Weight Stigma Is Not A Weight Loss Strategy

Welcome to all fired up. I’m Louise your host and this is the podcast where we talk all things anti diet. Has diet culture got you in a fit of rage is the injustice of the beauty ideal getting your knickers in a twist? Does Fitspo make you want to spit-spo? Are you ready to hurl if you hear one more weight loss tip? Are you ready to be mad, loud and proud? Well, you’ve come to the right place. Let’s get all fired up. Hello diet culture drop outs. I’m back with a one woman rant about how weight stigma is not a weight loss strategy. If you’d love us here on all fired up. Please help spread the word by going to Spotify or Apple podcasts and leave us a really fiery five star rating and a review. Of course, if you’re not yet subscribed, make sure you follow so you don’t miss out on a single exquisite rant. I’m downloading my rage weekly now so you don’t want to miss out. The all fired up podcast is brought to you by the brand new untrapped Academy. 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And then you can choose from either a $15 a month membership, to get access to recordings of the talks and skills trainings only, or a $25 a month membership where you can get access to everything live plus to have the support group and join the Facebook group. So there’s a membership level for everyone. And of course, if you’ve got anyone you know, clients, patients, friends, family members, colleagues, anyone you think that might benefit from joining the untrapped Academy, please let them know about us head over to untrapped.com.au and become a member now. Content and trigger warning everyone just before we get started once again, I’m talking in detail about a weight loss study. So it’s from obesity researchers the word obesity is mentioned as is quite detailed discussions of weight loss so if that’s going to be difficult for you, please look out for yourself and make the decision to skip this one Unknown Speaker 4:00 on with the show. So I’m on an email list for Medscape which is a newsletter that provides apparently medical information for clinicians and scientists. And this organization also provides continuing education for physicians and health professionals. So recently I came across this teasing heading self talk overhaul may help patients achieve weight loss. Now you know that for me that is like some kind of fury catnip so off I went to check out this article. So it was written by a person called Rebecca Pearl PhD, who is an Assistant Professor of Clinical and health psychology at the University of Florida College of Public Health and Health Professions over in Florida. So in this article, she is disclosing no relevant financial relationships and you know, that’s always something I check out when I go and read these kinds of things. So what does this article say? Look, the way I would approach this I’m going to read out Unknown Speaker 5:00 watch a lot of how the article is written. And then I’m going to pause and I’m going to interject with some fact check. So here we go. Quote, it’s common knowledge that the recommended first line treatment for Busuu is behavioral or lifestyle intervention with the goal of losing a modest amount of weight to gain significant health benefits. And quote, well, I object already. We’re in the first paragraph. Okay, yes, it’s recommended that this doesn’t mean it works, or that it leads to significant health benefits. So there is a solid 60 plus years of research to show that behavioral weight loss leads to tiny weight loss, usually in the realm of some five to 8% of starting weight. And this is in the short term like maximum six to 12 months. After this, the weight is regained. This is level eight evidence, this is the highest level of evidence that we can get in scientific research, we are sure that weight regain follows weight loss as we are that smoking causes lung cancer, the apparent significant health benefits associated with modest weight loss. It’s also an interesting nugget to dissect. So when we lose this tiny amount of weight, there are a smattering usually reduced secondary markers. So things like reduce blood pressure, sometimes reduced cholesterol, reduce blood sugars, stuff like that. And these markers, of course, tend to go back to their baseline once the weight is regained. Because when we go on these weight loss diets our body’s homeostasis, like a self regulating process by which our bodies maintain its sense of internal stability. Homeostasis is like where our bodies feel safe. This is lost our bodies notice when we’re losing weight. And this activates compensatory mechanisms which adjust to the new conditions. So our bodies do really clever things like slow down and metabolism slowed down our heart rate and lower our body temperature. So weight loss, researchers love to claim that weight loss leads to things like improved blood pressure, but all they’re really saying is a body which is slowing down to conserve energy, weight regain after behavior. Weight loss is driven by a very powerful physiological system. It’s got nothing to do with our willpower, nothing to do with our psychological attitude towards weight loss. It is a biological mechanism. We have a biological mechanism that regulates our breathing, and we really want to breathe in our bodies to keep us alive. No amount of psychological willpower will change our urge to breathe. And this is how we need to remember to look at this sort of stuff. One of the things never mentioned in the weight loss research industries, introductions to their research articles are the downsides of weight loss. Our metabolisms stay suppressed for months and even years following weight loss diets, our reward systems towards tasty foods are enhanced. And we’re basically not the same physical being as we were before we went on the diet, repeated weight loss efforts, of course lead to weight cycling, people going up and down in weight loss and regain patterns. And this is stressful. And this further impacts our metabolic disturbance. The reality of the weight science behind weight loss, dieting is never mentioned, all we ever hear about is this tiny sliver of the short term impact of dieting on secondary markets. And that’s what Beck’s is talking about in the introduction in this article, but I’m digressing. I hope though, that all of this helps you to remember that the whole idea that self talk is going to do anything at all to increase the likelihood of lasting weight loss is just utter bullshit. So let’s see what is said next in this article. Unfortunately, when pursuing weight loss, patients often think they need to beat themselves up to stay motivated. I’ve heard patients call themselves weak, saying that they need to stop being lazy and gain some self control in order to be less of a failure. They label their bodies as disgusting and themselves as worthless, all because of their weight. I object x, if people are saying this kind of stuff. This is evidence of internalized weight bias. People have internalized a very cruel narrative about larger bodies directly from diet culture. This is not a misguided, deliberate attempt by larger bodied people to lose weight, or fat sake. And I love that quote, all because of their weight, or because of how their bodies are being treated in diet culture. Now I’m angry friends, we go on, but some patients may worry that if they’re kind to themselves or too accepting of their bodies, they’ll lose motivation to stick with their health behavior goals. And, quote, citations needed. This to me It screams of a weight bias researcher who might want to think this way. Quote, in many people’s minds, weight management and body and self acceptance are mutually exclusive. What if patients don’t have to choose between the two? That’s a question that my colleagues and I have explored in recent research that attempts to reduce weight stay Unknown Speaker 10:00 MMA as part of standard weight related there. All I have to say to this, oh my actual god, this is the ultimate in what we like to call Splinter arcing. Or why can’t we have both? Why can’t we have lovely self acceptance and lose weight? Why can’t we eradicate homophobia and not be gay? Why not get rid of racism and still make everyone white? This is outrageous. Quote, contrary to belief that negative self talk and self blame can be motivated to improve health. We know that high levels of white self stigma are linked to unhealthy eating behaviors and less engagement in physical activity among other poor health outcomes. Thus, ironically, internalizing weight stigma actually undermines efforts to lose weight and maintain weight loss rather than make motivating healthy behavior change. And quote, oh, this really gets me going. These obesity researchers know the metabolic reality of weight cycling, but they are completely ignoring this, and pretending instead that the central reason people don’t lose or maintain weight loss is internalizing weight stigma. This keeps Of course, the focus squarely on the individual, which is diet culture does yoga, as no consideration. Also that lower levels of physical activity might be due to completely valid fears of how people are going to be treated in mainstream exercise environments, such as gyms, and also will the equipment even suit their bodies? And also can they even buy clothes to go into sad environments just absolutely drives me mad. And this last sentence about quote unquote motivating healthy behavior change is implicitly weight biased because BEX is assuming that the fat people need to change their behaviors. Unknown Speaker 11:54 Now’s a good time for us to chat about what weight stigma actually is because Beck’s is seriously misrepresenting things. So weight stigma is a consequence of something much bigger. If we genuinely want to look at eradicating things we need to look upstream and start there because diet culture creates weight stigma. So what is diet culture? Well, it’s a phrase meaning the overall system elevating thinness and pathologizing fatness, the body hierarchy where the thin ones are at the top seen as healthy and desirable, and the fatter ones are at the bottom and seen as unhealthy and undesirable. diet culture messages are everywhere and we breathe them in like air. Living in diet culture means our society upholds massive prejudicial beliefs about fatness. Those really unquestioned stereotypes about larger people, like larger people are unhealthy. Widespread weight prejudice leads to weight oppression where systematic power is wielded to marginalize people and groups with larger bodies. So things like obesity researchers Unknown Speaker 13:03 focused on the BMI as a pathology. Rather than seeing it as part of human size diversity. We also see massive weight based discrimination, exclusionary enactments based on body size, so awful things like delaying medical treatments because of the BMI or removing kids from their families. Because of their size. These are all really widespread systematic forces, and they get filtered down, and then they impact us at social and interpersonal and individual levels. So weight bias means the negative attitudes and beliefs about larger people. So like the GP thinking that larger bodied people are not trying hard enough to lose weight. And weight stigma is the social rejection and devaluation that happens to higher weight people. So rude comments from health professionals. And then underneath this is internalized weight bias, which we all have, regardless of our size, it’s the degree to which we personally adopt those negative weight based social stereotypes and judge ourselves or other people or both based on them. Internalized weight bias happens to people of all sizes, but it’s particularly awful for larger bodied people who also caught the brunt of multiple instances of weight based discrimination and stigma and begin to agree that their bodies are definitely the issue. So for example, my doctor had a go at me about my weight and rightly so. So you can see that weight stigma. It’s important, but it’s part of a bigger picture. It’s a consequence of diet cultures. Assumption of the body hierarchy. The pathologizing of fatness. Tackling stigma is not about being nice to fat people in order to encourage them to lose weight. We cannot keep the systematic aspects of fat phobia in place and just tweak the individual and social aspects. That’s like educating mental health professionals about homophobia whilst simultaneously Unknown Speaker 15:00 saying it’s okay to keep gay conversion therapy going back to the article quote. In our latest study, my colleagues and I tested the long term effects of including a group intervention to address weight stigma in a standard behavioral weight management program. More than 100 adults with obesity, who had experienced and internalized weight stigma were recruited for this clinical trial, which randomly assigned participants to receive either the weight bias internalization and stigma program, weight bias program, combined with the standard behavior weight loss treatment, I cannot wrap my head around the fact that these researches are quite literally running weight loss programs, plus what they’re calling an anti stigma program. I’m reminded of the famous quote from The Princess Bride from Inigo Montoya. You’ll keep using that word, I do not think it means what you think it means. It’s quite literally like tacking on an anti bias component to gay conversion therapy. Let’s keep trying to change your body while simultaneously teaching you body acceptance. Good Lord, they could stop. Also, have you noticed that the comparator group is behavioral weight loss, it’s not a size acceptance group. Now that might have made things interesting, but the fact that they didn’t even consider this is more evidence of the massive bias in this research team. Again, if we imagine that this is gay conversion treatment plus anti homophobe training, the comparator being gay conversion, and there’s no other group just leaving the gays alone plus anti homophobe training. What is not being done here is illuminating way to shape the narrative here weight bias researchers. Okay, so she says the weight bias program adapted evidence based psychotherapy techniques to target weight self stigma whilst providing peer support in a group treatment format. specific topics included challenging myths and stereotypes about weight, identifying and changing negative thought patterns related to weight and how they affect emotions and behaviors and responding to experiences of weight stigma, for example, to challenge negative thoughts, eg that they’re a failure because of their weight. Patients work together to examine all of the evidence that prove these beliefs were not true, and came up with ideas for how to revise those thoughts to be less judgmental, and more fair and accurate. Other topics focused on building confidence, increasing body and self acceptance and advocating for themselves and others who are mistreated because of their weight. Many patients shared examples of stigmatizing experiences in healthcare settings and discussed what they could say or do when facing judgment or discrimination from health care providers, as well as the importance of finding healthcare providers who treat them with respect. With discussions also tied in information relevant to health behavior goals, such as overcoming self consciousness about weight, that they could enjoy physical activity, I would bloody love to have been a fly on the wall in these meetings. Watching these researchers twist their brains into pretzels trying to tackle the participants negative thoughts about their bodies, whilst simultaneously upholding the central idea that they still need to change their bodies by starving them on weight loss diets. And when I mentioned challenging myths and stereotypes about weight room, I’m going to bet that the basic myth about weight ie that it’s possible to lose weight and keep it off without experiencing significant psychological and physiological consequences was omitted here, quote discussing what to do when facing judgment or discrimination from health providers. I mean, how long we actually in the room, in this group experiencing weight based discrimination, doing role plays on how to respond to weight loss discriminate, I just can’t. Also don’t you just love the tip about how participants need to just overcome self consciousness in order to enjoy physical activity because once again, the problem is the person not the culture. One just needs to overcome the self consciousness of just not having any clothes to wear to the gym because no one makes them in your size. This is not weight stigma work my friends. This is at best, a very clumsy effort at doing CBT style negative thought challenging and a little bit of assertiveness training in our horribly fat phobic environment. It’s hardly reinventing the wheel. Okay, so Beck’s claims that the studies end participants in the group that received weight loss treatment with the weight bias program, on average lost about 7% of their starting weight, compared with an average weight loss of about 5% in the group that received weight loss treatment alone, weight losses of these magnitudes and known to have meaningful health benefits. Well, here we go again with those meaningful health benefits. And we’re going to come back to her statement about the weight loss in a minute. It’s juicy, I promise. Beck says these findings challenge the notion that reducing weight stigma and promoting body acceptance will undermine motivation to engage in healthy behaviors and Unknown Speaker 20:00 Lose weight, we found loads such effect of x. This is not the point you have totally missed the point of weight stigma work. The central idea here is not that being nice to fat people will make them stop trying to lose weight, especially when your participants are actively being starved on a diet that you gave them. Ah, fix says in the article when asked questions such as how much they liked the program, what they learned and how they use the new skills and change their self perceptions. Participants who received the weight bias program gave higher ratings and those who only received the weight loss. Positive feedback from free response questions indicated that many people identified social support as their favorite aspect of the program. Others highlighted how the program helped them gain the ability to think differently about myself and other people and understand that weight really is separate from the person. They also described how they brought together the goals of weight loss and self and body acceptance saying I’m more accepting of me and at the same time more dedicated to obtaining a healthier weight. And it’s okay to be happy the way I am and still want to change the actual gaslighting fuckery these poor people have been exposed to is a crime. They’ve obviously not been taught to challenge the entire concept of quote unquote healthy weight, nor been informed about the massive amount of evidence out there showing that weight loss is next to impossible for the vast majority of people. These participants are being fooled into thinking that weight loss is possible. And I’ve even been trained in this program to believe that it’s been their thoughts getting in the way this whole time. This is not weight stigma work people this is horrifying. Our study results suggest that reducing negative self talk and internalized belief about weight certainly won’t undermine treatment outcomes and may have some benefits beyond standard weight loss treatment. At the same time, we also all need to do our part to change how society views and treats people with larger bodies and prevent the harms of experiencing and internalizing weight stigma. Unknown Speaker 22:03 When a completely self satisfied, smug face that article was whenever I read a press release like this, I always go back to the source and read the actual paper because over the years, I’ve learned some very consistent facts about weight loss research, ie one, the headlines, or press releases rarely match the study. And number two, even in the study that conclusions hardly ever met the actual data. So I went back to the study which was published in 2023. And there were nine authors of the study led by Rebecca pearl. All of them were firmly anti Fat people not to weight stigma researchers, Rebecca remember how she said in the article that she had no financial disclosures. There’s also no disclosures in the actual paper. But I did a little bit of background checking and quickly found that she has previously disclosed financial relationships with Novo Nordisk. Yep, that’s right, our old pals who are making the weight loss drugs, and they’re also the ones who are rewriting the narrative around fat bodies, centering weight stigma. X also has a very long and cozy relationship with Weight Watchers, a relationship I’ll be coming back to in future episodes. The actual paper is an extremely painful read, especially in the introduction with these obesity researchers excitedly recounting their mind boggling realization that weights D weight gets in the way of fat people trying to not be fat. I keep getting that Maxwell Smart comment in my head as I read this article, mystify that much. So many times, they’re skirting close to the truth, but then they just relentlessly miss the point. So for example, they say, quote, weight regain is a common experience due to the complex biological processes that counter weight loss, which may lead patients to feel demoralized and to lose self efficacy to continue engaging in health promoting behaviors. And quote, No shit, Sherlock. They know this, but they didn’t tell the participants. Their logic is nothing short of deranged. So from here, they talk about how they think that reducing weight stigma might increase self efficacy, which might make people exercise more because apparently that’s what they think they need to do to combat a complex biology they’ve just talked about. It’s wild. Anyway, so the research was done on 105 people who wanted to lose weight again, 90% women, mostly white, they was 29 group sessions over 72 weeks, so they did 20 weekly sessions, and then went monthly and then bimonthly. There were 52 people assigned to that behavior, weight loss, plus fake stigma training, and 53 to the standard starvation training. They will put on diets like 1200 to 1500 calorie diets. This level of restriction is equivalent to even less than what happened in the famous Minnesota Unknown Speaker 25:00 semi starvation experiments in the late 1940s. This is a very well known very famous paper, which really resulted in participants literally losing their minds with hunger. But these days, this kind of calorie guideline is widely viewed as a sensible thing to do that has no harm. But I digress. So for the first month, all of the meetings were just behavioral weight loss. And then the group that were doing the fake anti stigma training, they literally just tacked on the last 30 minutes of each of their group sessions from week five. And they were also encouraged to exercise for 150 minutes a week and then increase it to 250 minutes a week, by the 72nd week. So what happened 10 people jumped out of the fake stigma group and six jumped out of the normal starvation condition. When they finished the experiment, there were absolutely no difference between the groups on any of the secondary markers, which, as predicted changed slightly. When they’re looking at internalized weight bias measures there was again, no difference between the two groups at the end of the experiment. So by week 72, half of both groups had reduced internalized weight by scores. That’s interesting, isn’t it? It reveals a glaring flaw in the entire premise of this intervention, According to these researchers, just going on a diet reduces weight stigma? I think not. I think this, I think what we’re seeing here is weight loss going in a weight loss program like this, it improved weight based self esteem, which is a completely different kettle of fish, to genuinely unlearning and unpacking weight stigma. So I would suggest that the researchers should then measure everyone’s internalized weight bias scores, once everyone’s regained the weight, and the full pattern would they reveal because we’ve seen it time and time again, in behavioral weight loss research that people feel better when they’re at the bottom of their weight loss art, and then they pretty much feel terrible again, when it goes back to normal. So this is shocking that they haven’t done this. So what about the weight loss? Because remember, Beck’s told us in the Medscape article, that the fake weight stigma people lost more weight than the people in the normal starvation condition? Well, drumroll please, quote, no significant differences between the two groups were detected and quote, that’s right, folks, there was actually no difference. Even though there was a percentage difference, it wasn’t statistically significant, meaning there was actually no difference between the two groups. So she has deliberately misrepresented the data. In the Medscape article, the people in the fake stigma group also became no more physically active than the people who just did starvation. Leaning begs to claim in the discussion section that this is why there was no significant difference in weight loss. How abominable given all that we know about weight science, you could add in all kinds of potential thinking tricks to these behavioral weight loss experiments, and they would all not make a single bit of difference because five to 8% weight loss in the short term is all that’s physically possible because of weight science. It wouldn’t matter a psychologist could teach people to believe they could fly, this would not have an impact on the efficacy of behavioral weight loss, which after like 60 plus years of research needs to just get in the nearest bin and stay their ex and colleagues conclude incorporating information about weight stigma and strategies to reduce its internalization is feasible, acceptable and has some possible benefits and no harms for weight management in quote. Well, let’s discuss the no harms idea, shall we? Because I have some the harms are a continuing to mislead people about the reasons why weight loss doesn’t work, be appropriating the anti stigma work of decades of fat activist and fat studies scholars and incorporating it into your pissy little weight loss studies and see gaslighting people about what weight stigma really is. And seriously, behavioral weight loss no harms are you for real. Oh, my goodness. This has been the story of how an entire research study on weight bias is itself riddled with weight bias and will in fact, worsen weight bias. Right. I’m enraged and I’m in need of a long, calming walk. Thank you for listening, everyone. We’ll be back next week with more steaming, diet culture bullshit. Take care, trust your body. Think critically. push back against diet culture. Untrap from the crap

Transcribed by https://otter.ai