The HAES® Controversy: Is it Evidence-Based? (with Dr. Idz)

You might remember when I was a Health At Every Size (HAES®) advocate. HAES is a compelling rival to diet culture, and it’s easy to get sucked into this popular movement.

I've changed my tune a bit, and I’ve written about my thoughts on HAES®, but I knew I needed to recruit someone else onto the podcast so we could critically look at this movement together and have a balanced conversation about it. That’s why this week’s guest is Dr. Idz.

Dr. Idz is not only a powerhouse in his field but also has a knack for debunking health movements and trends. If you’ve seen his TikToks or Instagram reels, you’ll know what I mean. 

No stone will be left unturned as Dr. Idz brings the receipts of studies showing HAES® to be incorrect in ways, and we’re talking about A LOT of studies.

I’m really excited for you to hear this episode with Dr. Idz. He brings not just expertise but also a passion for nuanced conversations—a perfect match for the kind of discussions we love having on the podcast!

TOPICS COVERED 👇 

The Health at Every Size Movement (00:06:21)

Controversies surrounding the HAES® movement (00:09:43)

The potential harm of downplaying the implications of obesity (00:11:17)

Evidence debunking HAES® (00:21:30)

Discussion on metabolically healthy obesity (00:31:00)

Considering the impact on mental health (00:35:45)

Using outdated studies to support arguments (00:44:12)

Evidence supporting long-term weight loss interventions (00:48:54)

RESOURCES MENTIONED

HAES article (by me)

Dr. Idz's online school

Dr. Idz on Instagram

Dr. Idz on Tiktok

LEARN MORE
🔥 Work with me in Nourished & Free®
👀 Stalk me on Instagram
💻 Watch my FREE training, "Why Can't I Stop Thinking About Food?"

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Transcript

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Michelle (00:00:03) - We're back with Dr. is on the Nourished and Free podcast. And today we're discussing a topic that hits close to home for me, which is his health at every size, evidence based or not. Is the Hayes movement really grounded in science? Now, in case you're new here, I'm Michelle Yates, an eating disorder specialist dietitian, and this show is creating space for nuanced conversations around pressing topics in today's nutrition and wellness spaces. In my last episode, I talked with Eds about some key ways to know whether or not the information you're hearing is credible or trustworthy, which is an important episode. So please go back and listen to that if you haven't already, just so you can arm yourself with knowing if what you're hearing is is really grounded in research or not. And this flows really nicely into today's episode, because I personally have found a lot of red flags with the health of every size movement, and I wanted to have an open dialogue about it, which is something that I feel like there's not really opportunity to have. So to provide some context into what we're discussing. For anybody new to this topic, I'm a dietitian involved in the treatment and prevention of eating disorders, and diet culture is often the main culprit to blame. If you ask an eating disorder professional about why these disorders exist in the first place. Therefore, we have the anti diet movement, which is supposed to heal some of those broken relationships with food and our body and prevent eating disorders to from coming on in the future, or at least help to treat the ones that already exist. Now I want to be super clear. I value the work done in the anti diet space. My target population is women who are struggling with disordered eating all along the disordered eating and eating disorder spectrum. So I have seen the benefits of this overall movement in terms of treating and preventing eating disorders. But with that being said, I do feel like the anti diet space is perhaps getting away with some things that I think we should address and talk about more openly. So I wanted to have an open dialogue with Dr. is about this today because we've already had some small discussions about this on our own. And so I wanted to really dive all in and, and hit the record button so that we could share this conversation. So let's dig into health at every size, which is kind of the heartbeat of the anti diet movement. And I am going to post a link to an article that I wrote about health and every size in the show. Notes. If you want to have a more written look into into some of my thoughts that I had about this last year. Before we jump in, I want to reintroduce my guest today. In case you have not listened to my last episode with him. So Idris McGill is a medical doctor based out of the UK, and he has his master's in nutritional research. He's also board certified in lifestyle medicine. He's known as doctor EDS on Instagram and TikTok, and has a combined following of over 2 million due to his hilarious reaction videos, where he breaks down the flaws in the health and wellness videos and information that we see today. What I love about his videos is that he shares the actual evidence behind it, and he's also really great at having balanced conversations, so that's why I felt like he was a really good resource for this topic today, because we can both acknowledge that there's a lot of good with health at every size, but we also want to point out some of the things that we feel like might be it might be missing the mark with Dr. is has a really loyal community of followers and people who are interested in learning more about nutrition research and health and wellness and the science behind it, which is wonderful. And he's actually created an online school. It's called The School of Doctor Eds, and I've had the pleasure to be a teacher in that school. So I'm really thankful for that opportunity. And I'm also thankful that he took the time to sit down with me today to talk about these important topics. As we dig into this episode, I want to warn you, this is the same spiel I had with my last episode because we recorded it all in one go. Both of these episodes I made a mistake, and I used my AirPods as the microphone instead of my actual microphone, and if you know anything about tech, that was a really dumb idea. I didn't do it on purpose, let me say that. So it was a total accident. I made the mistake there, and only after we recorded did I realized that my audio quality was going to be severely impacted because of that. So I want to apologize in advance for me, the host of the show, having a terrible audio quality. I would expect more from someone that's hosting a podcast. So just know I'm aware of the issue and I will be correcting that going forward and triple checking to be sure that I have the right settings so that my mic is the actual thing. Picking up the audio. So I didn't want to scrap the whole episode because I felt like it was such a good conversation. And Dr. Is was already so gracious with his time that I was not going to ask him to redo that. If it was an episode I did solo, I would just rerecord it, no problem. But it's a little bit different. You have a guest, so I apologize in advance. I hope that you still enjoy this episode, despite it sounding like I'm on the phone and. Let's dig in. Okay. So I want to dig into on this topic of you know who to trust when it comes to nutrition advice. I want to dig into a sector of of the nutrition and health and wellness space that is super big, especially for me in the eating disorder dietician field, which is which is health at every size. So I know we've talked a little bit about this on our own, but I'm super excited to have that more balanced and nuanced conversation and be able to record it. So I did an intro on this to kind of explain a little bit more, but I'd love for us to kind of just jump in and. For us to talk about health at every size here, which is basically the heartbeat of the anti diet movement. And there's a lot of really popular anti diet influencers out there and stuff. So it can be tricky because they are credentialed professionals typically. So it's again you've got that trickiness of should I trust this person or not. Is what they're saying really evidence base. So let's dig in to health every size in particular and kind of have a conversation there and open dialogue and see see what we come up with here. So straight off the bat, why don't we tell the listeners what health at every size really is? Do you want to define it? Do you want to kind of dig into what it is?

Dr. Idz (00:06:20) - Yeah, sure. So. Essentially the health at every size movement or kind of Hayes movement is, you know, it's an approach to kind of, you know, like public health prevention and treatment that kind of seeks to de-emphasize or, you know, deprioritized kind of weight loss as the primary health goal. And in order to reduce stigma against basically fat people or kind of obesity in general. It's about, you know, the acceptance of all body sizes and the idea that health outcomes are not exclusively dependent on someone's weight. And instead it's, you know, rightly so, encourages behaviors that promote, you know, well-being regardless of whether they, you know, result in weight loss or not. Right. And some of the key principles that they, you know, they seem to advocate for is obviously about weight inclusivity. So you've got the acceptance, for all, you know, body sizes and shapes without kind of prioritizing one over the other. Right. You've got things that kind of enhance people's health. So, you know, focusing on well-being, this includes kind of attention to, you know, psychological support, kind of physical support, social well-being, you know, reducing kind of the barriers to healthy living. Then another big aspect of it is about kind of respectful being, kind of having showing respect and having respectful care to them. So it's about kind of, you know, challenging, you know, weight discrimination, you know, weight stigma, especially in medicine and especially in kind of social environments. This includes kind of equal access to already, as I said, kind of health care and the elimination of kind of biases in kind of the medical field, health policy. And then they have other key principles such as, you know, healthy dietary patterns, of course, you know, eating kind of around an intuitive style of eating, you know, it's individualized based on, you know, your hunger, how you're feeling, your nutritional needs. You know, you're kind of like even enjoyment of food, right? Pleasure rather than being externally regulated, you know, having like a structured, rigid kind of food rule system. Right. It's kind of less towards that, that kind of thing. And then you have obviously the importance of movement and, you know, encouraging kind of movement and all physical abilities and interests in engaging in, you know, things that you enjoy doing. So essentially what it boils down to is these Hayes advocates, they are traditionally critical of traditional weight centric models of health. And they argue that it can lead to stigmatization, you know, eating disorders and also, you know, cyclical weight loss. So, you know, weight cycling or yo yo dieting may be detrimental to health. And then, you know. Some people can go too far in this kind of field where I have no issue with any of what I've just summarized. And, you know, I'm sure most health Hayes advocates would actually agree with my kind of my summarization of of what it is they stand for. Right.

Michelle (00:09:43) - I would say so, yeah. Yeah.

Dr. Idz (00:09:44) - And I think, you know, this can it's important to note that the Hayes movement isn't without controversy. And that's for several several important points. You know, some professionals may argue that kind of excessive body weight has no inherent damaging effects and that obesity is, you know, the health outcomes associated with obesity are completely fabricated. And, you know, they lack the confounding variables which which we will get into, believe me. You know, I want to I want to really I really want to kind of unpick these, these topics and, and also the claim that, you know, even if you are classified as being obese based on a weight centric model, as long as you're metabolically healthy. So you've got, you know, healthy kind of biomarkers, you know, kind of blood pressure, you know, lipids, your glucose regulation. As long as your heart and your lungs are functioning well and you've got good fitness, then you can be whatever size you want to be and you'll be perfectly fine, right? Those are the main areas in which I disagree, and they are demonstrably, factually incorrect. And it can be damaging in that aspect. Right. So I think there needs there needs to be a better balance for Hayes advocates to 100% promote healthy behaviors, you know, not make weight loss as the end all, be all, of course. And, you know, promote the consumption of healthy foods, promote physical movement, promote, you know, stress relieving activities, and not be so rigid in kind of your health interventions and to promote the importance of socializing and, you know, just generally leading a health promoting lifestyle to the best of your ability and access, right? Yeah, yeah. But then don't don't downplay the implications of carrying excess adipose tissue, especially visceral adipose tissue. And don't make statements such as, you know, obesity has no inherent harm at all. And as long as you're metabolically healthy, you'll be completely fine. These are not correct. And it's misleading and it's potentially damaging to a lot of people. So I think those are the main points. Oh, and the other point is they think that when people lose weight, their health improves because of the things you're doing, not because of the weight loss. Right. So they're they're they're kind of I and I've had back and forth with dietitians about this literally publicly right online.  And they say actually, you know, even even a couple of doctors as well. They say, actually, when you see improvements in health markers from people losing weight, it's because they're improving the habits they're engaging in, you know, they're moving more. They're eating better foods, right? They're reducing certain, you know, fried foods and, you know, quote unquote, junk foods. And the weight loss is a byproduct that's not actually helped in any in any situation. Right. That's another point, a very vital point that I would strongly disagree with. And we can go over the evidence of that as well.

Michelle (00:13:05) - Yeah. Yeah. So for the listeners who maybe just need a quick definition on adipose tissue and visceral adipose tissue, do you want to just define that really quick for them.

Dr. Idz (00:13:15) - Right. So adipose tissue is basically fat tissue. So fat mass and you know carrying excess adipose tissue is typically defined as anywhere from kind of, you know, 20 more than 25% of total. So having 25% body fat or above for men or having 30 to 32% body fat for women.  Right. And as much as the Hayes advocates won't like me saying this, I'm sorry, but BMI very strongly correlates with body fat percentage. And all of the validation studies show this right as your BMI. There's literally a SriLankan cohort of ethnic minority people, more than a thousand people that are sighted recently in a in an Instagram screenshot post, and also a video where every single person that had a BMI over 30, which we would define as being obese, right, also had a body fat percentage that would also define obesity. Every single person there wasn't one exception. Right. So clearly, clearly, you know, people being obese. Still being classified as obese, depending on whatever definition you're using, whether it's BMI or body fat percentage. In the vast majority of cases, especially in the Western world where everyone's sedentary anyway, we don't really move. We don't really have that much muscle anyway. Right? For the vast majority of people, these definitions are perfectly sound to define someone as being obese. Yes, there are exceptions.  Of course there are exceptions. If you're an elite level bodybuilder and your 5% body fat but you're classified as being obese, then you're not obese, but you are still at an increased risk of health issues because you have your carrying excess weight, even if that weight is muscle. Right. So that's another interesting conversation we can have. Yeah. Yeah. So even carrying too much muscle is actually damaging. I'm talking too much. I'm not talking like a recreational gym goer who goes five times a week. I'm talking you've dedicated your life to this for 20 years and you've got insane amounts of muscle. And you're, you know, you're dieting in a way that's quite detrimental to your health, right? Yeah. Anyway, so so BMI in the extremes is strongly predictive of health issues. And that is strongly predictive of carrying excess or carrying too little body fat for the majority of people. Obviously exceptions are there.

Michelle (00:15:46) - Yeah. I think you bring up some really, really good points. And with the BMI, you know, I have told you before, I used to be a haze advocate and everything, and that's that's a conversation I used to have a lot too, about the BMI and about how it wasn't designed to predict health status and everything. But I mean, there is like there's room for nuance there, too, that we can recognize. Okay. Yeah, maybe it's not always showing us exactly what we need to know about a person, right? It doesn't give the whole picture of their health. But we can also say that there is logistic or logical evidence showing maybe there's some correlation there between body fat and everything. It's not always going to be the case. Just like you said, there are exceptions.

Dr. Idz (00:16:25) - In the same way that we shouldn't use BMI as a sole predictor of health outcomes, right? We shouldn't use anything as a sole predictor of health outcomes, right? We shouldn't use someone's cholesterol. We shouldn't use someone's blood pressure. We shouldn't use someone's estimated glomerular filtration rate EGFR for kidney function. Right? We shouldn't use someone's white cell count. We shouldn't use someone's hemoglobin count. Right? Yeah. No matter what metric you're using, you're not supposed to use anything in isolation. So this whole argument like, oh, BMI is not valid because by itself it's pretty meaningless. Anything, everything in medicine, like every every objective assessment or number we have in medicine, you're not using it in isolation. So that argument to me is just a not a valid argument to try and discredit BMI because as with anything, it's not very good at predicting things by itself. The only thing I would say, the only marker in all of medicine that I would say that is very good at predicting things by itself is probably LDL. It's probably yeah, LDL is probably the most robust clinical indicator for disease later in life. And that's cardiovascular disease.

Michelle (00:17:36) - Which is a type of cholesterol for those who don't know. Yes.

Dr. Idz (00:17:39) - Exactly. Yeah.

Michelle (00:17:39) - So yeah. Yeah. And I think the BMI discussion is like it's such a it's such a hot topic. Right. Because there's these people, this group of people, right, who are struggling with eating disorders or body image distress and hearing something like, oh, your BMI is high. It's just like literally the last thing they need to hear. But I also think that it's important not and this is somewhat new for me in the last year or two, is to not sugarcoat those things either. I think we can say respectfully, this may increase your risk. You might have an increased risk because of this. But also let's talk about the deeper stuff going on, though. And so I think that's an important balance that gets missed a lot. And why a lot of people in the US get really hurt by by the BMI discussion, because they do have those 8 to 10 minute meetings with their doctor. And the only thing that's really discussed is the BMI. So therefore you need to lose weight. And there's not much else discussion on the rest of their health which which is harmful. Right. Like that is that kind of weight stigma that we're talking about where it's like, hey, I'm a whole person. There's more to me than just my BMI, and I'd appreciate you digging into that more. You know, it's just it can make people feel dismissed. Yeah. For sure.

Dr. Idz (00:18:52) - I think it all just it all boils down to, you know, promoting healthy behaviors and, you know, not sugarcoating the fact that obesity is harmful, right? Yeah.  There's no reason why you have to fall on one side of the, of the discussion, right? Yeah. You could educate people as to the harms of excessive body fat, but also, you know, encourage health and routing behaviors which should indirectly lead to, you know, weight loss as a, as a primary goal or a secondary or. Primary goal, right? And you know, you do it in a way that's not kind of stigmatizing. It's not, you know, losing all hope. You're not saying to someone, if you don't lose a bit of weight, you're going to die and you know, you're worthless, you're useless person. No one saying these things are beneficial to anyone, right? All any credible professionals should be doing is a balance of education, implementation, accountability and also providing a balanced discussion surrounding the topic. Right. I think stigmatization is a massive problem. I think too many doctors, healthcare professionals, even dietitians. I've had many DMs you know about, oh, my dietitian put me on a 1000 calorie diet and said, I'm too fat and I need to lose weight. And it's like, yeah, you know, it comes from everywhere. It comes from everywhere. And I just think we just need to be a bit more sensitive, a bit more mindful, but also work on starting someone's health journey as a team and not making them your enemy. Right. They're not your enemy. Don't just demonize them. Don't just say, you know you're useless. You're fat. Right? You've got no hope for your health, right? Encourage positive change and maybe you'll see benefits later on, right? Don't be so kind of dismissive and, you know, not willing to hear their their genuine concerns.

Michelle (00:20:42) - Right. Yeah. So I feel like we've got we've got a lot of positives with the health of every site that he's movement and everything and he's advocates, which is that more like whole person type of health care, right, where you're seeing them as a whole person, not just the number on the scale or their BMI. And you're listening, being kind, not judging a book based on its cover, right, for lack of a better term. But but with that, you know, as you mentioned, there's maybe some maybe definitely some things that that missed the mark and that they're promoting or very passionate about that maybe there isn't a lot of evidence to back up. So dive more, if you will, into the, the, the things that you feel like there's there's just flat out evidence debunking haze in a sense.

Dr. Idz (00:21:30) - Okay. So yeah, one of the, one of the main points that I've come across, which is a clear red flag for any haze creator, is, you know, the notion that obesity is not harmful, right? This is I can't even begin to tell you the level of evidence we have. And I don't just mean observational. Let me just outline some things that I know from the top of my head, because I've written about this and I've done multiple videos about this extensively. So we have Minseo Kim et al, 2021, which is an umbrella review of 53 meta analyses. Yeah. If you don't understand what a meta analysis is, a meta analysis is a study of studies. Meaning you find studies on a similar on the same topic that look at the same outcomes that use the same types of people. So in this case it will be obesity and it will be, you know, the outcomes will be all kinds of health issues. There are 53 of them which include over 500. And I think it's 501 cohort studies and 12 Mendelian randomisation studies. And Mendelian randomisation is a type of it's a type of research study that looks at genetic variances in individuals, which then you assess basically the outcomes of these genetic differences. And then that helps you to infer causality behind certain exposures. Right. So being obese, for example. And the reason why that's so strong is because you take out the issue of confounding variables, because your genetics can't be influenced by how much you exercise or what you eat or. Right. So if you know that someone's genetic predisposition leads to someone having certain health issues, then that's a causal implication. That means it's causative, right? So it's a lot stronger than an observational study. And what they found was that, you know. Higher body weights and higher BMIs. And having obesity was linked to, you know, had strong evidence for heart disease, heart failure, atrial fibrillation, all kinds of strokes, hypertension, pulmonary embolism and the Mendelian randomisation studies. They found causal effects for all of these health outcomes, all of them apart from stroke. Right now, that's one piece of evidence. Then people might say, yeah, okay. Well, that's, you know, that's observational and there's some genetic studies there. But, you know, even though I just mentioned 500 of them, you know, but what about the randomized control studies. Right. What about where are the control studies? Well, I'm glad you asked, Hayes advocate, and I am glad you asked. Well, here here they are. Here they are. Right. So we have we have meta analysis of 53, I think 54 or 53, one of them controlled human studies by Chen Han Ma and colleagues in 2017. Right. That found high quality evidence that weight loss as a primary intervention. So the primary thing you're working towards is weight loss, right. Reduces all cause mortality by 18%. Right. There's another meta analysis in 2015 by I think Steven, I'm going to butcher his last name like tried chefs and colleagues in 2015, which was a meta analysis of 15 controlled studies that looked at interventions only over 18 months. They weren't short term, over 18 months.

Michelle (00:25:18) - Right. So interesting.

Dr. Idz (00:25:19) - On weight loss and mortality. Yeah, on weight loss and mortality. They found that weight loss directly led to a 15% lower all cause mortality, which is a risk of all death from all causes. Right. So. Now that we've established that obesity is inherently harmful by the overwhelming amount of observational, genetic, Mendelian studies and weight loss intervention studies that look at the impact of weight loss as a direct intervention, right. For people that say, oh, well, these people could have had a lower risk of dying because of how they went about their weight loss. Right. Not it wasn't really about the weight loss itself. It was about because they were moving more because they were eating better. Right. That's a good that's a good rebuttal. However. That is a very useful example to look at. And it was done literally in like I want to say like 19. 1997. Now this was by Sir Wit and colleagues that looked at the connection between dietary habits, weight loss and health. Right. So two groups of women were given diets that were identical in calories, identical in calories, protein, carbohydrates, fats. They and they ensured that both of them would lose weight. Right? The key difference was their sugar intake. So one group consumed a 120g of table sugar each day. And while the other group only had 11 11g, 11g of of sugar. Yeah. Despite the high sugar consumption, no reliable or credible professional would advocate for 120g of refined sugar in someone's diet. Right. Every single day. Every single day. Right? Despite the high sugar consumption.  Both groups experienced weight loss, lower blood pressure, and improved blood lipids. Now, if you're going to make the argument that weight loss isn't the thing that improves your health, how do you explain this study? They both lost similar amounts of weight, and they both had similar amounts of improvements in their blood pressure and their blood lipids. But the one group consumed 120g of added sugar every single day. So that's a direct slap in the face for anyone that says weight loss doesn't directly improve your health. Yes, it absolutely does. Because even if even if the method of you achieving weight loss is not optimal for your health, of course having lots of refined sugars or, you know, not exercising or not eating your fruit and veg, no one would recommend those things. It's only to prove a point that even if you are to lose weight via non health promoting habits, the fact that you're losing that excess adipose tissue will still improve your health to a certain extent. And in this study, it showed similar improvements to the group that only had two teaspoons of sugar.

Michelle (00:28:43) - Yeah.

Dr. Idz (00:28:43) - So that's a really, really useful example.

Michelle (00:28:47) - Yeah it is I love that. I actually just came across that a couple of weeks ago. I'd never seen that study before. And I was like, this is the coolest thing I've ever seen. I wish they would do like replicate it, you know, because I was like 97. I wish they would replicate it.

Dr. Idz (00:29:00) - Yeah. The thing is, with control studies now, we are obviously a lot more ethically sound minded. And we don't just do interventions that obviously have evidence for harm. Right. So you would be hard pressed to find a study like that to be done. Now, if anything, you know, the more lax kind of ethical panels we had back then, they were actually very good. You know, it's kind of like the mad scientist that does, you know, unspeakable things on people, then comes out with a world changing discovery. Right? It's kind of like it's kind of like we have the evidence from then, but we're not we're not really wanting to replicate those things because we know it can cause harm. So that's why we kind of we kind of have to look back. We have to look back to older studies where they're doing things that we would be like, okay, maybe let's not do that. Yeah, yeah. So, so so that's a very good point to discuss around obese being not inherently harmful when it clearly is weight loss as a primary intervention, not improving your health. But it clearly does. Right. And also it isn't the weight loss that is causing health improvements. It's the other things you're doing that's obviously they are synergistic in nature. If you're losing weight by doing health promoting activities, then yeah, your health is going to obviously massively improve. But if you're losing weight by not so optimal options, then you shouldn't say that that's not going to benefit you because it does. No one suggesting you do do that, but it's making the point that simply losing the adipose tissue can inherently benefit your health as well. Now, the next one, before I forget to move on to, is the notion that some advocates say that as long as you're metabolically healthy, right, whatever size you are is not detrimental. Like as long as you're moving, as long as you had good, you know, glucose homeostasis, blood lipid control, you know, as long as you have good blood pressure, right, then you're not at risk of illness, which goes against the notion that obesity is harmful now. I would say that. Being metabolically healthy. And there's a term called metabolically healthy obesity. Or who. Right. That's a common term you'll see in the literature that stipulates that if you're someone that's classified as obese but you have good health biomarkers, then you'll be called metabolically healthy obesity or a metabolically healthy obese individual. The problem with this is. Obesity is not an indicator of your health status at the current day, right? Obesity is a predictor of poor health in the long run. Sure, right now this is where the nuance has to arise because we have very good evidence. If we look at a cohort study, I believe it was in East Asia that was done by Rishi in 2017 that looked at 3.5 million people. They found that after five years, when compared to normal weight individuals, metabolically healthy obese people had a 49% higher risk of coronary heart disease and a higher risk of heart failure. Right. And these were obese people that had perfect blood profiles, right? They weren't ill. They weren't ill at the time. This was five years later. Okay. That's one major cohort. There's another one from 2021 by Zheng Zao or Z, who in 2021 that looked at 380,000 participants. This followed lean and obese people over five and 11 years. So even longer 11 years time, right? They found that after even after just five years, obese people with healthy blood results still went on to develop higher rates of diabetes, fatal cardiovascular disease, heart failure, respiratory distress, and all cause mortality compared to normal weight of individuals. Now, these aren't one offs, right? These are examples, but they're not one offs. There are meta analyses of 14 and 22 large observational studies looking at millions of people. By Phan et al. 2013 and Zheng et al. 2016 concluding that metabolically healthy obese people still have a higher cardiovascular disease, amongst other diseases, and the term they actually suggest. In one of the meta analyses, they suggest that using the term metabolically healthy obesity should shouldn't be used because it's misleading and it gives false hope to individuals. Right. So I've literally just cited more than four I don't know how many is that.

Michelle (00:34:06) - Six I don't know I lost track and also like impressed that you could remember all these authors names in yours. Off the top of your head. Round of applause people. Yeah.

Dr. Idz (00:34:15) - The thing is, the thing is because like, my week is spent, I don't know, analyzing probably 30 to 50 research papers a week. And because obviously I make content about a lot of them. And obviously my master's is in research interpretation and it's a big part of what I do. You know, I'm able to kind of like cite things off the top of my head quite a lot. And I just think it's important because, you know, I don't want to come here and just make statements and claims without showing receipts.

Michelle (00:34:44) - Sure.

Dr. Idz (00:34:44) - Because that's that's my, my, my entire persona is about, you know, what's your brand statement otherwise. Otherwise I would be like the people I call out, I jump on a podcast, right? I have a microphone, I have a camera, and I just make claims and everyone's like, whoa, you know, that's that's crazy. So I don't want to do that. I want to actually show people the evidence, and I'm sure lots of people will go and actually look up those those analyses, those Mendelian randomisation, those weight loss, you know, randomized controlled trials. And I probably just cited, I don't know, probably 600, 700 of them. And there's more. There is more.

Michelle (00:35:25) - Yeah. You bring up like amazing points. And I think what I kind of want to do in this moment is also like bring in another point of view here that. There is. There's discussions about this that when somebody is struggling with an eating disorder, they struggle with their body image, which is my target population. This is why you won't see me talking about how obesity is harmful or whatever. I can acknowledge that, but I don't talk about it because of my target population. So for anybody who's listening to this and is like, man, but I really struggle with my body image, I really struggle with my relationship with food. I think it's also and you might disagree with me on this, but I think it's also okay to acknowledge that maybe having conversations like this just isn't helpful for you right now. And we do need to focus on other things and being so preoccupied about your weight, even though there could be this objective reality of obesity and everything potentially making things or, you know, bringing your risk up, right? Like we can maybe acknowledge that, but not focus on it when we're struggling so much with the pressure of weight loss that it's that it's actually deteriorating your mental health. Right? I kind of feel like and you might again, you might disagree with me on this, but I feel like there's, there's a maybe a component there of perhaps that's making things worse. Just like from a mental health perspective, which can of course affect your physical health too, I don't know. I'd love to hear your thoughts on that.

Dr. Idz (00:36:54) - No, I think I would agree with with with what you're saying. You know, when I work with people individually, many of them do have a long history of disordered eating. You know, being being scared of. Yeah, being scared of anything, really. As in being scared of even having a bite of cake or, you know, not wanting to go to crazy when you go out for food with your family. And it's like very restrictive and it's very obsessive and it's compulsive and, you know, it's affecting their relationship with their family and their siblings. And basically what I do generally is, you know, I start off by saying, look, and let's not tell lies. I'm going to say straight up that, yes, you know, being overweight over time does increase your risk of certain illnesses. But let's not make that let's not be preoccupied with that. Why don't we focus on doing things that we can to improve the way that you're going about your lifestyle interventions, right. Promoting, you know, promoting flexibility and promoting the notion that you can enjoy yourself, you can enjoy your life, right? You can move. You can do things you enjoy doing. Yeah, you can you can go out on the weekend with your family and not don't worry about what you're eating, right. We can work on other we can work on other things throughout the rest of the week that aren't so fixated around rigid food rules, right. Where I'm a massive advocate for, you know, any single food can fit as part of a healthy dietary pattern, right? I'm a big advocate because I live by that, right? Give me how you do.

Michelle (00:38:36) - I love your pictures of what you're eating. You know.

Dr. Idz (00:38:38) - Whenever, whenever I post something on my social media, it won't be a quote unquote healthy meal. Do you know why I purposely do that? I purposely do that to show people that it's okay to enjoy a overly saucy barbecue ribs and tempura prawns and, you know, lots of sauce and have a mocktail full of sugar. Right? It's okay to have those things, right? That's why I post it, because it's important to acknowledge that if someone is so evidence based, like I try to be, and I'm not painting this picture that all I'm eating is Adam beans and asparagus and flipping grilled chicken. Yeah. Like I, you know, we should be under no illusion that, you know, disordered eating, mental health illness is at an all time high right now. I think it's something like 30 million Americans at some point in their life will have a history of disordered eating, right? They will have an eating disorder, by definition, and that's like 9% of the population. Right? So yeah, it's huge. It's you know, a lot of my content is around reducing the food, fear mongering around specific ingredients, around specific types of marketing that individuals do, preying on vulnerabilities. Right. It's very important. Whenever I work with someone personally, I don't completely avoid the topic. I say, look, right. You and I probably both know that carrying an excess amount of weight for a prolonged period of time can be detrimental, of course, but that doesn't mean we can't do things to mitigate that risk and reduce it to the best of our ability. Right. And the things we can do, even if you don't lose any weight, right, we can improve your movement. We can improve your stress levels. Right? We can work on your social inclusion with your family, laughing, smiling, being happy. Right? And absolutely I can shift what intervention I'm doing based on whoever I'm working with so it can be repairing the relationship with their food. Right. And I've had a I'm sure she wouldn't mind me talking about this. I'm not going to say her name, but I've had a long, long term client of mine who literally 18 months ago was completely, completely scared of having anything that was remotely calorific in nature. Right? Any kind of like she would even be scared of cheese. She wouldn't have any kind of like muffin. Like, you know, she would be eating. I'm telling you now. Like, I tracked her food for a decent number of weeks. She'd be eating nothing. It would be five, 6 p.m. until she would even have, like, a any kind of snack or a meal, right? It was just insane. And now we've come to a place where she's, you know, gained a few pounds. She was she was quite like, kind of underweight to begin with, you know, she's gained a few pounds. She has color in her face, you know, she's not scared to go out and eat a nice meal with her family. Lots of her family members are saying, you look so much. You look. You look really well. Like you. You just have color. And just like, you know, your face just has color in it. You know, you look good, you look healthy, right? And she's like, yeah. Like, you know, I'm not kind of restricting myself. I'm not I'm not scared about what I'm eating. You know, like I'm enjoying having a balance. If I want to eat a muffin, you know, one evening I'll eat that muffin. But I'll also make sure I'm having my fruits and vegetables. I'm having my high fiber berries. Right. I'm eating some some sources of lean protein. And it's just I think people need to understand that even though we're having these, these objective reality conversations about obesity, that doesn't mean we can't adapt someone's, you know, someone's intervention or someone's advice when someone comes to them and they say, look, I've I've struggled with this my whole life. I'm completely terrified of food. I don't, you know, whenever I look at it, I feel like I gain weight. Right? And we can be like, you know what? Let's not emphasis on your weight for the time being. Why don't we work on prioritizing health behaviors? And maybe indirectly, you might you might lose a few pounds, but if you don't, so it's okay. Let's just work on how you're feeling right now, okay. Yeah. We can we can review it at a later time. Right. It's completely like that's a that's a very sensible strategy. So I don't I don't disagree at all.

Michelle (00:42:59) - Yeah. Yeah. And I think that's that's where the conflict is with, with Hayes is that they're taking that type of principle right. Where we're individualizing care and we're saying maybe let's not focus on that. That seems a little unhelpful right now. And then they're making that the objective reality and making I'm not sure if I'm making sense here, but it's like that becomes the. The new thing for everybody. Right. And now we are negating all of this evidence on everything. Everything else in terms of obesity and all of that. And it's like, no, none of that matters because there are these people that exist. And we're not denying, right? We're not denying that there are those who need help with their relationship with food and the way they feel in their body. But but I think it's irresponsible to and again, like I'm speaking to myself a little bit here because I did really I was super into the haze thing for a while. So some of it I feel like I even need to update some of the things I've said in the past, but it's now we're at a point where. We're just, like, missing the mark on objective realities. And we're kind of starting to change the evidence with no evidence to do so. You know what I mean?

Dr. Idz (00:44:12) - Or you cite a study from the 1950s on 100 random people and you say, yeah, you know, they were told to go on a diet. They were told to go on a diet. They had no follow up. They had no intervention, they had no counselling. And yeah, 95% of people who tried to lose weight fail. What kind of evidence is this? This is even the author. Even even the author of that study came back 40 years later and was like, why are people talking about this study? This doesn't show anything. Yes.

Michelle (00:44:46) - I know, I know, it's one of those things where it's like, okay, the concept of that might not necessarily be wrong. Like, yes, there's a lot okay, restrictive diets, super restrictive diets. Yes. People don't typically do those for us, their life. We can objectively agree about that. But when you bring in a statistic like that, you need to be able to back it up with some solid evidence and not a not that study like you mentioned. But yeah.

Dr. Idz (00:45:10) - You know that. You know, the irony. The irony is, if I was to provide them a single study, right, of 100 people that had no controlled intervention, and I said, this shows that weight loss is helpful, right? Do you think they will accept that level of evidence?

Michelle (00:45:30) - No, not a chance.

Dr. Idz (00:45:32) - Now, of course, in my experience.

Michelle (00:45:33) - So why is it that I know there's a.

Dr. Idz (00:45:35) - No, of course not. No, of course not. They they simply wouldn't.

Dr. Idz (00:45:38) - Because. So if if you're not going to accept that level of evidence to counteract your point, why are you citing that level of evidence to make your point in the first place? It doesn't it doesn't make any sense. Right? It's like double standard, right?

Michelle (00:45:54) - It goes back to what we discussed in our last episode, which is that when somebody is unable to see opposing evidence and evaluate that and have balanced, nuanced conversations on all fronts and seeing all sides of things, then that's the red flag. And that's why I personally don't like to be a part of the haze movement. I appreciate a lot of things we talked about. Right. Are very positive things, and so I appreciate a lot about it. It's influenced my practice a lot, but I don't like to be associated with it because. Honestly, I don't want to be associated with a group of professionals that deny a lot of evidence. You know, like it seems unbalanced and biased and black and white. And isn't that what we're trying to get away from?

Dr. Idz (00:46:39) - And it goes back to creators that don't have a balanced or nuanced viewpoint and don't provide both sides of the argument. It's just one of those red flags, right? No matter what movement or no matter what. No matter what you're advocating for, it just falls into that category of not being balanced.

Michelle (00:46:58) - Right? Absolutely. Well. Dr. Idz I love this conversation. I hope that it's helpful for people. And again, just to kind of like wrap it up. I do want people to hear that we are not saying that it is right or helpful to judge people based on their weight, or to stigmatize them based on their way into not care about them as a whole individual. And to look at the rest. Right? We're we're just trying to say that it doesn't help to sugarcoat health care or to completely deny a really big piece of evidence that's that's lying out there. But we should still look at the whole individual and, and treat them as a human, you know? So this is great I love.

Michelle (00:47:35) - This before I forget. Yeah, I know that there's going to be something that we haven't touched on, but I'll just refer to some evidence that people can look at in their own time.  Right. This is that the concept that, you know, dieting or weight loss interventions don't last long term. Right. So this is the whole conversation around weight cycling, right? I and then the whole notion that 95% of of diets fail, I obviously, you know, we've gone very, very in-depth already. But let me just say, if you don't think that there's evidence in controlled human studies that weight loss interventions can last a long time, then I will just refer you to a couple of things. One is probably most notably the lookahead trial in 2014, which took over 5000 individuals with type two diabetes and assign them to an intensive lifestyle behavioral intervention that looked at their diet, that looked at kind of counseling, that had kind of regular check ins. And they found that compared to the other group, the intensive lifestyle intervention group, 50% of them lost more than 5% of their weight. 25% of them lost more than 10% of their weight and kept it off for more than eight years, and they were still not showing signs of regaining the weight. Right? 10% of weight for someone who's overweight is a big chunk of weight, right? Like that's not that's not something to joke about. So for all these people that I've, I've heard in the past, they say, yeah, well, there's no RCT showing. Weight loss can even work in more than two years. That's simply wrong, right? Another thing I will say is the National Weight Control Registry. That is the largest study on successful dieters of over 10,000 individuals that, on average, have lost £66 and kept it off for five and a half years on average. Right. So some of them have lost £300 and kept it off, and some of them have lost 30, £40 and kept it off. Right. And they showed that the lifestyle habits that were most conducive to long term weight loss were things like exercising for an hour a day, you know, watching less than an hour of TV a day because the average American watches 27 hours of TV a week, 27 hours of TV a week, right? That's almost four hours a day, right? There's I think there's it's pretty common sense to suggest why that would, you know, cultivate the environment of gaining weight. Right.

Michelle (00:50:05) - No need to go into that.

Dr. Idz (00:50:06) - Yeah. Yeah. Also the majority of them reduce their refined sugar intake. The majority of them ate breakfast every day, which sets the day off to a good start, you know. And also I will say there's another what is it again? It's a meta analysis of 29 randomized controlled trials by Anderson et al. In 2001. Right. They found 29 controlled trials. They found that people who initially lost £44 in the first year managed to keep off £15 over even after five years. And the reason why this is important, the reason why this is important, is because you don't actually need to lose that much weight to see clinically meaningful improvements in health right now. Let me just quickly touch on this. There's a very interesting, very, very good literature review in 2017 by Ryan and colleagues, which actually looks at the different levels of weight loss and what happens to people's health markers over time. Right. So they found that when you lose 2.5% of your weight loss in people that are overweight, we start to see improvements in menstrual irregularities and fertility, which is especially important in polycystic ovarian syndrome and other conditions. When you hit 5% of weight loss, we see improvements in glycemic control, obviously important for insulin resistant type two diabetes. When you hit 5 to 10% of weight loss, we see meaningful improvements in blood pressure, blood lipids, both of which are crucial to cardiovascular health. Right. And then at around 15% weight loss, we start to see improvements in nonalcoholic fatty liver disease and sleep apnea. Right. So this is really important. This is to show that even though it's not realistic when you're 50 years old, to try and get back to your weight when you were 20. Right. We all have responsibilities. We have families, we have work, right. We have other family commitments. We might be caring for someone. We might have people that are dependent on us. Right? So yes, of course it's not realistic to try and get back to your 20 year old, you know, university studying, you know, just whatever life you had back then. But the point is, is that it doesn't actually take a lot. Even a few kilograms, a few pounds can actually improve your health quite a lot. So I don't think we should reframe what it means to lose weight and what it means to be a successful Dieter, right? A successful diet shouldn't be. It shouldn't be. Okay, I'm going back to my beach body. Ready? Right? Yeah. It should. It should be. What do I need to lose in order to actually see improvements in health? Right. We should be looking at successful dieting as not losing your belly. We should be looking at dieting as what do I need to do to actually see beneficial improvements in my HBA? One C in my blood, pressure in my blood, lipids, in my mental health, in my fatigue? You know, can I go up my two flights of stairs without getting tired? Right. These are what we should reframe successful weight loss as. And I think we need to get rid of this whole thing about, oh, I need to lose £50 because then I'll be happy in myself that's probably that's probably not realistic.

Michelle (00:53:24) - Be realistic. Yeah.

Dr. Idz (00:53:26) - Yeah. Exactly. So I think it's also important to acknowledge that weight is not the end all be all. You can improve your health by just encouraging positive lifestyle change. But if you do want to lose weight because you do know it's going to be beneficial for you, don't chase unrealistic expectations. You only need a few pounds, a few kilograms, and to maintain that over the long term to actually see benefit, clinically meaningful benefit. And that's probably the take home message there.

Michelle (00:53:55) - Yeah, I love that. And I think it's it's good that you brought up just almost like the expectations that we have around those things and what dieting even means and then what being a success story even means. I think that's where the there's a lot of disconnect right now is because we, we can probably all agree that going on a 500 calorie diet a day and expecting to lose £100 and keep it off for the rest of your life, yeah, probably not going to happen in that context. Yeah, there's probably a 95% failure rate or 100. Yeah, right. But the context matters. And what we're meaning when we say dieting or success or even weight loss is like that expectation I think is where we maybe need to adjust things a lot is just where our expectations are. But generally speaking, we are usually talking about those extreme examples which, you know, like, yeah, there's just there's so much more nuance to these conversations than we typically allow for in social media and in the haze space. And it can be difficult to. Man just cater to one person's individualized needs when we are creating these umbrella statements, you know?

Dr. Idz (00:55:09) - Agreed.

Michelle (00:55:10) - Agreed. Yeah. Well, this is great. I so appreciate you. I have already taken up so much of your time, so I will let you go. I yeah, I'm super honored that you came on. I know you're a busy guy and I'm excited for people to hear these. I'm sure it'll create some conversations and especially with this episode that was my goal, was just to have a conversation about this topic that seems to be so emotionally charged, and I feel like we need to kind of take away that electricity a little bit and just talk about some evidence and be a little bit logical, you know, and and there's always going to be nuances. There's always going to be pieces of the conversation that we didn't get to. And that doesn't mean they don't exist. So I think if you're a health care professional, especially a haz advocate, and you're listening, which I kind of doubt that there's like HAES advocates hate listening to this, but maybe they are I don't know, maybe just consider is there some bias? And, you know, me and Dr. Ed's even have our own biases that we're trying to constantly sort through and minimize it and see past. And so everybody has their own little level of bias. And it's important to evaluate the discussion from both sides as best as you can and as clearly as you can. But at the end of the day, people are going to do what they feel called to do, right? And what their personal convictions are. And I think we can have respectful conversations with each other about that. We don't need to be breaking each other down just because we have different viewpoints, which is a big problem that I see in the HAES Advocate space. So yeah, I love it. Thanks. Dr.. Is you're you're wonderful and I'm excited to keep in touch and. Hopefully have future conversations. I'll be hitting you up about school videos here soon.

Dr. Idz (00:56:50) - Thank you very much. I appreciate had a lovely, lovely conversation and yeah, looking forward to people to hearing this with a, you know, open mind and perhaps, you know, try and reduce some of those preconceived, you know, viewpoints that we have. Yeah. So thank you very much.

Michelle (00:57:08) - Yeah. At the end of the day, I think a lot of us are saying the same thing just in different ways. Yes.

Michelle (00:57:13) - Yes.

Dr. Idz (00:57:14) - Some more sensationalise than others.

Michelle (00:57:16) - Yes, exactly. So where can work in follower or followers of the show listeners right now? Where can they find you?

Dr. Idz (00:57:24) - So on all major platforms at Dr. Doctor underscore ID Z that's TikTok, Instagram, Facebook. I've got the just don't get me started on that. There's so many fake profiles of me using my name.

Michelle (00:57:41) - So many issues with Facebook.

Dr. Idz (00:57:43) - Yeah, just such a it's my newest platform.

Michelle (00:57:46) - I mean, every day, every day you have a new thing about someone impersonating you. I'm like, Holy moly, saying that you're that you're pregnant. Yeah.

Dr. Idz (00:57:59) - Oh my God. You know, on my timeline, on my Facebook timeline, I literally get recommended fake profiles of me and I see them posting my reels. I'm like, I got you got to be joking. Like he is copying me like.

Michelle (00:58:15) - Amazing. Anyway, anyway, yeah, anything for the doctor doctor underscore. It's love it. And I'll put the I'll put links to your profiles in the show notes as well. Yeah, yeah. And I'll put the link to the school as well. The school is fantastic. School of doctor is this his his membership site for getting some more in depth look into hot topics today. So thank you so much. I hope you have an amazing rest of your week and weekend and we'll we'll chat soon.

Michelle (00:58:38) - Thank you Michele. Thank you.