If you’re new to my website and want to get to grips with some of the basics, I’ve prepared a list of Frequently Asked Questions below. If you can’t find what you’re looking for, then check out my blog post, my podcast and my social media accounts. If you still have a question, you can fill in the form below and I will try and add it to my list of FAQ. Please note that I never engage in any debates or discussions about the content of my website. If you’re hoping for a debate then you are welcome to pay for my time and can contact me through my agent.
FAQ: Why do you use the term fat? Isn’t that an insult?
- Why do you use the term fat? Isn’t that an insult?
- Is weight something that we can control?
- Is being fat bad for your health?
- Does being fat reduce your life expectancy?
- Does being fat cause diabetes?
- Does being fat increase your risk of heart disease?
- Does losing weight improve your long term health?
- What do you mean when you say “diets don’t work”?
- What are the risks of dieting?
- Is there really such a thing as too much exercise?
- Is there an alternative to dieting?
- What is weight bias/stigma?
- Why is weight stigma dangerous?
- Aren’t you more likely to die of COVID in a larger body?
- If smoking is a risk factor for disease, why isn’t weight?
Fat is an adjective. It is used to describe a person or object. Society turned it into a bad word and gave it negative and judgmental connotations. Those of us who have rejected society’s body standards have learned to embrace the word fat alongside words such as plus-size, larger body and even ugly.
On the other hand, most of us hate the word “ob*sity” and “bar*atric” because these are words that have been used to oppress us and deny us equal access to healthcare, insurance, employment, fertility treatment, adoption, and in extreme cases have led to children being removed from loving homes. These words are extremely offensive and triggering to many, which is why you will often see us censor the word.
FAQ: Is weight something that we can control?
Almost everyone believes the lie that body weight is simply a case of calories in versus calories out. That is nonsense. The first law of thermodynamics only applies to a closed system, and since our bodies are anything but, we need to stop buying into this idea. Will a calorie deficit result in weight loss initially? Almost certainly. Does this translate into long term weight loss? Almost certainly not.
Why? Because our body weight is not just determined by energy intake and output. There are other forces at work. Genetics plays a huge role. So do metabolism and hormones. Trauma impacts the neurophysiology of the brain including the parts of the brain responsible for appetite and hormone regulation. Chronic stress causes our adrenal cortex to release a number of hormones including cortisol which decreases metabolism. There are medications that alter our body chemistry and cause weight gain, and environmental factors that need to be taken into consideration. Most importantly, chronic dieting impacts our body mass in irreversible ways.
FAQ: Is being fat bad for your health?
This is a really difficult question to answer without first defining health. Health isn’t just about cardiometabolic risk factors like blood pressure and cholesterol. Health isn’t just the absence of disease either. It is personal, it is individual, and it is holistic. It is not just physical, but emotional, mental, spiritual and environmental. So you need to be specific.
For example, you might be wondering if being fat is bad for your joints? Well, that depends on whether or not you are active, have a history of trauma or injury, and any number of other things such as genetics. No one can say for sure that being fat is bad for your joints. And being fat is definitely not the only thing that impacts your joints.
FAQ: Does being fat reduce your life expectancy?
The short answer is no. There is no real evidence to support this hypothesis. In order to demonstrate that being fat leads to higher mortality rates, epidemiological studies need to adjust for fitness, exercise, diet quality, weight cycling, diet drug use, economic status, and family history among other things. They also need to ensure that the data they collect is reliable and therefore not self-reported. Studies that account for one or more co-founders in a rigorous fashion, demonstrate that the already weak association between higher body mass and greater mortality tends to be greatly attenuated or disappear altogether (Campos 2006).
In fact, several large studies have found that being in a larger body increases your life expectancy. One 19 year long prospective study of 3617 Americans found that in adults over 55 years at baseline, those categorised as “ob*se” were 32% less likely to die than those in the normal weight category (Lantz 2010). Yes, you heard that right. There are also a number of studies that demonstrate that being fat is protective. For example, patients who are admitted to ICU with sepsis are more likely to survive if they are in larger bodies. Same goes for patients with chronic kidney disease and heart failure and any number of other diseases. Experts refer to this as the “ob*sity paradox”.
Does being fat cause diabetes?
No. Nobody knows what causes diabetes but we do know that genetics and environment play a huge role in it. It is very important that we do not confuse correlation with causation. A study may show that two things are linked to each other, and we call this correlation. For example, there is a study that shows that being bottle fed during infancy is linked to being left handed. But that does not mean that one causes the other.
The link between bottle feeding and left handedness is probably just a co-incidence. But the link between Type 2 diabetes and living in a larger body is almost certainly not. Diabetes is caused by insulin resistance. Insulin is like a key that unlocks the door to your cells and lets the glucose (sugar) pass from your bloodstream into them. In the case of insulin resistance, some of the locks are faulty and the key won’t turn them. That means sugar cannot pass easily from your bloodstream into your cells where it is used as energy. Instead, the leftover sugar in the blood is turned into fat (lipogenesis). So it makes sense that the two are linked. But it’s the faulty locks (the insulin resistance) that causes weight gain, not the other way around.
FAQ: Does being fat increase your risk of heart disease?
There are lots of things that increase your risk of heart disease. Being fat is one of the least important factors. In fact, being Super Fat still carries a lower risk than all of the following:
- A history of migraines
- A history of rheumatoid arthritis and SLE
- A history of erectile dysfunction
- Taking regular anti-psyhcotics
You don’t have to take my word for it. You can calculate your own cardiovascular risk using the QRisk3 calculator. This is the tool doctors in the UK use to determine who is at high risk of developing heart disease within the next 10 years. Have a play around with it and see whether your risk decreases dramatically if you lose a lot of weight. In almost all cases, it is a mere 2-3% change. I worked out that for a healthy 50 year old woman, reducing her BMI from from 40 to 23 would reduce her risk of having a heart attack or stroke over the next 10 years by a measly 0.4%. And in order to do that she would need to lose 56kg (123lbs).
FAQ: Does losing weight improve your long term health?
The short answer is no. The long answer is that there is no real evidence to support this, and there is some evidence that suggests the opposite. There are studies that show improvements in health outcomes in the short term, but it is very difficult to tell whether these are due to lifestyle modifications or fat loss. There is no evidence that cosmetic surgery such as abdominoplasty (tummy tuck) or liposuction improves health outcomes.
There is evidence that weight loss (especially extreme weight loss) shortens your life expectancy. One study found that “weight loss of 15% or more from maximum body weight is associated with increased risk of death from all causes among overweight men and among women regardless of maximum BMI” (Ingram 2010). Also, studies have shown that it is safer to have a stable weight in a fat body than it is to go on frequent diets and yo-yo. Those familiar with the Framingham and NHANES studies may be interested to know that “all of the excess mortality associated with ob*sity in the Framingham study can be accounted for by the impact of weight cycling. Ob*se Framingham residents with stable body weights were not at increased risk” (Ingram 2010).
FAQ: What do you mean when you say “diets don’t work”?
I mean exactly that. In 95% of cases, people regain the weight that they lost within 5 years. The majority of the weight gain is within the first 1-2 years. In two thirds of cases, people end up heavier than they were when they started. In fact, intentional weight loss is the biggest risk factor for long term weight gain. Studies show that the more often you go on a diet, the more likely you are to gain weight (in a dose-response fashion).
Diets almost always work to begin with. That is because sudden changes in lifestyle will often lead to weight loss. However, the body is programmed to hold on to body weight to prevent starvation. Over time, your metabolism changes and you will notice that you weight loss plateaus. In order to overcome this, several studies have shown that people who are “successful” at keeping off the weight will develop behavior patterns that are very similar to people with eating disorders. This includes exercise addiction and food obsession, which in turn cause long term stress on the body.
FAQ: What are the risks of dieting?
Aside from being the biggest risk factor for weight gain, dieting is associated with a number of long term risks. In 1944, a group of health young men agreed to participate in an experiment in which they starved themselves in order for researchers to learn about how to treat starvation. They were placed on a diet of 1600kcal a day (please note that there are some doctors that routinely recommend half of this calorie intake to promote weight loss). You can read all about what happened to these 36 year old previously fit and healthy young men, and how this experiment changed their lives. [Self harm was common and one actually severed his fingers intentionally].
Since most people gain weight after losing it, the majority of people engage is some form of weight cycling over their lifetime. This has been linked to a number of different heath conditions, and when it is adjusted for in epidemiological studies, the link between weight and morbidity/mortality often disappears.
Dieting also promotes disordered eating patterns, poorer body image and self esteem, and therefore has an important impact on our mental health. This can lead to eating disorders and a range of mental health conditions. Remember that health is not just physical, so your could argue that dieting was actually quite dangerous for your health.
FAQ: Is there really such a thing as too much exercise?
Exercise is fantastic and there is no question that it benefits our health. However, there is such a thing as too much exercise. A recent study of male endurance athletes aged 40-64 years found that a third of them had cardiovascular disease and almost all of them had low-grade hypertension. This supports the well-known belief among specialists that too much cardiac stress from exercise can increase your risk of premature heart disease. Please note that endurance athletes undertake a minimum of 6 hours of exercise a week (which is twice the recommended amount) so these finding should by no means discourage people from physical activity. It just goes to show that too much exercise is, in fact, bad for you. And since exercise addiction is common in people who have managed to successfully lose a significant percentage of their body weight, this is something to bear in mind.
It’s not just heart health either. According to literature review on the pathology of osteoarthritis (Chen 2017), young adults who sustain a joint injury are four times more likely to develop osteoarthritis down the line. Professional athletes often pay for their success as they get older and are prone to early onset arthritis. We need to stop thinking of exercise as something your simply can’t get enough of. The truth is that, like all things in life, too much of anything is dangerous for you. Moderation is key.
FAQ: Is there an alternative to dieting?
I’m glad you asked. Now that you’re realised that the only people that benefit from weight loss are people in the weight loss industry, you may be asking yourself what else you can do to improve your health. Enter Health At Every Size (HAES™). First introduced to the world by Lindo Bacon and their team, it is underpinned by three important principles:
- Body Acceptance
- Intuitive Eating
- Joyful Movement
There are so many HAES™ aligned professionals out there who have rejected diet culture and provide evidence based support for people who are looking to ditch the diet once and for all. There is no question that health outcomes improve when people adopt a HAES™ approach which is probably why the Women and Equalities Committee (House of Commons) published their Inquiry into Body Image and reccommended that the government adopt a HAES™ approach within the next 12 months.
FAQ: What is weight bias/stigma?
Weight bias and weight stigma are often used interchangeably, but they actually have slightly difference meanings. Weight Bias is “the negative weight-related attitudes, beliefs, assumptions, and judgments in society that are held about people living in larger bodies” (Kirk 2020). Weight Stigma is “the manifestation of weight bias through harmful social stereotypes that are associated with people who live in larger bodies” (Kirk 2020).
Weight bias (sometimes called anti-fat bias) refers to the conscious and unconscious beliefs held by individuals about people in larger bodies. Weight stigma describes the ways in which that bias manifests itself in society. It is sometimes referred to as weight-based discrimination, and is on a par with gender and race based discrimination (Puhl 2009). It occurs in every area of society including education, the workplace, the media, politics, criminal justice, and of course, healthcare.
FAQ: Why is weight stigma dangerous?
Internalised weight stigma damages a person’s health. It decreases motivation, and leads to binge eating, avoiding exercise and postponing medical care (Bacon and Aphramor 2011). In the healthcare setting, weight stigma leads to loss of trust in the healthcare practitioner, a breakdown in communication, poor compliance and long-term avoidance (Phelan 2015).
Weight stigma can manifest itself in so many different ways. Examples of anti-fat bias include a general dislike of fat folk, believing that an individual is to blame for weight gain, believing that weight loss is easy to achieve and the responsibility of the individual, or even the fear of gaining weight yourself. These attitudes (whether they are conscious or unconscious) will impact the way that people in larger bodies are treated. Whether it is shaming them, ignoring them, giving them unsolicited advice, or contributing in some way to their oppression (eg. by not hiring them after interview because they “don’t fit” the company).
Aren’t you more likely to die of COVID in a larger body?
There is no question that deaths from COVID have occurred at higher rates in people with larger bodies. However, that does not automatically mean that being in a larger body increases your risk of dying of COVID if you contract it.
For example, we know that Sexually Transmitted Infections (STIs) are more common in people aged 16 to 25yrs. However, that does not mean that people aged 16 to 25yrs are more likely to get an STI. You are only at risk of getting an STI if you don’t use barrier methods during sexual intercourse.
Just like there are a number of reasons why younger people are more likely to contract an STI, there are also a number of reasons why people in larger bodies have been dying of COVID at higher rates. Until we fully understand those reasons, it is essential that we protect fat folk, which is why most were offered the vaccine early. However, we cannot assume that fat bodies themselves responsible for poor outcomes.
During the Swine Flu pandemic in 2009, experts claimed that people in larger bodies were more likely to die. 7 years later the research confirmed this. However, the research also showed that it wasn’t the body itself but the delayed treatment that caused this excess in mortality. The question remains whether we learned our lessons in time for this current pandemic.
If smoking is a risk factor for disease, why isn’t weight?
Smoking is a behaviour. It’s pretty black and white. Either you do/did smoke or you don’t/never did. Sure, there are different degrees of smoking (in medicine we refer to pack years), but ultimately it is pretty simple to measure.
Weight is not a behavior. It is a descriptor. There are a number of different reasons why a person may gain or lose weight, and they all interact with eachother in different ways. So unless the evidence accounts for all of these different factors, then we are unable to draw any real conclusions from it.
You can advise a person to stop smoking. But that is not the same as telling them to lose weight. Telling someone to change their weight is like telling someone to stop being depressed. Sure there are ways to improve your mental health, but you can’t tell a person to just cheer up and assume that will cure their depression!
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