemed emotional. 

If you're ready to take a deeper dive into the non-diet approach and learn to truly trust yourself with food, check out my Intuitive Eating Fundamentals online course

The Truth about Intentional Weight Loss

By now you're probably familiar enough with my work to know that I practice a philosophy called Health at Every Size (or HAES), which helps people focus on health-promoting behaviors rather than weight loss. 

The reason HAES takes weight loss out of the health equation is because intentional weight loss is not only unsustainable 95+ percent of the time (and most people actually gain back more weight than they lost), but pursuing weight loss also causes more harm than good to your physical and mental health. 

You've likely experienced this harm firsthand if you've ever done something to try to lose weight (a diet, an eating plan, a "lifestyle change"), because most people who pursue weight loss end up having negative reactions.  

Maybe for you it was following the diet or plan during the day (or during the week), and then eating large quantities of food and feeling out of control at night (or on weekends). 

Or maybe it was obsessively planning meals, tracking and logging everything you ate, and just thinking about food nonstop.

Maybe it was exercising in a compulsive, self-punishing way.   

Or maybe it spiraled into cutting more and more foods out of your diet and being afraid of the foods you used to love.

These are all incredibly common, completely normal reactions to the deprivation that people feel when pursuing weight loss.

And they're also not helping your health.

There is a better way to support both your physical and mental health, and that's where Health at Every Size comes in.

My guest on this week's episode of Food Psych is an expert on HAES, and she's also one of the smartest, most well-spoken people I know.  

Writer, speaker, and health coach Ragen Chastain explains why healthcare providers need to stop prescribing intentional weight loss, how weight stigma (not body size) is likely responsible for the health issues typically associated with higher weights, why weight loss doesn't actually improve physical performance, the true meaning of the word "health," and lots more. 

Tune in to this incredible episode to hear Ragen's wisdom, and join us in the Food Psych listener Facebook group to share your thoughts! 


P.S. If you haven't seen my pal Isabel Foxen Duke's free video training series, Stop Fighting Food, be sure to check it out! I signed on to be an affiliate for Isabel's private coaching program this year because I love her work so much, so if you end up joining that you'll be supporting my work, too. But either way, check out the videos to get some great tips for making peace with food! 


This post was originally published in my weekly email newsletter

The Problem with Trying to Control Your Body

Chronic dieting is about control.

Control over our bodies and our eating, sure—but really, at a deeper level, control over how people treat us, how many resources we get, and our access to happiness and success.

Because in this fatphobic society, it can really seem like the only way to have those things is to have the "right" body—which only seems to be attainable through dieting and punishing exercise.

It's SO understandable that we'd think those things, given everything we've been told by our culture.

The problem is that they're not true.

Because paradoxically, grasping after control over food and our body size actually makes us feel completely out of control.

That's the subject of this week's episode of Food Psych, with my amazing friend, fellow anti-diet coach, and 3-time podcast guest Isabel Foxen Duke.

Isabel shares why it's part of the human condition to want control, how emotional eating is connected to diet culture, why bingeing is a natural response to deprivation, how to use social media in diet recovery, why she believes it's the duty of every health professional to understand privilege and dismantle oppression, strategies you can use to stop fighting food and your body, and lots more.

Tune in right here to listen to this incredible conversation. It's one of my all-time favorites on the podcast, and I know you'll love it, too!

Speaking of things I know you'll love, Isabel has a free video training series called Stop Fighting Food that gives you a deeper dive into some of the ideas we discussed on the podcast, and it's freakin' awesome.

I'm such a longtime fan of Isabel's work that this year I signed on as an affiliate for her group coaching program, so if you sign up for it then you'll be supporting my work, too. But either way, definitely check out the free training series and of course the podcast, because Isabel is just SO. DAMN. SMART.  

This post was originally published in my weekly email newsletter

How to Resist the Pull of Diet Culture During Tough Times

Normally I write to you on Mondays to let you know about the latest episode of Food Psych. But today I want to start with something more urgent.

Today I want to make space for the fact that many of us are reeling from the act of terrorism in Charlottesville over the weekend. Many of you may be in pain, and I feel it too. 

I want to make space for the fact that Black lives matter.

I want to make space for the fact that white supremacy needs to be unequivocally condemned.

I want to make space for the fact that when folks are struggling with disordered eating, it can be SO tempting to turn to dieting or eating-disorder behaviors in the wake of traumatic incidents like this.

So you may be feeling the pull back to those behaviors, even if you’d felt like things were going pretty well on your journey to peace with food. If this is you, have compassion for yourself, because those behaviors have been a coping mechanism in the past. 

And I want to urge you NOT to act on those thoughts now, as true as they may seem. 

Because you deserve to be present, feel your feelings, and speak out, even when things are painful.

You deserve to live a life free from the confines of diet culture, even when that life is difficult, as all of our lives inevitably are sometimes.

I'm sending love and compassion to all who are hurting right now, and I want to make space for it because it’s important. 

If you’re feeling sad, you’re not alone. And you don’t need to change your body to fix it. 

I believe in justice for ALL bodies, because we won't achieve true body acceptance in our society until we put an end to bigotry. 


This Week on Food Psych

Psychologist and author Deb Burgard, one of the founders of the Health at Every Size movement, discusses weight stigma in the healthcare system, pursuing joyful movement, size oppression and the exclusion of larger bodies from eating disorder treatment, how she got involved in fat activism and feminism, how to find joy and healing, and lots more.

I also answer a listener question about how to keep yourself from bingeing in a stressful work situation.

Listen to the episode here, and check out one of Deb's pearls of wisdom below!

This post was originally published in my email newsletter.