When I saw the Facebook post, I literally saw red. A piece called "Long-Term Weight Loss Maintenance in Obesity: Possible Insights From Anorexia Nervosa?" was published by the International Journal of Eating Disorders under the heading “An Idea Worth Researching.” The researchers responsible for this debacle are Loren M. Gianini PhD, B. Timothy Walsh MD, Joanna Steinglass MD, and Laurel Mayer MD.
Sweet fluffy lord, where do I even start? How about by talking about how low-quality this research is?
The first line of the piece reads: “Successful and sustained weight loss is critical to reduce the morbidity and mortality associated with obesity.” The authors provide absolutely no evidence of that claim, and that’s because there isn’t any.
Nobody has done a study that shows that fat people who are successful at suppressing their weight long-term have the same health outcomes as people who were never fat, or fat people who practice healthy habits, or that they would have had absent the weight loss.
So this whole enterprise is based on the (thoroughly unscientific) idea that if we can make people look alike, they will have similar health outcomes. It is akin to suggesting that, since male pattern baldness is highly correlated to heart incidents, we just need to get bald men to grow hair to reduce their rate of heart attacks. The state of research around weight and health is such that this kind of egregious unsupported statement makes it through peer review, but that doesn’t make it valid, and it very seriously calls the researchers’ competency into question. (If you want to see what the research actually says about weight and health, I recommend checking out Bacon and Aphramor’s work on the subject.)
They want insights into how those with anorexia maintain weight loss? I can help them out: People with anorexia maintain weight loss because they have a complex bio/psycho/social illness that is often deadly. It’s not something that we should consider trying to replicate, even in part.
Lest there be any doubt of their lack of scientific rigor, they next invoke the National Weight Control Registry, claiming “The National Weight Control Registry (NWCR) has usefully collected information regarding the techniques by which individuals have been able to successfully lose weight and maintain it.”
The only bit of truth in that statement is that the NWCR has collected information. The “registry” depends on people proactively reporting their weight loss. The NWCR considers “success” to be losing 30 pounds (regardless of one’s starting weight) and (claiming to) maintain the loss for one year. Of course, most people lose weight in a year, but they gain it back in years two through five, so they’ve given themselves a four-year efficacy cushion. But that’s not even the most credulity-straining bit.
That honor belongs to the fact that they started in 1994, so they’ve been around 23 years. According to their own website, they are tracking 10,000 successes since then. That would be 10,000 out of 1,035,000,000 attempts (based on the estimated 45,000,000 diets that happen per year). Then they ask the volunteers questions and come up with statistics like: Of Those who maintain weight loss, 78 percent eat breakfast every day.
What they don’t know is how many of the 1,025,000,000 dieters they aren’t tracking also did these things but didn’t maintain weight loss. What the NWCR does is simply find coincidences among a minuscule group of outliers. (Interesting side note: when I first wrote about the folly that is the NWCR in 2012, they claimed to have 10,000 successes. Now, five years later, their website claims that they have…wait for it… 10,000 successes. Sigh.)
I’m going on at length about this because the researchers who created this paper ostensibly want us to think that they are credible, and these two issues alone tell us that they aren’t. But, in truth, we didn’t need to get this far. They want insights into how those with anorexia maintain weight loss? I can help them out: People with anorexia maintain weight loss because they have a complex bio/psycho/social illness that is often deadly. It’s not something that we should consider trying to replicate, even in part.
Suggesting that we should figure out how to apply a deadly illness to fat people is ludicrous on its face for a number of reasons, not the least of which is that THERE ARE FAT PEOPLE WITH ANOREXIA.
Papers like this are part of the Eating Disorder Community’s fat phobia problem. Sometimes it comes out as the kind of half-assed, healthist, ableist body positivity that tries to put size, health, and ability limits on who gets to appreciate their body — not to mention who gets to nourish their body rather than trying to starve it in the “hope” that it will eat itself and become smaller.
Sometimes it’s eating disorder treatment facilities that open weight loss programs (even though the concept of intentional weight loss can make it impossible to fully recover from an ED, and even though they have no evidence to suggest that they can help anyone with long-term significant weight loss).
Sometimes, as the brilliant eating disorders specialist and psychologist Deb Burgard first pointed out to me, it can take the form of prescribing to fat people what we diagnose in thin people. For an example, we need look no further than the abomination that is The Biggest Loser. If a thin person says that they severely restrict calories and exercise for 8+ hours a day, those are red flags for an eating disorder. If a fat person does the same thing, we put them on TV, give them a trainer to "encourage” them with mental and physical abuse, and watch the ratings soar.
This study seeks to find ways to be more specific and purposeful in that dangerous practice. Time and again, fat people have been shown that the “war on obesity” wants us thin or dead and doesn’t much care which, and this is a perfect example of that.
A thin-obsessed world perpetuates eating disorders and fat phobia. A world that acknowledges and celebrates the diversity of body sizes, and that focuses on access to weight-neutral mental and physical healthcare for people of all sizes (rather than focusing on trying to make everyone the same size) is better for everyone’s health.