I am questioning right now if this post belongs on the Fatosphere feed or not, because I’m exploring some thoughts that may be inconsistent with fat acceptance and size acceptance philosophies.
Is there ever such a thing as a healthy intentional weight loss?
Many outside of the Fatosphere and size acceptance circles believe so. Within the Fatosphere and fat acceptance philosophy, the belief is that no matter how well-intentioned, no matter how small the weight loss goal, no matter how sane and safe the methods used are, weight intentionally lost will be regained, and in the process, health in the broadest sense will be impacted in a negative way.
I am not sure I’m entirely on board with that philosophy.
I’m not advocating for widespread intentional weight loss. I am arguing for body autonomy, and the right for people to experiment with mixing up their health-related behaviors to achieve their own goals. I don’t think fat acceptance is opposed to body autonomy, but being anti-dieting does mean removing dieting from the tool kit an individual has at their disposal to work with to achieve their health-related goals. I’m not pro dieting, and I’m not aligned with the forces out there making money off of dieting. But I wonder about safe, sane changes to eating habits that might get lumped in with dieting.
I’m making many assumptions here. But let’s start with this made up case study. Let’s take for example someone with a family history of type 2 diabetes. Let’s say that over time, their weight has increased, due to many factors, but including some that have to do with being sedentary, and patterns of eating that are entirely normal in their cultural context. Let’s say that this person has had their fasting blood sugar tested annually. And let’s say that a recent fasting blood sugar test revealed an increase in the fasting blood sugar. And then when the test is repeated a few months later, it’s still higher than what’s considered normal. What’s the best course of action, within what this individual is interested in and willing to do? Let’s say this person decides to begin exercising, and to change up some eating habits, and also has the intention of losing some weight — not tied to some ideal weight, but would use that as one of a few outcomes to track the impact of her changes. So, over time, the change to eating patterns and to going from being sedentary to more physically active does lead to a return to the normal range of her fasting blood sugar. And, it has also led to losing perhaps 15 pounds. The new eating patterns and physical activity are feeling like a new norm, and not a constant struggle (but an occasional one), and there is minimal regaining of weight, and for a while at least, fasting blood sugar stays in the normal range. Let’s fast forward a few years, and perhaps all of the weight is regained, but the increased physical activity is maintained, but her fasting blood sugar again is up, and this time high enough to warrant a diagnosis of diabetes. Appropriate diabetes treatment is initiated, and there are again adjustments to physical activity and eating habits, as well as some medications added.
What role would I say the initial, intentional weight loss effort at the time of diagnosis of prediabetes played in the big picture for this individual?
I would say I don’t think it was harmful, given that it was driven by the individual, that the focus was on what she wanted to have happen, and with the hope that she did not tie her self-worth to the weight loss, or view herself as a failure for weight regain. That may or may not be what happens in the real world, but if that were so, I am left thinking that the intentional weight loss attempt wasn’t the wrong thing. It wasn’t the only possible response, but it was an okay one. Again, this is entirely made up — not a real person, so there are no real outcomes to report.
One of the problems I had with Linda Bacon’s book Health at Every Size: The Surprising Truth About Your Weight is that to me, it advocated the same behaviors that are encouraged with weight loss, but without tying these behaviors to weight loss. I don’t have a problem with it now, but at the time, I thought, why would I ever eat less unless I thought I would lose weight? These days, I can see that for me, there are benefits to eating less overall, and eating less of specific foods, whether or not weight loss happens, but at the time I read that book, it seemed hypocritical to me — like it was advocating dieting but not weight loss. Of course, right there in the book Dr. Bacon points out that it’s likely to feel that way when you first read it, especially if you still associate changing eating habits with dieting rather than action you may take as a form of self-care.
I am in favor of self-experimentation with physical activity and switching up what one eats. I can see that in some cases, this may lead to a decline in weight, at least in the short term.
There’s something that comes to mind that Dr. Jon Robison writes in his article “10 Things You Can Do Right Now to Ease Concerns About Your Weight and Improve Your Health” that appeared in a special report from the Wellness Councils of America (WELCOA). (You can download the whole article here.) He writes:
Because the concepts that thin equals healthy and weight
loss equals better health are so deeply ingrained into
the fabric of our culture, after examining this different
approach people will often still ask this final question:
If I do all of this will I lose weight? The answer to this
question goes straight to the heart of the difference between
the Health-Centered and Weight-Centered Approaches.
The answer is that, if people follow the suggestions outlined
here, there are three and only three possibilities:
1. They will lose weight
2. They will gain weight
3. Their weight will not change
What is wonderful about this answer, unlike almost any other
answer related to this topic, is that it is undeniably scientific
and unarguably true. If people are above their natural
weight, they may lose some weight. If people are below their
natural weight, they may gain. If people are close to their
natural weight, they may stay the same. Which one of these
outcomes will occur is often not predictable. What is
predictable is that people will end up healthier and much
less concerned about their weight and their health.
I think my point is that if people do lose weight as a result of changes to physical activity patterns and eating patterns — whether or not that weight loss is maintained — is that bad? I think not. I do try to disconnect the concepts of health and weight loss and the behaviors that could lead to improved health with or without weight loss. I do think that on an individual level, if a person decides to make changes to their eating patterns and physical activity patterns, they will do well to keep Dr. Robison’s three potential outcomes in mind, and try to be as detached as possible from any particular outcome.
For me, doing a variety of things to better control my type 2 diabetes has resulted in a weight gain that has stabilized. I’m getting about 3 hours of moderate physical activity per week right now, and I’m not cutting back on my food intake, although I’m experimenting with what and when I eat — and, yeah, I wish my weight was down back where it was when I began the medication changes I needed to make six months ago. But I’m also in pretty good health — although there are some things I wish were different that do appear to be related to weight gain. I’m considering trying some other routes to diabetes control that might make it easier to eat less overall, by my experiencing less hunger, but I’m certainly taking the best possible care of myself at my current size, and fighting hard against any internal or external pushes to devalue myself because I’m at a higher weight — whether this weight gain is temporary or here to stay.