Ignoring the Harm: Why We Justify Suffering for Weight Loss

 When doctors recommend weight loss, they describe the supposed benefits but remain silent about the harms—reduced metabolism, increased appetite, hormonal disruption, eating disorders, and profound mental health impacts. This ethical failure extends beyond outdated diet advice to newer interventions like GLP-1 medications, where we celebrate short-term metabolic improvements while ignoring gastrointestinal distress, financial burden, social isolation, and unknown long-term consequences. 

In this episode, Asher challenges the dangerous assumption that fat people should suffer to become thinner, exposing how this narrative serves the weight loss industry's profits while treating fat bodies as unworthy of basic ethical consideration in healthcare. 

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Chapters

• 0:41 Welcome and Episode Introduction
• 7:54 The Long List of Harms from Intentional Weight Loss
• 14:48 Why We Ignore the Harm Weight Loss Causes
• 23:50 The Truth About GLP-1s
• 27:41 You Don't Deserve to Suffer

Transcript

Hello, and welcome to episode 36, Season 5 of the Fat Doctor Podcast. I'm your host, Dr. Asher Larmie, and welcome back!
I literally just stopped recording last week's podcast 2 minutes ago. It's been a week since you've last heard from me, though. Last week we talked about the three main reasons why fat bodies are hated and feared in equal measure. I talked about social reasons, the moral reasons, and the health reasons.
This week, I want to talk a little bit about how we use these reasons to justify the harm caused by intentional weight loss.
Just for those who are new, for those who aren't aware, or those who need a refresher, intentional weight loss is harmful on so many different levels. I know a lot of people, a lot of doctors, nurses, health professionals, just go and try and lose some weight like it's obviously going to benefit you. They don't even pause breath to mention that there might be some unwanted harms as a result of attempting to lose weight. They don't mention them, it's just not part of the conversation, which is really completely and utterly ethically indefensible, because when you are recommending anything, any form of treatment, whether it's a medication, or surgical, or just some kind of behavioral changes or anything, any lifestyle changes, it doesn't matter what it is. When you make a recommendation, you are duty-bound to describe both the benefits and the risks.
You know, pros and the cons. You can't just gloss over them, pretend they don't exist. And they do. And you can't plead ignorance to this either, because come on now, the evidence is overwhelming. I am not going to be telling you anything that is new. We've known about this for decades and decades.
I'm not cherry-picking evidence either. The evidence is overwhelming. Even the experts, even the weight loss experts themselves. The doctors who work in obesity medicine, they go to these conferences. All the experts come together in an international conference and all agree about this stuff. So there's no question about it.
Intentional weight loss is harmful for a number of different reasons. Number one, and I'm just going to give you a little list, and it's not an exhaustive list, but just as a refresher course. Number one, when you attempt to lose weight by restricting how much energy you intake, whether that's through caloric restriction, whether it's because you go on a medication that suppresses your appetite, whether it's because you have your stomach stapled so it's much smaller, whatever it is that you do, you are no longer consuming as many kilojoules or kilocalories of energy.
And when that happens, your body responds very predictably, every single time, the same way, no questions asked. Your resting metabolism is reduced. Plummets. Goes down. Decreases. Your resting energy expenditure, your basal metabolic rate, whatever you want to call it, is reduced.
This persists long after you stop restricting your energy. If you can stop, obviously, if you've had your stomach stapled, it's a lot harder, but this persists. It is persistent. Your metabolism doesn't just kind of shoot back up the next day. Your metabolism is still down there in the dumps. Takes a really long time. Possibly until you've restored all of your lean mass, which takes a long time.
Speaking of which, you know, weight loss is not fat loss. Do not confuse the two things. Everyone's like, you need to get rid of your fat. Nobody says you need to get rid of your skeletal muscle, but you do. When you attempt to get rid of your fat, you will also get rid of skeletal muscle. In fact, you will lose skeletal muscle in preference to fat. Why? Because it requires far more energy to maintain muscle than it does to maintain fat.
So, reduced metabolism. Decreased lean muscle, decreased skeletal muscle. Another thing that is absolutely predictable will happen, no matter what you do, is your appetite will increase.
Your resting energy expenditure, your metabolism decreases, your appetite increases. This is just what happens when you reduce your caloric intake. Especially if you're having less, you're taking in less energy than you use. So it's an energy imbalance. It's not just that you're eating slightly less, I'm talking about you're deliberately eating less energy than you need to survive.
So your appetite increases. And I have zero problems with, I don't think that's a con. I don't think that that's a risk. I don't think that's a side effect. So what if your appetite increases? It's not the end of the world. But that can be quite distressing for a lot of people. It also increases the food noise. You become much more obsessed with food. You think about food a lot more.
And we've known this for a really long time. The Minnesota Semi-Starvation Experiment, I speak about all the time, I refer back to it all the time, because these were 36 men. White men in the 1940s. They were what were called draft dodgers, they didn't want to join the armed forces, and so they volunteered for this experiment.
These men did not think about food except for the next meal. They didn't have to think about food. This was men in the 1940s. They were not cooking, they were not, that's not how they were socially conditioned. And so, when they were put on a starvation diet of 1,600 calories a day, 1,600, can you imagine? It's a luxury for most people, but anyway, when they were starved, they become obsessed with food. They were obsessed. They thought about it, they started collecting recipes, they talked about food, they dreamt about food.
Food noise, we call it food noise. It's a thing. We've kind of pathologized it, food noise. Food noise is literally your body's way of going, you need to eat more. You're not eating enough, so you need to eat more. So, how do we get you to eat more? We make you think more about food. It's very logical, it's very simple, very basic. It's not complicated. And yet this happens.
So if you don't want to be obsessing over food all the time, stop restricting what you eat. That's how to stop thinking about food all the time. Once you allow yourself to eat whatever you want to eat, you stop thinking about food.
Anyway, I have a long list here, and I'm only 3 down. There's more. Intentional weight loss disrupts your hormones. All of your hormones, every single one of them, disrupted. The delicate hormonal balance within your body is disrupted when you intentionally consume less calories than you need to survive.
It will impact the insulin pathway, it'll impact your reproductive hormones, your thyroid hormone, your hormones you've never heard of. Like, antidiuretic hormone. You've never thought about your antidiuretic hormone, but it's linked to your blood pressure, and when you don't eat as much, your ADH is disrupted. Increases your blood pressure.
Intentional weight loss causes digestive problems. It can cause constipation. It can cause damage to the very delicate balance of bacteria within the gut. You heard of the gut-brain axis? Did you know that your gut and your brain are very much connected, both through hormones and by nerves? Fascinating stuff. Really interesting. But yeah, intentional weight loss messes with that.
Intentional weight loss causes gallstones. People come to me and say, oh, I went on this massive diet, and it didn't help my pressure or my cholesterol, but it did give me gallstones. And they say it like I'm supposed to be shocked, and I'm like, well, yeah. I know. It's a well-known, well-documented fact, isn't it? And yet doctors aren't saying that. Doctors aren't saying to people, by the way, this might give you gallstones. If you go on a diet and you lose a ton of weight, that might give you gallstones. More importantly, and this is the bit that really boils my piss, they recommend weight loss for gallstones.
Make that make sense. Not only does it not work, but, whatever. You get the issue here, I don't need to explain it to you.
Intentional weight loss causes changes in our body composition, reduces skeletal muscle mass, also messes with our fat cells, and I keep reminding people, fat is an organ. I know for most people, fat is just an unpleasantness, something they want to be rid of. We just don't want to have any. Actually, it is an essential organ within the body. It has its own blood supply, its own nervous supply, it produces some very important hormones. You can't live without fat. People without fat die.
But it causes changes in our body composition in our fat cells, in our skeletal muscle, and those changes can be permanent. So those changes are not necessarily things that we can kind of fix. It's kind of like smoking can cause long-term damage to our lungs. People always panic, then. They're like, well, have I done the damage? Has the damage done? I'm like, well, it doesn't matter, does it? The damage is done.
No point crying over spilt milk, as I was often told. So, even if there is some long-term damage there, unless you want to cause more damage, something you could do about it, so stop doing the damage. In other words, stop intentionally trying to lose weight, and then you won't cause any more long-term changes to your body composition. It is not the end of the world, but it does happen.
Speaking of weight cycling, remember before I was saying that when you try to lose weight, two things happen, your metabolism is reduced and your appetite increases? That is why weight loss is not sustainable for literally pretty much everyone. Those people who do manage to sustain long-term weight loss usually do so through harmful methods. They don't want to admit it, we don't want to admit it, but basically, I don't want to diagnose people with eating disorders on the internet, but yes, the behaviors that they exhibit are very similar to those that could be easily diagnosed with an eating disorder.
Speaking of eating disorders, there's one study that showed that intentional weight loss, severe dieting amongst teenagers increased the risk of an eating disorder by 18 times. 18. There's no doubt that dieting is the biggest risk factor for any eating disorder, actually.
But going back to weight cycling, there's eating disorders, which is problematic, but also, the fact that weight loss is not sustainable, that we tend to lose, and then gain, and then lose, and then gain, and then lose, and then gain. We call this weight cycling. And we know that this is linked to all sorts of poor health outcomes as well.
So, that's quite a long list already, right? We've talked about the metabolic changes, the hormonal changes, digestive issues, we've talked about changes in your body composition, skeletal muscle. Talked about weight cycling, we talked about the risk of eating disorders, and we haven't even touched on the mental and emotional impact of dieting.
Not only does it make you feel like crap, it's linked to depression, it's linked to poor body satisfaction, low body satisfaction, poor self-esteem, internalized stigma, shame, depression, anxiety. Substance abuse, suicidal thoughts.
There are studies that show that dieting can impact not just your mood, but your concentration, your ability to memorize things and focus on things, all sorts of things. Your brain doesn't just need calories, it needs carbs. And people are just being told left, right, and center to just never eat carbs again. It's horrendous. Really, really bad for many things, and including your brain, which is kind of an important organ in the body.
In addition to the mental and emotional well-being, then there's your social life. We don't talk about social health very well, but intentional weight loss has a really incredible ability to isolate people. Social isolation is actually a risk factor for poor health, in of itself. But it can be very isolating.
Dieting also impacts your finances, for the most part. Very few people are dieting for free. That's also a problem. So yeah, that's just some of the many reasons why intentional weight loss is harmful in all sorts of different ways.
So how do we get away with it? Why is the weight loss industry thriving? And why are we as a whole, as a society, absolutely willing to go ahead along with it? We know diets don't work, we know that they don't improve our health, we can admit that they're harmful, and yet we still go through with it. We're still doing it, we're still pursuing weight loss all the time. How, why is this happening?
And I guess in the last episode, we talked about why fat is framed as the problem. We are taught to hate and fear fat in equal measure. Why? Because of social reasons. That fat people don't belong in society for moral reasons, that fat people are worth less, or are worthless, and for health reasons. Because somehow we linked being fat and being healthy, even though the two really have nothing to do with each other.
And so if that is the problem, if that is framed as a problem, then weight loss is therefore framed as the solution. Which is kind of good news for the weight loss industry, which is worth hundreds of billions of dollars a year.
Here's the thing, even if weight loss was a solution, even if it was sustainable, even if it actually did improve health conditions, it doesn't, but even if it did. Question, what about the harm? Even if there were benefits, what about the harm it causes? Why do we not consider that. Why do we not mention it. Why does this part of the conversation never, why is this part never included in the conversation?
And I don't get it. How do we justify harming fat people over and over and over again?
I spoke last week, I said I was at a conference a couple of weeks ago now. I was on a panel talking about weight stigma, and, as panels often go, there's never enough time. And there was only one question from the audience. And, basically, this audience member was just like, I hear you, you say about evidence, but I've been on a GLP-1 for I don't know how many months, and my cholesterol has come down, my blood pressure has come down, my A1C has come down, my this has come down, my that has come down, basically was telling me the virtues of being on a GLP-1. So how can you say that weight loss isn't good for your health?
And I looked at that guy, and I was just like, I hear you. But more importantly, I have heard some version of this for a lot longer than GLP-1s have existed. And this is the thing, I've been doing this job now for 20, or 25 years, almost. This is not the first time I've heard someone say that. I can distinctly remember when everyone was talking about the 5-2 diet, intermittent fasting. And there were all these people going, how can you say intermittent fasting doesn't work when my blood pressure has come down, my A1C has come down, my this has come down. It was the same story, it just wasn't GLP-1s.
There are weight loss drugs, I don't need to tell you, it's not the first weight loss drugs to ever exist. People say it about bariatric surgery. They say it at the beginning, and there's this kind of desperation in society. Because if fat is a problem, then we need a solution. And so, anytime someone comes up with a solution, especially someone with good marketing, good PR. We are so ready to buy into that solution. So ready. We are primed, because being fat is a problem. And a lot of us are fat, so we're ready. We have been rejected by society. We have been told that we are worthless. We have been told that we cannot be fat and healthy, that our health is very much determined by the size of our bodies, and so we're primed, we're ready, and someone comes up with a solution, and we will grab it, and we will stop caring about the evidence.
Because here I am in a conference, as I said, this is a conference specifically for skeptics. This is a conference about science and critical thinking, and people are scientists and critical thinkers, and they look at evidence, and they are interested in evidence. And here's a guy saying, well, it must be true, because this has been my experience. And we all know that anecdotal evidence is not evidence. I'm sure this guy knew that as well. I'm sure he knew it. I'm sure if you asked him, is anecdotal evidence real evidence that we should be basing our beliefs and our understanding on? He'd probably go, no. But in this case, he bypassed all of that, because he was so determined to believe that he had found the magic solution. And it had worked!
And it'd been out for a few months, so of course it worked. I was like, well, yeah, I mean, it's not news. When you start starving yourself, your HbA1c will go down, as will your blood pressure and your cholesterol, and it will stay down probably for a year, maybe 2 years, maybe sometimes even longer, but not more usually than 2 years.
2, 3, I mean, you know, everyone's different, I don't want to, how long is a piece of string, but the evidence makes it very clear that it doesn't work in the long term. Your body will readjust. I've just explained to you how, your body readjusts. Hormonal disruption, reduced metabolism, increased appetite, all sorts of reasons why this doesn't work in the long term. It just works in the short term.
So I'm looking at this guy, and I'm like, there's so many ways I could answer this question. But what I really didn't want to do was I didn't want to invalidate his experience. Because it obviously was working for him, and he was feeling really good about life. And I didn't want to say, it's not going to last. It isn't going to last. But I didn't want to say that. I don't want to be the person that said that.
And you know, his HbA1c has come down. He's taking a medication that is prescribed to diabetics. It should come down, it's supposed to come down. And if your HbA1C comes down, if your insulin resistance reduces, that improves your blood pressure and your cholesterol, to a degree, for some times, but it also stresses out the body. And so, at some point in time, the stress to the body somehow, the balance is tipped, at some point in time, the stress to the body actually is worse than any benefits for the insulin resistance, and so, that's why we don't have any long-term evidence that this drug benefits health conditions.
It does reduce HbA1c when we do have evidence that it works on diabetes. I would like to just point that out. It's a diabetic drug, these GLP ones, and yes, of course they work on diabetes. So I'm not saying they don't work long-term for diabetes. And maybe they do to a degree, because as I said, they're working on the insulin resistance, maybe they do bring down your cholesterol a little bit, maybe bring down your blood pressure a little bit. So that might work, but there are also lots of ways to bring down your HbA1c and blood pressure.
The critical thinking piece that was missing was that he was assuming that because he took this drug and lost weight. Then, therefore, weight loss had all of these health benefits. And I was like, that's a post-hoc fallacy, it's what we call it. When one thing follows another, and then we assume that it causes the other. The weight loss was a side effect of a medication that was clearly benefiting him, in terms of his numbers, whatever those numbers were. That is not evidence that weight loss works.
And I said to him, and I don't think he liked this part, I said, look. Novo and Lilly spent a fortune on the STEP trials, the Wegovy trials, the semaglutide trials, to prove that these weight loss drugs are good for you. They collected a lot of data about blood pressure, and HbA1c and cholesterol. They collected all the data. And they didn't publish it. Or they didn't publish a statistical analysis, I should say. And you gotta wonder why.
If this drug actually did benefit your health, why didn't they publish the data? They had done so many trials since then, trying to prove to us this is good for our health, and they failed at every hurdle. Yeah, they'll say, they'll tell you it's good for your cardiovascular health. That's not what it's saying. Not really. I mean, there was a study, and it helped a group of very old people that had a heart attack in the past possibly not have a second heart attack again. I mean, it was a bit iffy, but not that convincing. There's no evidence, no overwhelming evidence that it improves your heart health.
The lies they tell us. But what is really interesting is that we still aren't talking about the harms. We talk about this drug. Does it work? Does it not work? Is it the miracle cure that we've all been taught to believe that it is. And there are people arguing about whether it's cheating, are you cheating by taking this drug?
That's the argument that we're having. These are the conversations we're having. You go and Google Ozempic, or Wegovy, or Semaglutide, and you see the articles that are being written, and the speeches that are being made, and all this stuff. Is it ethical? Is it moral? Is it cheating? Does it work?
Nobody is talking about how harmful this drug is. Nobody is saying, oh, by the way, it's really a horrible drug to take. It makes you feel like crap. This guy didn't mention how crappy he was feeling. Maybe he was one of the lucky ones, he didn't have any side effects, but I refuse to believe that, because looking at the data, almost everybody has side effects. Maybe we've learned to accept them and tolerate them, and everybody has a different level of what they're willing to tolerate and accept, but they do have side effects.
They have gastrointestinal side effects. They do impact your metabolism. They do, I have to say, they do shut off your appetite, and therefore you don't have as much food noise as you normally would if you went on a diet, but they do disrupt your hormones. In fact, we don't have any definitive answers about how it impacts the insulin pathway, your pancreas, your other hormones. Nobody's looked into this. We don't know how that's going to impact people in the long term. We could be causing serious damage to our body's endocrine system with these drugs, and we wouldn't have the first clue. Because we have what, two, three years' worth of data? We don't know.
It does cause changes in body composition. People who take it, will, the moment they stop taking it, will gain weight. And for the most part, people are taking this drug privately, because it's not free for most people, even in the UK, where it is technically, you should be able to get it technically free, most people can't. They don't qualify, or have to wait too long, whatever, or there's a supply issue, whatever, so actually people are buying it privately.
So, it is impacting you financially. It does impact you socially. If nothing else, it makes you have diarrhea all the time. And unpredictably so, or it makes you vomit, or you can't go out and enjoy a meal. It impacts you socially. It does impact your mental and emotional well-being. As somebody who has taken a GLP-1 for my diabetes, to be fair, not for weight loss, but it doesn't matter, it did impact my mental and emotional well-being, and there's more and more evidence that it does. This is emerging evidence.
It's been linked to worsening arthritis. Folks, there's potential links to cancer. This is not some permanently safe drug, it's not safe. Why are we not talking about this? Why are we not talking about the harm? Why are we not asking the question, is it worth it? Does the benefit outweigh the risk? Or does the risk possibly outweigh the benefit?
It just makes me really angry that fat people are not worthy of this conversation, that there's nothing that society isn't willing to put us through in order to make us thinner. It doesn't matter how much we suffer. In fact, we should suffer, right? We've been told that we are worth less, so of course we should suffer. We have been told that we are unacceptable, that we are abnormal, that we are undesirable, so of course we should suffer.
It's part of the course, it's almost a way to redeem yourself. Slightly. Somewhat. Not fully, but you know, you're worthless, but you can be worth a little bit if you at least suffer to get thinner. And it's not fair.
It's not fair that we don't have this conversation about harm. It's not fair that as health professionals, we're not having this conversation about harm. Why are we telling people to consider the shots without, in the same breath going, here are the benefits, and here are the risks?
That is your responsibility as a healthcare professional. You don't have the right to just skip over the risks. It is ethically indefensible, and yet that's what doctors are doing on a daily basis. Have you considered the shots?
Makes me mad, as you can tell, boils my piss. I didn't actually intend for this episode to turn into a rant about semaglutide, but there you go.
Folks, It's not okay to ignore the harm. And I'm talking to the fat people out there right now, I really need you to hear this. You don't need to suffer, you don't deserve to suffer. You should never have to suffer, you shouldn't feel obligated to suffer.
You can just be fat and exist and not be punished for it.
You have the right to say, I don't want to be punished for something that really is pretty much out of my control. Even if I could control it, I still have the right to choose to be fat, if nothing else. I am a human being, and I am entitled to live a life free of pain and suffering. Or to at least pursue a life that is free of pain and suffering. There are some things we can't control. We suffer in so many ways, we experience pain, sometimes our bodies just are mean to us. And we end up in pain and suffering, but that's something we can't control, but we at least have the right to pursue a life that is free of pain and suffering.
No more just ignore the harms, just ignore the side effects, just ignore the downside, and focus on the plus side. It's worth it. It'll be worth it in the end, it's not worth it. Nobody gets to tell you that it's worth it for you to suffer.
So yeah, that was the message. That's the end. That's all I have to say about that. Thank you very much for being here, and for listening, and we're going to keep having these conversations, I hope, about suffering. About the fact that we don't deserve to suffer. And about the many harms of intentional weight loss. We've got to stop ignoring that.
And if you are being told to lose weight by a family member, a friend, a doctor, a healthcare professional, a colleague, whatever, the internet, I urge you to turn around and go, and what about the harms? What about the risks? What about the dangers? Talk to me about that. Look me in the eye and tell me that that's what you want for me, and for my life. Tell me that you want me to suffer physically, and mentally, and emotionally, and socially, and financially. Look me in the eye and tell me that you think that's what I deserve.
See what they say.
Alright, next week, I'm going to be talking about Cosmo. The name Cosmo came to me, I'm obsessed with this name now. So I'm going to be talking about Cosmo, Cosmo story, Cosmo's trip to the diabetic clinic. Cosmo's not me, I am not Cosmo, but we may have lots of things in common. So, come back for episode 37, and have a good week in the meantime.