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Recently I tweeted a pretty controversial tweet about how diets don’t work, but I specifically mentioned keto and intermittent fasting and it got a LOT of attention. On today’s episode, I’m explaining it and diving into the 50-tweet thread that I followed up with to expand on the research behind why diets don’t work.

Context:

There are a few necessary points I need to make about this tweet for context before I get into it. You can read the full thread here.

1

Just because I’m anti-diet does not mean I’m against medical nutrition therapy.

I am anti-diet because we do not have evidence to support the use of diets for long-term weight loss (as I’ll explain soon). I am not against using diets for healing or for medical purposes. This obviously gets tricky when doctors recommend weight loss as a treatment for a disease (which I believe is unethical), but I am not against people doing diets to prevent, manage, or treat a disease if that is what you feel is medically-necessary for you.

The reality of diets like keto and IF in the media is that these diets are not being sold to you in the same form they are being researched. The form of keto that your uncle’s wife’s sister is doing is not the same keto that is being studied to improve insulin resistance. It also gets messy because you should question any diet that promises weight loss. No diet can make that promise, period.

1. Just because I’m anti-diet does not mean I’m against medical nutrition therapy.

2

I am never judging you for going on a diet.

I don’t want you to think that just because I’m anti-diet, that I am ever judging you for going on a diet. I used to diet too. I get it. You are taught by *everyone* in this world to hate your body and that you need to shrink your body to be accepted and loved. We all are! So please do not misinterpret this as me shaming you for dieting.

I am simply trying to share the research so that you can make an informed decision because oftentimes medical providers do not give you the full story when it comes to the risks of pursuing weight loss through dieting.

2. I am never judging you for going on a diet.

3

Anecdotes are not evidence.

The number one response that I got from the thread was from people who had lost weight from keto or intermittent fasting and who wanted to “prove” to me that these diets worked by showing me before and after pictures.

First of all, I find before/after pictures to be incredibly harmful. There are a lot of people happily living in your “before” body wishing that their bodies were not constantly displayed as your miserable before picture.

Second, before/after pictures are not evidence. I don’t even consider the few randomized controlled trials that people sent me showing that keto works over a few months to be good evidence because of how much research we have about weight regain and harmful side effects of dieting after 1 year. Until there is more research showing the longer-term effects of these diets on weight loss (long-term meaning studies with 1-year to 5-year follow-up that ALSO look at disordered eating and quality of life), I cannot ethically recommend any of these diets for weight loss. The cons heavily outweigh the pros, which we’ll get into soon.

3. Anecdotes are not evidence.

4

If something is working for you, don’t let one tweet thread threaten that.

At the end of the day, what you do with your body is up to you. I am primarily concerned with preventing eating disorders, debunking pseudo-science, advocating for fat acceptance, and educating about health from a weight-neutral perspective. So yeah, I’m going to pick a fight with weight loss diets no matter what because they are responsible for eating disorders. Unfortunately, the diets that people initially set out to do for health often end up being extremely restrictive, stressful, isolating, and dangerous. So yeah, I have a problem with that.

But if something is working for you in your body and it’s making your quality of life better, don’t let my tweet thread threaten that. If you are threatened by a tweet, chances are that something in this thread spoke to you, in which case I am here if you want to learn more.

It can feel really scary at first to have your diet mentality threatened if you are deep in disordered eating. When I was struggling with my disorder, I would have bitten anyone’s head off if they tried to tell me that what I was doing was potentially harmful. But that’s because somewhere deep down I KNEW that it was harmful. I knew that my disordered relationship with food wasn’t healthy. I just wasn’t ready to admit it yet.

If you aren’t ready to see that yet, that’s okay. But I hope you’ll be open to hearing some of this information, or at least keep me in mind when you are ready.

4. If something is working for you, don’t let one tweet thread threaten that.

If you aren’t ready to see that yet, that’s okay. But I hope you’ll be open to hearing some of this information, or at least keep me in mind when you are ready.

Diets Don’t Work: The Research

Okay so I’m going to talk about why diets don’t work, but first I want to explain a little bit about our current medical model to give you a background on why we’re even discussing this.

The problem with our medical system

Our current medical system is weight-centric, meaning that we heavily rely on weight as an indicator of health. Doctors commonly factor weight and BMI into their treatment plans, blaming weight for medical issues that oftentimes have absolutely nothing to do with weight, and then recommending weight loss as primary treatment instead of giving bigger people real treatment options.

Based on the research that we have on the harmful effects of dieting, I personally find this extremely unethical and grounds for medical malpractice. That’s because we currently do not have any evidence to support the use of calorie-restrictive diets for long-term weight loss (keep reading for more info on this). We also do have research to show that doctors are biased against bigger bodies and let their biases impact their care.

The “Obesity Epidemic” & Weight Stigma Research

The research shows that people in bigger bodies receive worse medical care, are treated worse in society, are less likely to be paid fairly or have equal access to jobs, physically cannot fit in many public spaces, and have worse health risks.

Everyone loves to blame “ob*sity” (censored because this word is actually stigmatizing in itself) for CAUSING health risks or chronic diseases, but in fact, our research right now shows that weight is only CORRELATED with disease risk. We’re learning now that weight stigma may be the real cause of the health gap between people in smaller bodies and people in bigger bodies.

So, what is weight stigma? Basically, it’s the oppressive treatment and marginalization of people in bigger bodies because of their body size. The fact that we even have an “ob*sity” epidemic is actually causing weight stigma, which has been linked to poor metabolic health and increased weight gain.

That’s right. The “ob*sity epidemic” is actually making people gain weight.

Why “Ob*sity” Is Stigmatizing

The word “ob*sity” can be translated in Latin to mean “to eat yourself fat”. The word itself puts personal responsibility on the individual for body size, even though body diversity is as normal as height diversity.

The only reason we even have the so-called “ob*sity epidemic” is that, in 2013, the American Medical Association voted for it to become a disease, even though their research committee recommended AGAINST classifying it as a disease. It was only made a disease for insurance.

People in bigger bodies receive worse medical care

In one study, a sample of 2284 physicians showed strong explicit & implicit “anti-fat” bias. Anti-fat bias is assoc. with beliefs that people who are fat are “lazy”, “weak-willed” and “bad”. Physicians with anti-fat bias are more likely to report fat patients as a “waste of time”.

Physicians often flat-out refuse the same medical exams and treatments for people in bigger bodies that they recommend for people in smaller bodies. People in bigger bodies are also more likely to avoid health care completely in order to avoid being stigmatized.

So why don’t people just… lose weight?

Seems simple enough, right? Lose weight, and you’ll be treated better! Wouldn’t that be nice.

Here’s the thing. If you’ve ever recommended that someone just lose weight because you’re “concerned about their health,” I highly recommend you stop yourself before doing that again. Check out my video on why we need to stop commenting on bodies or celebrating weight loss.

Do you think people in bigger bodies haven’t thought about that before? Like do you really think that if losing weight were really as simple as you’re saying it is, that people would still exist in bigger bodies? No.

Here’s the thing that everyone needs to understand:

Fat people are not lazy thin people trapped in fat bodies.

Not only is body diversity normal, but there are a ton of biological and physiological preventing the body from losing weight.

Most of the following research is from a book called A Clinician’s Guide to Acceptance-Based Approaches for Weight Concerns by Margit I Berman.

When I say diets don’t work, I mean they don’t work long-term. We have plenty of evidence to show that diets work in the short-term. But then this thing happens after a year that can only really be explained through biology.

That v-shaped trend you see in the graph shows that people who lose weight in weight loss diets experience rebound weight gain after one year. This happens over and over and over again. In fact, we don’t have any long-term weight loss studies that DON’T show this trend.

The common rebuttal here is: “Of course people gain weight when they quit the diet”. But here’s the thing… this happens in studies where participants maintain their dieting behaviors or even add on new dieting behaviors. The weight still comes on.

This can best be explained in the context of survival. It doesn’t make any physiological sense for the human body to be able to drop weight rapidly in response to starvation. As a species, we never would have survived famines.

The effects of dieting on the body

Some of the effects of dieting include:

Increased risk of anxiety and depression
Increased risk of developing an eating disorder
Slowed metabolism
Increased loss of lean muscle mass
Obsession with food
Increased cravings for high-fat, high-sugar foods
Impaired hormonal response, including decreased fertility and loss of menstruation in cis women
Reduced hunger/fullness cues
Increased risk of weight gain
Increased risk of chronic disease
Weight cycling

So when I talk about informed consent with dieting, I mean that doctors need to be fully explaining the risks of dieting when recommending weight loss.

The irony in all of this is that ‘”some meta-analyses and comprehensive reviews report that obes*ty treatments, on average, cause weight GAIN over long-term follow up” (Mann et al, 2007; ayyad & Anderson, 2000)’.

The current understanding of why all of these things happen when the body is underfed is biological like I mentioned before. All of these mechanisms help the body retain weight, store energy as fat, reduce hunger, and become super efficient with energy burning just in case you’re trapped in the wilderness without food for a few weeks.

You are not failing your diet, your diet is failing you

The statistic that I failed to mention in my tweet thread is the common one that is thrown around: 95% of people in weight loss trials regain the weight within 1-5 years and 1/3 – 2/3 of those people regain more weight than was originally lose in 4-5 years.

We do not have a single diet that has been studied to be effective for long-term weight loss, and even in the case of short-term weight loss, the risks pretty dramatically outweigh the benefits.

One of the first studies on the effects of dieting on the body is called the Minnesota Starvation Experiment. I’ll explain that in a later post, but for now, you can read about it here.

In the study, 36 men were assigned calorie-restrictive diets of ~1800 calories/day for 6 months. In that time, the men became extremely weak, would hoard food, became obsessed with food, and experienced severe personality changes, emotional distress, fatigue, decreased sex drive, and difficulty focusing. Sound familiar?

There’s so much more that can be said on the topic of why diets don’t work, but I’ll stop here and get to the happy part of this whole thing.

If Diets Don’t Work, What Should We Do?

Health at Every Size is a weight-neutral model of health care that has human dignity in mind. I highly recommend checking out resources like the Health at Every Size practitioner registry, Fat Friendly Docs, and All Go to find practitioners and places that are fat-friendly.

If you’re a clinician, I highly recommend checking out Fiona Wiler’s Health, Not Diets Digest and Unpacking Weight Science podcast.

In general, if you get anything out of this, it’s to stop focusing so much on weight. There is so much evidence that shows us that focusing on health behaviors like eating more fruits and vegetables, balancing blood sugar, exercising, and reducing stress actually have a significant impact on reducing risk factors for chronic disease, regardless of whether or not you lose weight.

At the end of the day, you don’t owe anyone an explanation for your body. If you are bigger and you just want to have a normal relationship with food and not have to dedicate your entire life to losing weight, I’m here to support you and there are countless other professionals online who will support you as well.

Yes, there will be misinformed people and medical professionals who try to tell you that you need to lose weight, but they probably do not know the full story. Now that you do, I hope you will be more empowered to make decisions that feel healthy for you. You do not have to restrict and starve yourself just because people don’t know the research.

In the same sentiment, we need to stop telling people to lose weight or commenting on people’s food choices. It’s incredibly disrespectful and can be really triggering for someone with an eating disorder. You cannot tell whether someone has an eating disorder just by looking at their body, and you cannot tell someone’s health just by looking at their body either.

Finally, we need to start listening to fat activists when they talk about this stuff. The most frustrating part of all of this is that I can be saying the exact same thing as someone in a fat body, and yet I will be taken more seriously and listened to more closely because of my body size. If you want to start learning from people who have actual lived experiences of being in a bigger body, I will be linking to all of my favorites below.

Again, I hope that this tweet empowers you more than anything else. You are so unbelievably worthy and amazing exactly as you are and you do not need to change your body for anyone.