Second, do no harm. First? NO FAT CHICKS.

[alexandraerin]

1. Here is a two-year-old article about a study that found how people feel about their weight is a better predictor of health and mortality than how much they weigh.
   
2. Here is an abstract of a study demonstrating that overweight and obese patients have a lower rate of cardiac death than "normal" weight patients.
   
3. Here is an abstract of a study demonstrating one of the many ways "failed weight loss attempts" damage a patient's health.
   
4. Here is a list of weight loss strategies that will not fail over the long term for the vast majority of the population:
   
   
   So why do doctors focus so much on their patients' weights?
   
   Note I'm not questioning doctors who focus on any of the following:
   
   
   • Blood pressure.
     
   • Blood sugar.
     
   • Cholesterol.
     
   • Nutrition.
     
   • Exercise.
     
   • Risk of diabetes or other diseases.
     
   
   But all of those things have two things in common:
   
   1. They are not the same thing as being fat. They are things that a given person, thin or fat, may or may not have a problem with.
   2. Fatness is used as a shorthand for all of them, in popular culture as well in the world of medicine. And why not? Doctors are people, too. They hear the same stuff growing up that we do. They heard it from their doctors, who were after all people, too.
   
   If you're a doctor and you're worried that your patient will be killed by blood pressure or cholesterol, why talk about their weight? Even if there weren't negative health implications to pressuring your patients to lose weight (and there's plenty of evidence that there is!), wouldn't that be like going for the overly complicated bank shot? Why would you get all fancy with your attempt to save a patient's life instead of addressing the actual issue?
   
   Here are some guesses:
   
   
   • Because we have a culture that pathologizes and polices bodies as a means of control.
     
   • Because we love any narrative in which other people's misfortunes are 1) preventable and 2) their fault.
     
   • Because "thin == healthy, fat == unhealthy" is appealingly easy.
     
   • Because it's what we're taught.
     
   
   If you have any doubt that the focus on patients' fatness is taking attention away from their health, you might find this interesting. I believe it's by the same Paul Ernsberger who wrote in 1987:
   
   "The idea that fat strains the heart has no scientific basis. As far as I can tell, the idea comes from diet books, not scientific books. Unfortunately, some doctors read diet books." (Source.)
   
   I've turned off comments on this journal because I'm not interested in having a debate. No, it's not that I'm not willing to listen to opposing viewpoints... on this subject, as so many others, I can't help hearing opposing viewpoints. The viewpoint that fat is unhealthy and losing weight is beneficial to your health is ubiquitous. We are swimming in the opposing viewpoint.
   
   Keeping comments open is only going to bring in more people who are parroting unproven (or disproven) assertions about what fat does to the body, keep insisting that doctors should shame their fat patients even while there is no real solution at hand even if fat were a problem, and generally encourage the status quo to rear its ugly head.
   
   If you disagree with me, disagree with me, but you don't need to say it and I don't need to hear it. If you're so sure I'm wrong, go do some reading with an open mind. Somebody accused me of cherry-picking studies. I sort of did: I had masses and masses to choose from and I picked the first few ones I could think of off the top of my head. The research is out there. It's just ignored or parsed to fit the conventional wisdom.