Not sure which way I’m heading

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.

Photo of me looking pudgier than I have in a while, and smiling next to a dogwood tree.

This is me next to a blooming dogwood tree. Photo snapped by a 6-year-old.

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.




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12 responses to “Not sure which way I’m heading

  1. Annabelle

    It’s important to separate the ideology and the science. Although the 95% statistic is bandied about a lot, the science is actually not that cut and dried. Meta-analyses of the data have shown that in fact between 17% and 30% of people can maintain a weight loss over time, depending on which study you look at. What’s wrong with nearly all of these studies, though, is that they are done on people who are doing very low calorie diets that simply aren’t sustainable. There really hasn’t been that much done on people who genuinely made a sensible lifestyle change. Further, the body’s defense of its fat seems to kick in once the body has lost more than 5-10%, suggesting that maintaining a moderate weight loss below this threshold is certainly possible, assuming the person has made a permanent lifestyle change.

    After that 5-10%, things get trickier and more problematic. Dramatic weight loss can be maintained, but at a very steep price – constant vigilance. Calorie counting, portion weighing, the works… forever. Most people can’t maintain the obsession. The people who can, or at least the ones I’ve come across, seem to treat their own body like an ongoing science experiment and really get into the data. Either that, or they end up as fitness instructors or go into nutrition etc.

    For many other people, that’s the royal road to eating disorders and yo-yo dieting, with all the problems that come along with it.

    Having said that, people undergo intentional weight loss for specific reasons all the time. Patients who are going to have cardiac surgery who are overweight are often put on a vegetable soup diet for a couple of weeks. Although dramatic weight loss in a short time isn’t likely, the little bit of weight loss can improve their odds markedly. Body builders who have a competition coming up will strip fat down and then carefully manage the weight regain. It’s a lot more complex than the fatosphere suggests.

    All of that aside, it sounds like you’re on the right track for you anyway. It’s more important to get the diabetes under control and if doing that means you’re putting some weight on, better that than the alternative. One of the side effects of starting some moderate exercise and overhauling eating is that the next thing you know, you want to do a bit more exercise. The extra pounds may begin to drop off naturally.

  2. To me, if you adopt healthy behaviors and your weight changes, then that’s intentional behaviors not intentional weight changes.

    If that doesn’t seem a difference, try this:
    How are you measuring progress? By the scale? By how much energy you have? By how far you can walk? By less back pain? By blood glucose?

    If you don’t lose weight and just get healthier (by whatever measures you choose) would you feel you have met your goals? Would it be worth it?

    If you decide that you really want to pursue weight loss, and not just health, then yes, you probably want to get off the fat feed. But that is absolutely your decision to make!

  3. Hmmm, interesting.

    For me, there’s a difference between saying, “I don’t want to hear about your diet because I find it triggering” and “if you’re trying to lose weight, f* you forever.” I’m not interested in policing anyone’s food intake one way or the other, but at the same time, this is a society where fat people (especially women) are under relentless, nonstop pressure to diet, and every fat person who says they’re dieting makes it harder for the rest of us to resist the pressure that we know from past experience will be very, very bad for us to cave in to. So and so is dieting! She’s losing weight! What’s the matter with you, fatty! I saw you eating those fried clams, you worthless, lazy so-and-so!

    For me, it’s kind of like those diets like GAPS that are supposed to “cure” autism, but are hella expensive, inconvenient, and socially isolating, and the “cure” rate on them is not exactly anything to write home about anyway. If people like eating that way, if they get something out of it, fine. But I wouldn’t want to walk into an ASAN meeting and have someone hawking this diet as some kind of hard-sell pitch for “normalcy.” (I am actually the ASAN chapter lead here, so it wouldn’t happen in my meeting, anyway.) How I’d feel about someone in my life being on GAPS depends on how they talked about it; if it’s “being autistic is GOING TO KILL ME and this will cure me!”, then yeah, what I’m going to think is, what must you think of me, then, if I insist on eating those awful brain-damaging grains? (People say it doesn’t have anything to do with judging the other person for not following their lead, but believe me, if they’re saying stuff like that, they do.) If, on the other hand, they just said they like the fact that they don’t have to spend all day in the bathroom and that it gave them more clarity, balance, better sleep, etc., then who would I be to object?

    In a weight neutral society, dieting specifically for weight loss would be seen as the experimental treatment that it actually is — something that sometimes works for its intended purpose, but usually doesn’t, and then you gotta say, “Okay, that didn’t work, what else you got?” But context is everything; the ‘Sphere exists because we have precious few places we can go that are free of diet talk. But for your own personal life? Hey, if you are pretty sure it will work for you and nothing else will, then go for it. What do I know?

  4. sarah

    My only problem with this idea is the whole state of mind issue. If you walk into “lifestyle” changes thinking you’ll lose weight, even a little, what happens if you don’t lose weight, or you lose weight at first, but soon plateau? Do you begin to think that changing your eating patterns and moving more aren’t ‘working’ so you end up stopping the behaviour that’s making you healthier? That’s the kind of outcome I see as harmful. What is this hypothetical person using as a marker to determine if her changes are helping her?

  5. meerkat

    “no matter how small the weight loss goal”

    As I understand set point theory, you do have some leeway, so for example, someone who wants to lose 15 pounds and is starting on the heavy side of their natural range, could meet their weight loss goal and keep it off permanently without much trouble. But anyone who is socially acceptable after having lost only 15 pounds already has a lot of thin privilege. If you weigh 300 pounds, 15 pounds is 5% of your weight, and that’s how much “successful” dieters are able to keep off in all those studies you hear about. But you’d have to be pretty tall for 285 pounds to give you a kyriarchically approved BMI.

    I do not disbelieve that people can lose small amounts of weight and keep them off! I do not even think it is necessarily unhealthy! It is probably highly individual, as all bodies are different. Also, not cumulative (I don’t generally believe you can lose 100 pounds and keep it off if you just do it 15 at a time). I don’t particularly care if people want to lose 15 pounds and keep it off, so long as they don’t assume I would be just as thin as them if only I followed the same diet.

  6. “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?”

    For me it depends if the weight loss was intentional or it was merely a side effect of the other changes.

  7. Working toward more healthful food intake and activity is not a bad thing but, alas, for many it seems to come with some horrible, horrible baggage. Maybe on this one you are just trying to dig the pony out of the pile of manure? 😉

    Although “lifestyle changes” can sometimes be code for weight loss talk, it doesn’t have to be. I’m making some pretty significant lifestyle changes right now — but they’re based on what my body feels like it needs and I am doing it with no expectation of where the scale will go. It sounds as if you are simply taking care of yourself in your own body, which is an amazingly positive thing.

    My experience has been that when I am pushed and bullied and pushed a little more to do a certain thing, I wind up — either way I decide — not knowing whether the decision came from me, or whether I caved, or whether I simply rebelled. We are under a lot of pressure in this world on body issues, and it can be difficult to pick your path through. It sounds as if you are doing just that right now.

  8. I think there can be a such thing as healthy intentional weight loss. First, a lot of people gain weight in a negative way due to life problems they go through, whether it’s a medical condition, depression, sudden boredom due to loss of job just off the top of my head. Weight gain can be bad or good and weight loss can be bad or good, depending on the circumstances and measures of both. Now when people gain weight, it can often be hard on their boned and cause joint problems, breathing problems, mobility issues. I do not believe those who say a body will always automatically adapt to excess weight. Some people can but not everyone. Ok so for example, I have an aunt who is a relatively thin person, struggles with a life problem and starts eating excessively, gains 50 pounds in a matter several months. Then she starts to suffer from joint and muscle pain. She decide to make an effort to go back to their healthier eating schedule, lose the excess weight and then feels better again. This has been a healthy weight loss. Obviously it’s not going to be simple for everyone to do, but I do think the general idea is entirely possible.

  9. G

    Interesting post; lots to think about here!

    I agree that it’s your body and your choice, and I think this totally belongs in the ‘Sphere. But, I think how well you keep your sanity through your weight loss adventures depends on your mindset. (That’s why we start HAES right? to free up the brainspace that diet culture takes up?) Perhaps you’d be better served by seeing this as an adjustment to your habits to manage your illness, rather than following a prescriptive diet. See how it works over a period of time, evaluate how your diabetes symptoms are changing, and go from there? Good luck, and take good care of yourself.

  10. Thanks to all for the amazing comments!!!!
    I apologize for the delay in their showing up — I was away from the computer for a whole day and I haven’t set up the ability to approve comments from my phone yet.
    What’s interesting is that I really wasn’t talking about myself so much as the theory here — I don’t think I would ever talk about intentional weight loss attempts on the ‘sphere. I have found it interesting (and not novel to others who have commented here and elsewhere) that for me, my recent weight gain has been associated with better health, overall. The changes I’m considering making aren’t for the sole purpose of weight loss — they have to do with managing diabetes. The approach I’m currently using has lead to quite good diabetes control, but at the expense of experiencing more hunger. If I switch things around a little, I may be able to get the same, or even better, diabetes control with less hunger — not less than I need, but the right amount to match what I need to be eating for nutrition and pleasure and life — but it will take more effort and organization, something I haven’t been willing to commit to. It would mean having a regimen more like someone with type 1 than type 2 diabetes, which is a heck of a thing to take on if it’s not required.
    I wonder how this works, though, in the real world — people who aren’t on the ‘sphere who are fat and want to have improved health may have trouble separating out the weight-related outcomes from the other benefits (i.e. improved mood from being physically active). I talk with many women where I live and work about this sort of stuff — all over the map when it comes to weight (but mostly — not exclusively — white and middle aged) and I find that the mindset that losing weight is key to happiness is a tough nut to crack. I’m told that my apparent comfort with my body, expressed by what I do and what I wear and how I talk, is something that challenges perceptions of what it means to live in a fat body. So, since my body will likely always be varying degrees of fat, I will keep on being myself.

    Thanks again to all who participated in this conversation!!!

  11. What I wish someone had explained BEFORE I lost radical weight (more than 10% from highest established weight) were the hormonal transitions. (But I don’t think people, including doctors, even recognize them.) I also wish they had warned me of the hormonal changes I would go through during pregnancy and in the months after childbirth. People recognize the existence of those transitions, but make light of them (unless post-partum depression threatens the baby). It’s a similar process, pregnancy and weight loss/regain. There are unexplainable and unpredictable mood and attitude shifts that exceed what the joy and disappointment of the process alone would suggest.

    My point is, even if you enter into weight-loss with the mindset that you are only incorporating it, modestly, for health reasons, your hormones can enter the picture, F**k everything up and morph your mindset before your own eyes. Your hypothetical person above, who loses and regains 15 pounds. She should know, before the process, that no matter how reasonable she is (and I think even if she throws her TV set out the window and refuses to look at a women’s magazine), on her way down and up there will be hormonal changes that science and medicine have not explained. Weight loss conveys some euphoria that is often heightened by social rewards — “you look great” — but I think it exceeds what would be predicted by mere social rewards alone. It’s hormonal. During the weight loss phase, a euphoria exceeds hunger (which is not experienced as particularly annoying or unpleasant) interprets muscle soreness positively, etc. Then there’s a honeymoon period where weight stablizes for a bit. Then during weight regain, the pendulum swings more violently. Hormonally induced hunger, unrest, edginess and discomfort is followed by some relief/euphoria from intake of food (possibly heightened flavor), which lasts roughly as long as it takes to eat, then depression sets in (probably because of social stigma and shame). The shame and depression are particularly awful if clothing starts to get tight, uncomfortable and unattractive — showing underwear lines, etc. Donating too-small clothes to charity is a depressing, personally humbling feeling, even if you only partially regain what you lost. And the process can happen with only a 15 pound shift.

    This is an incomplete answer, but I leave it as a cautionary note to those who would attempt this.

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