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  • Writer's pictureMeg

What do I do if my Doctor wants me to lose 20 lbs?


I recently had a conversation with a colleague, Sarah Hill MS LPC, of Wholehearted Therapy (wholeheartedtherapyllc.com) about doctors and weight. She shared that her doctor had recently instructed her to lose 20lbs to have healthier cholesterol and better values on other health markers. Sarah was upset but resigned. She felt she was going to have to lose the weight. This conversation made me sad on a profound level. It also made me deeply angry (at the doctor not at Sarah). In this post I outline some of the problems with prescribing weight loss as a medical treatment. This is a huge issue, far deeper than can be addressed by a single blog post. Each of these sections could be expanded, there are articles and books written about these topics. This is just a peek into the biggest issues around the topic.


This is a long one, so to sum up, fatness is not related to health. Being fat isn’t inherently unhealthy and it is not inherently healthy. Fat people contain multitudes. Thin people too contain multitudes. There are fat people who run marathons and thin people who struggle to stand up and walk. Body size is not a cause of health or a lack thereof.


But Meg, there are studies!


Yes. There are correlational studies that link fatness to a variety of negative health outcomes. But there is a difference between correlation and causation. Correlation means there is a relationship between two variables and causation means one variable causes another. A correlation looks like this: “Research says that on days when people eat more ice cream there are more car break-ins.” That can’t be causal, right? Basic common sense means we all know that ice cream does not cause car break-ins, and similarly we know that car break-ins do not cause people to eat ice cream. In this case the correlation, the relationship, does not indicate car break-ins are caused by ice cream eating. There are other variables that are much more likely to be causal. On days that it is hot, people eat more ice cream. On days where it is hot, more people leave their car windows rolled down. Car windows being down makes it easier for those cars to be broken into. The correlation (ice cream eating and car break ins) can be better understood by the introduction of the variable of heat. Correlation does not equal causation.


It’s a hell of a lot easier to demonstrate a correlation than a causation, especially if you aren’t trained to look for correlation vs. causation, or only have time to read the info as presented in the popular media. No shade if you only read the popular media, but it doesn’t provide the whole story. The fact remains that if something has a causal relationship you have to prove it. Demonstrating correlation is not enough.

All of the studies that “prove” that fatness causes a lack of health are correlational. There are no studies that prove there is a causal relationship between fatness and ill health. Say it loud for the people in the back. There are no studies that prove there is a causal relationship between fatness and ill health.


Okay, so why do doctors say it?


Fat phobia is rampant in today’s society. (Charlesworth & Banaji, 2019). We all just somehow “know” things about fat people. They are lazy, they are unhealthy, they smell bad, they don’t exercise, they are ugly inside and out, Remember that common sense knowledge I mentioned earlier? Ice cream can’t possibly CAUSE car break-ins. We know that through common sense. Unfortunately common sense is a tricky thing. It is influenced by what we are raised to think is true, or what society teaches us is true. The concept that ice cream doesn’t cause car break-ins is pretty widely accepted, but what about issues that are more complex or where bias can come in? There is significant oppression in this country based on weight (Tomiyama et al., 2018). The stereotypes in this country are myriad, cruel, and damaging. Anti-fat bias is very real and causes significant harm (Brody 2017; Anekwe 2022).


All of the citations in the previous paragraph demonstrate that most people in this country view fat people as somehow less, somehow worse.


Doctors are people. Doctors too suffer from anti-fat bias.


Medical schools are deeply biased institutions and the medical profession has long been known to do unethical things based on that bias. Forced sterilization of poor women of color (Lennard 2020), the Tuskegee experiments (CDC Office of Science 2023), exposing autistic children to abusive and often painful “therapies” to “cure” their autism (Delatorre 2023), and conversion therapy (GLAAD) are just scratching the surface.


Why would we believe that the biases currently found in the medical system don’t get enacted on fat people?


Doctors have very little training about fat folks in med school. They practice more frequently on thin cadavers and often greet fat cadavers with disgust (Goss et al. 2020). (If you are someone who reads citations, be careful with the Goss article, it was very hard to read as a fat person.) They are trained by their instructors that thin bodies are ideal and that fat bodies are problems to be dealt with (ibid). They are simply not equipped to treat fat bodies because they aren’t taught techniques for fat bodies and they are not taught that fat bodies have value.


Sometimes patients are told that the treatment they need will only work if they are skinny. Forty-one point nine percent of people in the US are considered “obese” (Trust for America’s Health 2023). Why are we trying to change 41.9% of patients in ways that can be really harmful rather than doing research for medical techniques that actually work on fat people?


If something doesn’t work on 41.9% of patients, maybe the something should change - not the patient.


Are doctors prescribing something that doesn’t actually work?


Diets don’t work as a long term solution. Ninety-five percent of dieters gain back the weight they lost within five years (Gordon 2020). Many gain back more. Frequent dieting ( is linked to myriad health problems including problems with cholesterol and blood pressure, and increased mortality (ibid) Weight cycling (the weight loss and increase associated with dieting) is often considered more unhealthy than being fat (ibid).


Why are doctors prescribing weight loss so frequently? My guess is that it’s easier to blame individual patients when they don’t succeed at keeping the weight off than it is to challenge deeply held cultural beliefs and prejudices. It’s easier to say, ‘well, I told Meg to lose weight and she didn’t, that's her problem’ than to look at the systemic bias baked into medicine and heartily backed by diet culture. Weight loss is a $75-billion dollar industry (Business Wire 2023), think about who stands to benefit by millions of people losing and then gaining weight over and over.


Doctors aren’t bad people. Overwhelmingly, they got into their profession to help people. Most of them genuinely believe that weight loss will help. The fact that there are a lot of doctors with good intentions doesn’t mean they will automatically know what’s right, especially when fat stigma and diet culture are such loud voices in society and in medical training in particular.


So yes, doctors are prescribing something that doesn’t work. If a cancer treatment had a 95% failure rate would they prescribe it to everyone with cancer? No. Why are they doing it with weight loss and why do we let them get away with it?


What do I do when my doctor prescribes weight loss?


This is not an easy question. I don’t have a comprehensive answer here. I suggest going in armed with facts. Aubrey Gordon’s book “You Just Need To Lose Weight” and 19 Other Myths About Fat People (2023) has a ton of them in the section about fatness and health. Regan Chastain (found at https://danceswithfat.org/) has a lot of information too. And beyond those two there are lots of other sources of information out there. So go in armed with knowledge and with the calm it can bring.


I also suggest ignoring the doctor’s advice completely if at all possible.


If your doctor continues to prescribe weight loss it might be time to find another doctor. If your doctor berates you or makes you feel less than for your body size it is DEFINITELY time to find a new doctor. There are a lot of Health at Every Size providers (try https://asdah.org/listing/ to start finding them) out there and, though HAES is not perfect, it’s a pretty good indicator of whether you are seeing a doctor who is going to treat you like shit.


I’m not saying finding a good doctor is easy. I have a lot of doctors with varying amounts of skill with fat bodies. I often settle for good enough. Find doctors who treat you like a human and help with your health problems. They are out there. Sometimes it feels like they are unicorns, but they are out there. Often the best way to find them is through other fat people. Ask your fat friends who they see.


If you have health markers you’d like to improve, there are tons of ways to get healthier that aren’t based on weight loss. According to Health At Every Size ® Registered Dietitian and Nutrition Therapist Meredith Blumenthal MS, RDN, CD, of Nutrition with Meredith ( www.nutritionwithmeredith.com)


If you want to improve your cholesterol, focus on increasing your intake of foods that are high in soluble fiber, like oatmeal, beans, and avocados. Soluble fiber helps reduce the absorption of cholesterol in your bloodstream and leads to lowered levels overall. Additionally, cutting back on alcohol consumption can improve High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) levels. Other positive health behaviors that have been shown to decrease cholesterol include managing stress through medication, therapy, joyful movement, or social support.


Drink water. Reduce stress. Do more things that nurture you. Strive for balance in your life. Ditch your shitty doctors (that helps a lot).


If you are in a situation where you have been told that you have to lose weight to get treatment, the first thing you should know is that I’m deeply sorry you are in that situation. There is some action you can take. Talk to your doctor. Psychotherapist Dr. Christen Mullane of Ginkgo Leaf Therapy (gingkoleafhealth.com) suggests trying these conversation starters


"I would like to focus on being healthy at my size."

"I recently became aware that anti-fat bias contributes to ill health. How would you suggest that we handle that together?"

"Have you heard about the Health at Every Size study?"


If that doesn’t work, get a second opinion, or a third one. Turn to the internet, turn to your friends, talk to your other providers. If you want top surgery, there are surgeons out there who will operate on fat people. It’s hard to see them but they exist. If your doctor won’t perform your hernia surgery, talk to a few other doctors before you give up and decide your only option is losing the 150lbs your doctor told you to lose. Fatness as a barrier to health treatment is very real and I hope you can find other more supportive providers.


All of us, including me, need to step up our activism around health care access for fat people. We deserve doctors who understand that losing weight is not easy and it is rarely successful. We deserve to live in a world that understands that fatness and weight loss are complicated and multifaceted issues. We deserve treatment that is kind and effective. It is everyone’s responsibility to make sure we get it.


Reference list


Ankewe, C. (2022, June 2). Weight stigma: As harmful as obesity itself? Harvard Medical School Blog. https://www.health.harvard.edu/blog/weight-stigma-as-harmful-as-obesity-itself-202206022755


Brody, J.E. (2017, August 21). Fat Bias Starts Early and Takes a Serious Toll. New York Times. https://www.nytimes.com/2017/08/21/well/live/fat-bias-starts-early-and-takes-a-serious-toll.html ;


Businesswire. (2023, May 5). United States Weight Loss & Diet Control Market Report 2023: The $75 Billion Market Grew Nearly 15% in 2022 from the Depressed Level of 2020 - ResearchAndMarkets.com. https://www.businesswire.com/news/home/20230505005166/en/United-States-Weight-Loss-Diet-Control-Market-Report-2023-The-75-Billion-Market-Grew-Nearly-15-in-2022-from-the-Depressed-Level-of-2020---ResearchAndMarkets.com


Center for Disease Control and Prevention Office of Science. (2023, January 9). Tuskegee Health Study and Health Benefit Program. cdc.gov. https://www.cdc.gov/tuskegee/index.html


Charlesworth, T.E.S & Banaji, M. (2019, August 14). Research How Americans’ Biases are Changing (or not)... Harvard Business Review. https://hbr.org/2019/08/research-on-many-issues-americans-biases-are-decreasing


Delatorre, A. (2023, February 8). This History of Treatment for Children with ASD. Royalty Sensory Gyms. https://www.royaltysensorygyms.com/the-history-of-treatment-for-children-with-asd


GLAAD. Conversion Therapy. https://glaad.org/conversiontherapy/


Goss, A. L., Rethy, L., Pearl, R.L., DeLisser, H.M. The “difficult” cadaver: weight bias in the gross anatomy lab. Med Educ Online. 2020; 25(1): 1742966. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144266/


Lennard, N. (2020, September 17). The Long, Disgraceful History of American Attacks on Brown and Black Women’s Reproductive Systems. The Intercept. https://theintercept.com/2020/09/17/forced-sterilization-ice-us-history/


Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5


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