Weight Loss Doesn't Improve Your Health

Weight loss doesn't improve your health—and I'm tired of having to prove it. While doctors continue pushing weight loss as a cure-all, the evidence tells a different story. The Look AHEAD Study followed 5,000 diabetics for 10 years and found that weight loss didn't prevent heart attacks or strokes. Similar studies show no long-term benefits for diabetes, arthritis, blood pressure, or fatty liver disease. Yet fat patients are still forced to advocate for basic medical care while being blamed for conditions that have nothing to do with their weight. It's time for healthcare professionals to stop putting the burden on patients and start practicing evidence-based, weight-inclusive care.

For anti-diet and healthcare professionals, it's time to stop second-guessing your weight-inclusive approach, and get the research, tools, and professional certification to confidently counter medical weight bias:
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Chapters

• 7:33 The Look AHEAD Study - cardiovascular disease evidence
• 19:53 Healthcare practitioners' responsibility vs patient burden
• 27:45 Launching the No Weigh Movement weight-inclusive training program

Transcript

Hi everyone, and welcome to episode 30 of season 5 of the Fat Doctor podcast. I'm your host, Dr. Asher Larmie.

Today, I am going to be talking about something that I have talked about ad nauseam, but we'll keep on talking about because it's important. And that is the fact that losing weight does not improve your health.

Very broad subject, right? It doesn't. And it's really difficult to have this conversation with people, because there are like a million "what abouts." You know, I'll talk about diabetes, and they'll go, "alright, that's diabetes, but what about this? What about this? What about this?" And so they go, "what about this?" And I'm like, "oh, I'll go and have a look, and I'll do the research, I'll come back to you," and then I'll do the research and come back to them, and then they go, "yeah, but what about this?" And so on and so forth.

So it's really tricky to have this conversation about why losing weight doesn't improve your health. But I am very confident. Very, very confident. Now, there isn't a study out there that demonstrates that weight loss improves long-term health. Whether it's your long-term health markers, like blood pressure, A1C, cholesterol, or whether it's actual long-term health outcomes - heart attack, stroke, diabetes, arthritis, I'm reaching for the ones that are really commonly brought up.

But yeah, whether it's health markers or health outcomes, there is no study out there that shows that weight loss is beneficial in the long term. We do see some in the first 6 months to 1 year, usually never beyond a year, certainly not beyond 2 years.

And people go, "oh, why does it work in the short term and not the long term?" And I'm like, well, that's actually very complicated. It has a lot to do with how the body responds to intentional weight loss. I could give you a long lecture about that, I can tell you all about the various processes and pathways. I can explain it to you from a pathological point of view, but you just find it really boring and probably switch off after a few minutes. Unless you're a nerd like me.

So, suffice it to say, why does it work in the short term and not in the long term? It's not a question that I'm going to answer today in this podcast episode, because it doesn't matter why. It doesn't. So, if it doesn't work, it doesn't work. The end.

Losing weight does not improve your health, people, it just doesn't.

But "Asher, what about..." yeah, okay. I'm gonna do a few "what abouts." Not all the "what abouts," but some of the "what abouts."

So, common "what about" - you know, "what about your risk of heart attack? Well, Asher, you're trying to say that losing weight is not going to reduce my risk of a heart attack?" Yes. Yes, that is exactly what I'm going to say. I'm going to tell you confidently that it doesn't. In fact, when it comes to heart attacks, that's the one that I'm most confident about.

Because there's a study called the Look AHEAD Study. There are many studies, but the Look AHEAD Study is one of my favorite studies to talk about, because this one just... you know, it's not perfect. So they got a bunch of, I'm at 5,000 or so diabetics, so already high risk of a heart attack, yeah? So, we're going to put you on a diet, and you're going to lose some weight. And they put them on a diet, and they lost some weight, and then they gained it, and lost it, and gained it, and lost it, but they managed to sort of, over a long period of time, we're talking 10 years, this group of people managed to maintain some degree of weight loss. They did lose weight successfully. More than once, in most cases.

They follow them up over 10 years, so that's some really good quality data, right? 5,000 people, so a large number, over 10 years, multiple attempts at weight loss. We're talking diet, exercise, meal replacements, you name it, they went at it. They didn't have weight loss injections at the time, so they didn't use those. Although that would have been very tricky because, of course, weight loss injections are also used to treat diabetes, and so that could have caused problems, and actually may well have impacted the data anyway, but it doesn't matter.

Doesn't matter, because this study was very clear. They were looking for heart attacks and strokes. That's what they were actually looking for. The primary outcome was the number of people who have a heart attack or a stroke - cardiovascular event. And they stopped the study after 10 years, because of what we call a futility analysis, it wasn't working.

It didn't work! Weight loss did not prevent people from having heart attacks. There are two groups, control group, this is the weight loss group and didn't win. Just didn't work. The end.

So when someone says to you, "losing weight is going to prevent you from having a heart attack," no, it's not. This is really good evidence to suggest that that's not the case. So where are you coming up with that? And there isn't another study just as good as that that proved that it... the study doesn't exist. And, you know, if anyone says so, you just go, "okay, show me the study."

I need a study that looks beyond 2 years, because 2 years is nothing, in the grand scheme of things when it comes to heart attacks. I don't want an observational study, ideally, but if that's the best you can do, then, you know. Observational studies are much more prone to bias, because an observational study is basically looking at a bunch of statistics and drawing conclusions from them, essentially. Whereas an interventional study, where you actually take two groups, one's a control group, and one's a group that's actually having an intervention, and you follow them up, that's not saying it's not biased, but it's less biased.

But yeah, the study doesn't exist. There isn't a study out there that you were going to be able to find that shows that losing weight is going to reduce your risk of a heart attack. And we know this! We've known this for a really long time, but if anything, you know, feel free to drop the Look AHEAD study as the landmark study that proved without doubt that losing weight has no real bearing.

There are some studies that show that exercise reduces your risk of a heart attack. Small amount, but does. Exercise is not to be confused with weight loss, and it's not exercise for weight loss, and any of the studies that show a sort of a reduction in cardiovascular events with people who exercise, and the studies are not that impressive, but even if the studies exist, I assure you that will be independent of weight loss. There's nothing to do with weight loss. The exercise itself may be beneficial, maybe. I'm not saying it's absolutely necessary, but it may be beneficial, but that is not the same as weight loss.

Alright, so that's cardiovascular disease. How about diabetes? Diabetes is another common one. That's what everyone always said to me, "you're fat, good luck with your diabetes," and of course, then I got diabetes, and so I became a stereotype, a walking stereotype, a fat person with diabetes.

So, does weight loss prevent diabetes? Again, we've got a study! A very long-term study. It's open to interpretation. If you look at the first couple of years of that study, then you'd probably be able to argue, yes, weight loss does reduce the risk of diabetes. They took a group of people who were already in that kind of stage before diabetes, where they're already demonstrating insulin resistance, they're already showing with their blood tests that they have some degree of insulin resistance, and they were recruited for the study, and they were studying, they've been studying for more than 20 years.

I'm not gonna go into it in too much detail. But there was 3 groups. There was a group that was kind of the control group, there was a group that did diet and weight loss, and then there was a group that took a drug called metformin.

And they wanted to see whether that would prevent this cohort of people who already had some degree of insulin resistance, whether these interventions would prevent them from getting diabetes. And to begin with, it seemed that the weight loss intervention did prevent diabetes. That was, you know, it seemed to be the most effective at preventing diabetes, but that was the short-term data. When you look at the long-term data, you're like, nah, much of a muchness. There's no real difference. Minimal, if that. And certainly could be explained by other factors. So, no, weight loss doesn't prevent diabetes.

What about arthritis? Arthritis is a common one, right? So there was the PROOF study. And I'm trying to remember what PROOF stands for. It's something about prevention of osteoarthritis in overweight, or possibly the O-word, females. I think that's what PROOF stands for.

Again, they looked at, took a group of people, followed them over a period of time, there was a control group, there was the group that was on glucosamine, which is a supplement, there was a group that was on diet and exercise, and they actually had 4 groups, it was all very interesting. And basically, what they showed was diet and exercise did not prevent osteoarthritis of the knee. Glucosamine possibly did have an impact, but diet and exercise didn't.

So, that weight loss did not reduce your risk of developing arthritis.

Blood pressure, does weight loss improve blood pressure? No. Plenty of studies that show that's not the case. In fact, possibly over long term, it can increase your blood pressure.

Same with your cholesterol. Plenty of studies that show, nope, it does not benefit your cholesterol. In fact, several weight loss intervention studies have shown an increase in LDL cholesterol, which is the quote-unquote "bad cholesterol."

So, nope. What else? I should have written a list, really.

Fatty liver disease, that's another one that often gets blamed on being fat, because the liver is fat, therefore, it's because you're fat. That's bullshit. The liver is very important in the role of processing glucose and fat. It stores fat, it turns fat. I'm not gonna get into a long lecture about how the liver works, but it is part of that process, the insulin pathway, et cetera, et cetera.

So, yeah, anyone who is insulin resistant is probably going to have some degree of fatty liver. And the more insulin resistant you are, the more likely you are to have fatty liver. Of course, if you have insulin resistance, the more likely you are to be fat, because insulin resistance makes you fat. So, you know, that's why diabetics tend to be fat, that's why people with PCOS tend to be fat, that's why people with fatty liver tend to be fat. If you have insulin resistance, it's really hard not to be fat.

Even with PCOS, the people who have PCOS and don't have insulin resistance tend not to be fat, and the people who have PCOS and have insulin resistance, in general, not all, but in general, tend to be fat.

So yes, of course, we see these conditions in fat people, because they have insulin resistance. But does weight loss improve fatty liver? Absolutely not. There's lots of studies that show that this doesn't work long-term. In the first month, maybe. In the first six months, maybe, but after a year to two years, no.

And even, interestingly, I was looking at the fatty liver - I mean, I use the term NAFLD, but because that's how we know it. The fatty liver kind of guidelines that we use here in the UK. I was looking at the guidelines and how they were formed. I was looking at the actual evidence for the guidelines. Whenever you look at the guidelines in the UK, there is a link you can click on that takes you to the actual full guidelines process. It's usually 200 pages long, and they look at, they answer, they ask all sorts of questions and answer all sorts of questions, do literature searches, et cetera, et cetera.

And they said, well, there's no evidence that weight loss improves fatty liver disease. And then they said something along the lines, but because everybody does it. Because it's just so common now, because we just... because we know that we know that we know. Like, of course there isn't any evidence. Why would anyone find evidence for something that we know about. They genuinely said that, okay, I'm paraphrasing, but I was just like, are you kidding me?

You're a guidelines committee, you can't possibly get away with saying that shit, but they did, they wrote it. Like, in the actual, it's written on paper. And I find that hilarious. It's not funny, really, because people get sick as a result, but I find it hilarious that they think they can say that. And that we'll just go, "okay, yeah, sure, that's fine, that's how it works."

That's not how it works. If you don't have evidence for a recommendation, then you have to make it clear that there is no evidence for that recommendation. Not, "oh, well, we do it, and so that would... that's good, you know, it's just so common now." So, it's such common practice that we... that there's no wonder that there's no evidence for it, really? Okay, so where's the historical evidence for it, then? At some point in time, there needs to be some evidence.

Okay, I'm just going off on a tangent now. Yeah. I don't know if I missed out any of the important ones. Kind of fatty liver, I did all the cardiovascular ones, I did diabetes, I did PCOS, insulin resistance.

Menopause... There are actually doctors out there that say if you lose weight, your perimenopausal symptoms will improve, yeah. That's not true. Anything, kind of, gynecological, actually? I've heard some really ridiculous things about gynecological conditions and how weight loss will improve them. No, they won't, no, it won't. Never does.

The problem, I think, with a lot of gynecological conditions is that we have so little evidence for them in the first place, because that only affects a certain group of the population. The group of the population that nobody in the healthcare profession really cares about, because they don't have a penis.

So, yeah, there's that. Oh, my favourite, my favorite, lose weight for your mental health. Oh, it's a great argument. There's higher rates of depression in fat people. So lose weight, and your depression will improve. Yeah, so a lot of studies have actually shown, no, the reason that fat people are depressed has a lot to do with poor self-esteem and poor body image, and that has a lot to do with weight stigma.

And so, really, weight stigma is the reason that fat people experience higher rates of depression, so if you really want to improve fat people's lives, don't tell them to lose weight. Deal with the weight stigma.

So, weight loss does not improve your health. It really doesn't. I'm so confident to say that. And instead of having to prove myself, I turn this question around, you know. People will say to me, "Asher, what do you say when somebody says, well, what about..." I go, no, that's fine. Go find me the evidence. Find me the evidence to prove that I'm wrong, not the other way around. I am not here to provide countless paper after paper after paper that proves what I'm saying is true. Because even when I do that, it's never good enough.

So I'm sick of it. You go find the evidence. That suggests that weight loss will improve my health. Beyond the first two years. Go find it. Come back to me once you've found it. I'm here. I'm ready and willing to look at that paper.

Now, if the paper's not up to par, if it's very low-grade, low-quality evidence, then don't waste my time. If you only want 10 people in the study, or, you know, it's a study that is really... And there are ways to grade evidence, right? Like, you know, to say whether it's low-quality, moderate, or good. It needs to be at least moderate, okay? Not very low. And not low.

Go find it, come back, let me know. I'm waiting. Especially you lot on YouTube that keep telling me that my medical license was revoked. You go find them. I'd love to see you go find them.

Oh, dear. Anyway, so... But there are... there are many people that come to me and will say, "my doctor said that I need to lose weight for..." and whatever they tell me, I'll go, "that's not true." There's no evidence that losing weight will improve that condition. And also... there are also lots of other ways to treat that condition that have nothing to do with losing weight.

So, there's two issues here. Number one. The evidence is... the recommendation is wrong. And number two, in doing so, you failed to make the correct recommendations. Instead of treating the condition, you went and told them to lose weight, which isn't going to work. And so, actually, what that doctor is doing is putting you in harm's way. So, you need to go back to that doctor, I understand that it's easier said than done.

But what about my blood pressure? What about my cholesterol? Same answer. What about, you know, my risk of diabetes, my HBA1C, same answer. What about, no, same answer, same answer, it's always going to be the same answer. That recommendation is wrong. And also, they have failed to treat your condition. Two reasons why you need to go back to them.

But it's tricky, isn't it? It's really, really tricky, because doctors don't give a damn whether they're giving out bad advice to fat people. They've been emboldened by a medical profession that is encouraging them, in fact, sometimes paying them to recommend weight loss. So they don't mind that they're recommending something that is not backed up by evidence, because they're being told to do it!

So then what do you do? Then it gets tricky. If doctors are allowed to get away with harming their patients. If they're never held accountable for harming their patients, if guidelines committees, which are often very much entangled with the weight loss industry and often the weight loss industry has a lot of influence over and sway over them. If those guidelines committees are turning around saying, "yeah, you should be recommending weight loss, even though there's no evidence for it." If we have politicians that are pressuring the NHS, or the healthcare system, I should say, to recommend weight loss. If we have hospitals that are literally refusing to treat patients over a certain weight. Then, what do you do? Caught between a rock and a hard place, right? It's really... really difficult.

So, there has to be a way around... and I have a lot of information on The No Weigh Movement website, NoWeigh.org, that gives you some information. So I just have a lot of resources that give you some information. I offer masterclasses with more information, I offer one-to-one support, I've got the consulting room, there's all sorts of ways that I try to help fat patients.

But again, this month, I'm kind of changing my tune a little bit. Because I'm tired of fat people having to work so hard to get the healthcare that they need. I'm sick of it. Why should I spend my time trying to get fat people to advocate for themselves to get the right healthcare. Like, of course I'm gonna do it, because they need... because fat people need it, and I want to help people.

But it pisses me off, because that's not their job. Fat patients... do not... it's not their job, it's not their burden to educate their healthcare practitioners that, no, that recommendation is not based on any evidence, and no, I'm not going to lose weight because I don't believe that's going to benefit my health, and actually, I want you to treat me properly. Like, why should fat people have to do that?

It's the healthcare practitioners that should be doing it. Why are fat people being forced to advocate for just decent care. Just... average care, like, I'm not even asking for top-notch care at this stage, just basic care will do. For goodness sake! It's ridiculous.

So again, I'm talking to the healthcare practitioners that are listening to me today. I am talking to the anti-diet professionals that are listening to me today. Yeah, the dietitians and the nutritionists, the people who are... I know, I see you. You have clients, you have clients who are struggling with these issues, and you want to help these clients. I know you do. I know you genuinely care about them. And yet, you know. Your client says, their doctor says they need to lose weight for their diabetes. What are you gonna do?

Your client comes along and says, "oh, she's been diagnosed with high blood pressure, surely I need to lose some weight." And they were doing really well with their intuitive eating journey, and then all of a sudden, their blood pressure goes up, and it's got nothing to do with their weight or intuitive eating. There's so many reasons. It could just well be the political climate that's put their blood pressure up, or maybe there's another reason, but all of a sudden, "oh, I've got to lose weight."

My client's convinced that if they lose weight, it's going to improve their PCOS, and then they won't have their hirsutism as much, and they won't have the emotional and physical challenges that come with living with this long-term condition.

My client, you know, is really worried about their cholesterol levels, my client is in a lot of pain. And they keep being told if they lose weight that they won't be in pain, so of course they want to pursue weight loss. I get it! I absolutely get it.

You... I'm talking again, to the professionals, right? You need to be able to support those fat people. Rather than them having to support themselves, you want to. I suspect you want to help them. It's not that you don't want to, but you don't have the means to do that. So that's why I want to talk to you.

About what I'm offering over the next few weeks. So this is specifically for people who want to practice confidently. Right? But don't necessarily have the evidence to practice confidently. So they know, you know that anti-diet sort of beliefs are correct. You know that intuitive eating is the right way forward. You know that practicing in a weight-neutral or a weight-inclusive approach is the right way to go, but you don't necessarily have the medical evidence to back it up.

And you are frustrated at watching your clients receive harmful advice from medical practitioners. And at the same time, you are unprepared when your clients challenge your weight-inclusive approach and go, "yeah, but what about my health?" Again, you want to be able to answer, but you kind of stumble a little bit, because no one's offered you the training or the support to do that. I get it.

I'm also talking to the healthcare practitioners out there. The doctors and the nurses and the physical therapists and the anesthesiologists and whoever you are out there, and you're like, "I... Do you know what, Asher, I've been following you for a while, and, secretly I really want to be a weight-inclusive practitioner myself, but it's really hard. What do I do?"

I get it. I do, and that is why I have created a program specifically for you. There's two parts to this program. The first part is the weight-inclusive training. It is a 12-module course. You will get a certificate at the end of this 12 modules. It is not easy. It is going to require you to put in the time and the effort. And the money, actually, to advance your skills. It's not simple.

I am going to be talking to you about why weight loss... What controls weight? Why weight loss is unsustainable, which most of you know, but I'm going to be giving you a lot of evidence about that, and I'm going to be talking to you about why weight loss doesn't improve your health, why it doesn't prevent you from getting a health condition, why it doesn't improve your life expectancy. I'm going to be talking about the harms of weight loss advice, specifically the physical and the psychological harms of weight loss advice. I'm going to be talking to you about why weight loss is linked to eating disorders, how quote-unquote obesity policies are actually causing major problems within our societies, and actually making us sicker. I'm going to be talking about weight cycling, what that actually means.

What the evidence says about weight cycling, why a lot of the evidence about weight cycling is limited, and what you need to be able to take away from that evidence, what we can take away from it, what we can't take away from that. I am going to be talking about weight stigma, I'm going to be talking about how weight stigma impacts patients, I'm going to be talking about how weight stigma impacts us as professionals.

I'm going to be talking about medical coercion. I'm going to be talking about paternalism. I'm going to be talking about our duty of care. I'm gonna be talking about BMI-based surgical denials, and weight loss advice in case specifically of surgery. And I'm gonna be talking about how to make people aware of the impact of the weight loss industry funding on healthcare as a whole, what to look out for, how to avoid it, how to challenge it.

And that's the program. And, in addition to that, I have a library of masterclasses. There are currently 17, there are 14 masterclasses, there are 3 much more in-depth courses, one on insulin resistance, one on diabetes and one on PCOS, but there's also 14 masterclasses. I will continue to add to that masterclass library. You've got a condition that you want to know more about. I will add another masterclass on it, no problems, anytime, any condition comes up. Now, you get access, lifetime access to all of these things.

Once you've completed the 12 modules, you'll get a certificate saying that you completed the 12 modules. You also go on a database that I am going to be creating. And this is, I guess, information for everybody right now. The No Weigh movement, we're going to be setting up a database of healthcare, or of professionals that have taken this course.

That doesn't necessarily mean that I can recommend them 100%, you know, that they are definitely good people, because that's impossible to tell. But at least you will have the confidence to know that these professionals have undertaken rigorous training when it comes to medical weight stigma, medical weight bias, and weight-inclusive healthcare. So yeah.

I'm launching it. I don't know if I have launched it by the time this podcast is released, because I don't do dates very well. But it's either going to be launched soon, or it has been launched... And I really hope that there are some healthcare professionals out there that are going to be joining me.

And I really hope that there are some fat people out there going, "I know someone who needs to do this training." Is it free? No, it's not free. I'm not doing this for free. I worked really hard to create this thing. You do have to pay. But there are payment plans, and hey, I'm sorry, we're all professionals. Professionals have to pay for CPD - Continuous Professional Development, by the way, if people are wondering what that means. And the, you know, if you wanted to go to the free ones.

And I have... I'm guilty of going to the free ones sometimes, just to make up the hours, and to look like I'm doing a good job, but you're not going to get actual good quality training from free training. If you want actual good training, you have to pay for it. So I know it's not free, in case anyone was wondering.

Have you got a problem with that, then you should stop listening to the Fat Doctor podcast, because this podcast is not for you.

I really, really, really hope to hear from some healthcare professionals listening to me today, or just professionals in general? I don't know whether you count yourself as a healthcare professional, but professionals, anti-diet professionals, HAES-aligned professionals, whatever you call yourself. I'd love to hear from you.

And next week, I am going to be talking about, I think it's... I think the name I chose was Casey. It was Casey's story. And Casey's story is one that I think a lot of you will relate to about what happens when the person that you trust, the professional that you trust, lets you down.

All right. That's me. That's you. As they say in school, and that's you. See you next week.