![]() A review of multiple randomized control trials demonstrated a “ strong evidence for the efficacy of diets”. If you aren’t yet convinced, and still want to prescribe weight loss, consider that the most common outcome of dieting is weight gain. Importantly, weight loss, even when intentional, “ increases the risk of premature death among ‘obese’ individuals” (1). Further, up to 75% of “obese” individuals are “metabolically healthy”, based on studies that measured blood pressure, HDL, triglycerides, and plasma glucose (10). Even without controlling for confounders, “most epidemiological studies find that people who are overweight or moderately ‘obese’ live at least as long as normal-weight people, and often longer” (1). ![]() ![]() When our studies control for confounding variables such as weight cycling, diet drug use, economic status, and weight stigma, many of these effects disappear (9). In medicine we pride ourselves on differentiating correlation from causation yet we have collectively abandoned these principles with regards to the links between “obesity” and poor health. Problematic origins aside, I was still convinced that because “obesity” is associated with increased morbidity and mortality, it should be treated. As noted in a recent CMAJ article, we must recognize that “the conflation of obesity with racialized and colonized communities is part of a long tradition of marking marginalized populations as diseased” (8). BMI is an especially poor measure of health in non-white people, particularly Black women (7). When life insurance companies wanted to charge policyholders based on height and weight, physiologist Ancel Keys (who thought of “obesity” as “disgusting” and “ethically repugnant”) re-introduced the BMI (5,6). His work was used to justify the eugenics movement in the 1920s–30s (4). The committee found that “obesity” has “no specific symptoms associated with it,” and that “medicalizing obesity… could lead to more reliance on costly drugs and surgery… some people might be overtreated because their BMI designated them as having a disease, even though they were healthy” (3).īody Mass Index (BMI), used to define “obesity,” is a measurement created by Belgian mathematician Adolphe Quetelet, to identify the characteristics of the average white man. “Obesity” was only declared a disease in 2013 by the American Medical Association, against the advice of the steering committee they had hired to study the issue. Instead, the word fat is being reclaimed by the Fat Justice community as “an objective adjective to describe our bodies, like tall or short” (2). In fact, the term is derived from the Latin obesus, meaning “having eaten oneself fat,” inherently blaming fat people for their bodies. ![]() I had never questioned the word “obesity” I considered it as an objective, neutral label for a disease. I was dismayed to learn I had been harming patients by focusing on weight, and that there was a large body of evidence challenging the above “facts” (1). In 2021, I came across the Health at Every Size (HAES) community and the Fat Justice movement. I recorded patients’ BMIs and counselled them on weight-loss strategies, believing that I was helping them. Medical school taught me that “obesity” is a cause of morbidity and mortality, and that weight loss is its cure. Maya Rosenkrantz, Maria Oswald, Andrew Brown, and Ljuba Pavlovich for their helpful edits and suggestions. ![]() Katarina Wind ( biography, no disclosures) Acknowledgments ![]()
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