Robin's Story
Heart Health Without Weight Loss
At 45, Robin is a dedicated high school art teacher who volunteers once a week at their local community centre and lives with an aging rescue cat. Cooking and crocheting are their love languages, and they’ love nothing more than creating homemade gifts for loved ones.
It started with a routine medication review for their migraines. Robin hadn’t been to see a doctor in years – not since their PCOS diagnosis in their early thirties. As a fat person, Robin knew that medical offices were rarely safe spaces, so they avoided them whenever possible. Little did they know this appointment would turn into a life-or-death ultimatum. If they did, they probably would have stayed at home.
Robin's Medical Journey Begins
It started with a routine medication review for their migraines. Robin hadn’t been to see a doctor in years – not since their PCOS diagnosis in their early thirties. As a fat person, Robin knew that medical offices were rarely safe spaces, so they avoided them whenever possible. Little did they know this appointment would turn into a life-or-death ultimatum. If they did, they probably would have stayed at home.
The visit should have been simple: renew the migraine medication and leave. Instead, they encountered an overzealous new doctor who speacliaised in “lifestyle medicine” and insisted on blood tests before renewing the prescription. Feeling cornered, their medication essentially held hostage, Robin reluctantly agreed.
A few weeks later, they received a text message: “Please make an appointment to speak to the doctor about your latest blood test results.” Robin’s anxiety spiked as they feared the worst, and did what anyone would do in their situation. They avoided making the appointment for as long as possible. When they couldn’t take the anxiety anymore, the news was both better and worse than expected.
“You have high cholesterol,” the doctor announced, seemingly concerned despite Robin’s own relief that it wasn’t something more immediately serious.
When Heart Health Becomes a Moral Issue
Robin’s doctor quickly connected the dots in the most predictable way: high cholesterol + family history of heart disease (Robin’s father had a heart attack at 55) + PCOS + being fat = impending death. “If you don’t do something soon, you’re going to die,” was the message, though delivered more tactfully through medical jargon.
Knowing Robin’s resistance to traditional dieting, the doctor cleverly reframed the approach: “This isn’t about weight loss – it’s about preventing a heart attack.” This subtle shift worked. Robin had divorced diet culture years ago, but preventing heart disease? That seemed like a reasonable health goal.
Armed with a leaflet detailing a “heart-healthy diet,” Robin diligently followed the recommendations. Five portions of fruits and vegetables daily, legumes three times weekly, oily fish twice weekly, olive oil instead of butter, and on and on the rules went. Essentially, it was vegetables and lean protein with everything enjoyable eliminated. Some would argue it was a diet by any other name.
These weren’t foods Robin enjoyed, and the restrictive eating made them miserable, but they persevered, because this was about heart health, not weight loss.
The Follow Up
A year later (having postponed the intended six-month follow-up three times already), Robin returned for more blood tests. The results were unchanged—still slightly elevated, but not dramatically high cholesterol.
The doctor was unimpressed. When Robin explained they weren’t trying to lose weight – just following the heart-healthy diet – the doctor’s demeanor changed instantly. “Oh, you don’t want to lose weight? Why not?”
“I don’t believe in weight loss. I don’t believe it’s particularly beneficial.”
And just like that, Robin was labeled non-compliant.
Every medical visit followed the same pattern. PCOS? Lose weight. Migraines? Lose weight. And now cholesterol? Lose weight, lose weight, lose weight. Their blood test results felt like a test that they had failed – proof that they weren’t looking after their body the way they should be.
Their doctor made them feel like they were being morally graded rather than receiving medical care. And now, despite following the prescribed diet, nothing had changed. Double failure. The non-compliant patient who clearly doesn’t care about their health.
Without further discussion or explanation of options, the doctor prescribed Atorvastatin 20mg, barely looking up from the computer while writing the prescription.
The Heart Health Without Weight Loss Dilemma
Robin left the appointment with prescription in hand but deeply conflicted. On one hand, they didn’t want a heart attack. On the other, they didn’t trust their doctor and hadn’t been given enough information to make an informed decision about statins.
Searching online only led to more weight-focused, stigmatizing information. Robin felt stuck between taking a medication they knew little about and risking their heart health. They wished they could find a doctor who supported their heart health without weight loss. Someone who would treat them like a whole person instead of just a number on the screen.
Furthermore, Robin couldn’t help but wonder whether there were evidence-based alternatives for maintaining heart health without the constant focus on weight loss. After all, they had tried dieting multiple times throughout their life with no sustainable results.
What Evidence-Based Heart Health Without Weight Loss Looks Like
Robin left the appointment with prescription in hand but deeply conflicted. On one hand, they didn’t want a heart attack. On the other, they didn’t trust their doctor and hadn’t been given enough information to make an informed decision about statins.
Searching online only led to more weight-focused, stigmatizing information. Robin felt stuck between taking a medication they knew little about and risking their heart health. They wished they could find a doctor who supported their heart health without weight loss. Someone who would treat them like a whole person instead of just a number on the screen.
Furthermore, Robin couldn’t help but wonder whether there were evidence-based alternatives for maintaining heart health without the constant focus on weight loss. After all, they had tried dieting multiple times throughout their life with no sustainable results.
Weight inclusive healthcare
Imagine if Robin had encountered a doctor who offered cardiovascular care without weight loss prerequisites. This doctor would have started with reassurance: “Look, I’m not particularly worried about this. Your slightly elevated cholesterol isn’t anything to panic about, and it’s not your fault. You couldn’t have prevented it.”
This doctor would have acknowledged Robin’s anxiety about their father’s heart attack but would have calculated Robin’s actual cardiovascular risk, which would turn out to be a 2-4% chance of having a heart attack or stroke in the next ten years. This is an objectively low risk.
They would have explained the difference between primary prevention (for someone who’s never had a cardiac event) and secondary prevention (preventing a second event), clarifying that Robin’s situation is much less urgent than their father’s would have been after his heart attack.
Most importantly, this doctor would have shared crucial information that Robin’s actual doctor withheld:
- Dietary changes haven’t been proven effective for preventing heart disease. Studies consistently show any initial benefits disappear after 6-12 months.
- Weight loss has no benefits for cardiovascular risk. In fact, weight cycling (losing and regaining weight) actually increases heart disease risk.
- Plant sterols may help slightly reduce cholesterol, but they’re expensive, require special products, and only reduce cholesterol by up to 10% as opposed to 20-30% with medications.
- Movement, stress reduction, and sleep improvements may help slightly but won’t dramatically change risk factors.
- Medications like statins can reduce heart disease risk by approximately 25%, but this translates to a very small absolute risk reduction for someone like Robin (from 4% to 3%).
Informed consent
With this information, Robin could make a genuinely informed decision about their health. Maybe they’d choose medication, maybe not. Either way, it would be their choice based on understanding rather than fear and shame.
This approach represents basic medical ethics—informed consent, patient autonomy, and non-maleficence (do no harm)—not some extraordinary level of care. Yet fat patients have become so accustomed to substandard treatment that even basic respect feels revolutionary.
Additionally, Robin would understand that pursuing heart health without weight loss isn’t just a personal preference—it’s actually aligned with the scientific evidence. The focus on weight loss as the primary intervention for cardiovascular health lacks robust long-term support, especially considering that:
- Most people cannot maintain significant weight loss beyond 2-5 years
- Weight cycling (losing and regaining weight) may cause more harm than remaining at a stable higher weight
- Many thin people also develop cardiovascular disease, indicating that other factors are critical
Achieving Heart Health Without Weight Loss
Robin’s story highlights how health markers like cholesterol have become moral measuring sticks rather than neutral medical information. When doctors use terms like “good” and “bad” cholesterol or label patients “non-compliant” for making informed choices about their own bodies, they’re making moral judgments, not practicing medicine.
The arbitrary cutoffs for “normal” cholesterol keep shifting lower, creating more “patients” requiring intervention, while the goalposts constantly move. Meanwhile, research shows that social isolation, economic deprivation, and chronic stress influence heart health far more than individual behaviors—but these factors receive little attention from healthcare providers.
Weight inclusive healthcare
Imagine if Robin had encountered a doctor who offered cardiovascular care without weight loss prerequisites. This doctor would have started with reassurance: “Look, I’m not particularly worried about this. Your slightly elevated cholesterol isn’t anything to panic about, and it’s not your fault. You couldn’t have prevented it.”
This doctor would have acknowledged Robin’s anxiety about their father’s heart attack but would have calculated Robin’s actual cardiovascular risk, which would turn out to be a 2-4% chance of having a heart attack or stroke in the next ten years. This is an objectively low risk.
They would have explained the difference between primary prevention (for someone who’s never had a cardiac event) and secondary prevention (preventing a second event), clarifying that Robin’s situation is much less urgent than their father’s would have been after his heart attack.
Most importantly, this doctor would have shared crucial information that Robin’s actual doctor withheld:
- Dietary changes haven’t been proven effective for preventing heart disease. Studies consistently show any initial benefits disappear after 6-12 months.
- Weight loss has no benefits for cardiovascular risk. In fact, weight cycling (losing and regaining weight) actually increases heart disease risk.
- Plant sterols may help slightly reduce cholesterol, but they’re expensive, require special products, and only reduce cholesterol by up to 10% as opposed to 20-30% with medications.
- Movement, stress reduction, and sleep improvements may help slightly but won’t dramatically change risk factors.
- Medications like statins can reduce heart disease risk by approximately 25%, but this translates to a very small absolute risk reduction for someone like Robin (from 4% to 3%).
Finding Your Way Forward
If Robin’s story sounds familiar, know that you’re not alone. Whether it’s cholesterol, blood pressure, blood sugar, or any other health marker that’s become weaponized against your body, you deserve evidence-based, weight-inclusive care that respects your autonomy.
Remember these key points about heart health without weight loss:
👉 High cholesterol is not your fault
👉 You couldn’t have prevented it
👉 Weight loss won’t provide long-term solutions
👉 Evidence-based treatments work regardless of size
👉 You deserve respectful, effective healthcare
👉 Addressing social determinants of health often has greater impact than individual behaviors
👉 Reducing stress may be more beneficial than restrictive dieting
Next time you’re told to “just lose weight” rather than receiving comprehensive care, consider using this script:
“I have researched the benefits and risks of intentional weight loss for high cholesterol. I do not wish to pursue this approach and do not consent to discussing my weight during consultations. I would like to discuss evidence-based treatments that work regardless of body size.”
You deserve healthcare that addresses your actual needs, not just another prescription for weight loss.
Where To Next?
For too long, fat patients have been forced to contend with a healthcare system that prioritizes weight loss over actual evidence-based treatment. But there’s a better way. By advocating for weight inclusive medical care, we can create an environment where all patients receive appropriate treatment, regardless of their size.
This is why I’m currently writing a book where I dive deeper into these transformative weight-inclusive approaches to patient care. And I want you to be a part of the process. High cholesterol is featured in Chapter 5, which is ready for your perusal. Check out No Weigh for more information.
If you’re navigating high cholesterol or other cardiovascular concerns and are tired of having your symptoms blamed on your weight, know that you’re not alone. Join our community in The Weighting Room, where you’ll find support, resources, and healthcare professionals who understand. Additionally, you can book a consultation with me.
Want to learn more about effective cholesterol treatment without weight loss requirements? Check out my comprehensive on-demand masterclass, free for anyone with a masterclass membership or available to purchase on demand.
