This week on the podcast, we have Dr. Joshua Wolrich, currently known on Instagram as @drjoshuawolrich, but previously known as @unfattening. He is a UK doctor who is passionate about debunking nutrition fads and fallacies and talking about the nuances of weight loss. Together, we dive deep into weight, weight loss, and the issues around prescribing weight loss in the medical community.
In this episode, Joshua and I talk about:
- Joshua’s journey to anti-diet culture
- How to talk to your doctor about health at every size
- Weight loss and informed consent
- Celery juice (and why it’s not going to cure you)
The Journey From @unfattening to @drjoshuawolrich
With the handle @unfattening, Joshua started out on Instagram as weight loss account. My first interaction with him was after someone sent me a post of his that I didn’t agree with, and I lashed out in his comment section (don’t worry, we get along much better now!). At the time, I thought he was another doctor that didn’t know what he was talking about. Turns out, he was new to the whole destroying-diet-culture world and was trying to figure it all out for himself.
Throughout his weight loss journey, Joshua quickly became familiar with the problematic nature of weight loss and began shifting his view on diet culture. Instead of focusing his social media platform on weight loss, he wanted balance information on the harms of prescribing weight loss while reconciling that with the fact that he had lost weight.
For a while, he justified the name @unfattening by thinking that it helped attract the same kind of people that he wanted to help. At a certain point, he realized the name was inherently stigmatizing. The first thing it made you assume about the account was that fat was bad and he would help you ‘unfat.’ As catchy as the name was, eventually it wasn’t his brand anymore. For that reason, it had to go.
Unpacking ‘Unconditional Permission’
When Intuitive Eating was still fresh for Joshua, he saw the tenant of ‘unconditional permission’ as an excuse to justify only eating nutrient sparse foods. The post he made (yes, the one we initially fought over) was his attempt to explain that just because you have unconditional permission to eat doesn’t mean you should eat all foods. The message came across in the wrong way. As he’s familiarized himself more with Intuitive Eating, he’s also become better able to express it.
Now, Joshua preaches that the better your relationship with food becomes, the less problematic moderation becomes. Although you are honoring your body when you choose nutrient-dense foods, if you don’t start from a position of unconditional permission, it can end up being restriction masking itself as moderation because it’s coming from a place of fear rather than freedom.
Moderation can be restrictive in itself, which is why it’s important to give yourself unconditional permission. From there, you can allow your body to settle into a natural balance. That’s where your body prefers to be, but NOT when it’s coming from a place of fear.
Is Weight Loss Always Problematic?
Joshua consistently gets messages from followers who have a health issue that is related to weight, but they don’t know what to do. This advice is really hard for him to give, and his opinions on this make him feel like he’s on the outskirts of the non-diet culture.
He doesn’t believe that wanting to lose weight is mutually exclusive to understanding the problematic nature of diet culture.
He feels that there are times where weight loss can be beneficial for health. That being said, going about it in a non-problematic way is extremely difficult (if not impossible). If anything, folks need to heal their relationship with food first. But even at that point, you get into questions of whether the weight loss will actually improve their health (which is a much longer and more complicated conversation). He believes it’s a bit nearsighted to pretend weight loss will never help health- the tension between the two is ridiculous.
The anti-diet community takes a more extreme approach in speaking out against the pursuit of weight loss, because the evidence doesn’t support the benefits of dieting or calorie restriction for weight loss. The fact is, we don’t even know if weight loss is going to work. We don’t know if it’s going to lead to better health. It’s confusing when there are so many things when you have so many things in society telling you to look a certain way. In those moments where talking about weight loss is just too nuanced to communicate over social media, Joshua tends to say that it’s not his job to tell people whether or not they should be losing weight.
The Weight Loss Grey Area & The Medical Field
A lot of people in the medical field get weight loss confused. It’s relatively easy from a statistical perspective to look at the extremes of higher weight and lower weight generically and say that respectively losing weight or gaining weight will improve health. It’s easy to forget that the middle ground is extremely complicated.
An example of why extremes are easier to than the middle ground:
In your abdomen, you have a large blood vessel called your abdominal aorta. As you age, a large percentage of the population experiences that aorta getting slightly wider. This is called an abdominal aortic aneurysm- the wider it gets, the higher the chance it’ll rupture. We know that rupture is pretty much almost certain death, so there’s a point where we have to intervene. However, the risk of doing an operation is incredibly high. There’s a lot of research on the point at which the benefits of doing the operation get outweighed by the risk of death. In the UK, there are now screening programs so we can determine the point at which the benefits of surgery outweigh the risks. That’s the difficulty with weight loss- there’s such a grey area where the risks of intervention are much higher than the benefits of actually successfully losing weight. If we were robots, we’d all lose weight and that would be fine. But we’re not. We need to be pretty sure that undertaking it would be worth it.
This is why the relationship with food needs to be taken into account- the better your relationship with food, the better outcomes you’ll expect from the intervention.
That doesn’t mean the risk is zero, but it becomes less risky.
The complicated nature of this makes it extremely hard as a doctor- you want to do the best for people, but sometimes you just don’t know what that is. Joshua understands the problematic nature of weight loss, but not all doctors do. The ones who prescribe it are not evil; they’re just trying to help.
Why Prescribing Weight Loss Ignores Informed Consent
When we’re talking about doctors advising weight loss, there’s no informed consent involved. People don’t know the risks, and they don’t know that in a lot of weight loss studies, even the people who maintain their dieting behaviors still put the weight back on.
With weight loss, there’s a risk of:
- Damaging your metabolism
- Harming your relationship with food
- Developing anxiety
- Developing depression
There isn’t accurate informed consent happening, and that’s a huge ethical problem.
Coming from a medical background, Joshua deals with consent all the time. Part of that consent is explaining alternative options, the benefits of going ahead, as well as the risks. It’s always a balance of risk versus reward. From a research perspective, we’re still in a place of trying to understand the risk/reward side of all this. This is largely because of how the research has been done- it has totally ignored people’s relationship with food.
Joshua is here to remind you that there are a lot of different methods to losing weight. Although they’re all problematic, some are less than others. That being said, you can never make them completely unproblematic. In a robotic sense, weight loss isn’t a bad idea- it’s the way that people ignore the impact on their relationship with food that is the issue. Focus on your relationship with food first. Although that won’t make any weight loss method less problematic, you’ll at least have more awareness around whether or not it’s wrecking your relationship with food.
It’s still hard- most people aren’t going to be able to focus on weight loss while having a good relationship with food. He doesn’t know how to distinguish that- and that’s the issue with indiscriminately advising weight loss.
Celery Juice & Why You Should Be Skeptical
Celery juice is not a cure-all. Sure, maybe there are some benefits, but people take it WAY out of context when they label it as a medical miracle.
The Origins of Celery Juice
Joshua explains that there is someone who lives in LA and calls himself the Medical Medium. One of those two words is correct- he is a Medium. He says he talks to his ‘source,’ that tells him nutrition information ahead of its time (and ahead of the research, which is really convenient).
The latest prescription from the Medical Medium was that celery should be juiced (about 12 ounces) and drank by itself, first thing in the morning. If you drink that on a daily basis, you’ll pretty much more everything- mainly skin conditions, inflammatory bowel disease, and cancer. The Medical Medium claims that he was ‘told’ that the Epstein Barr Virus (EBV), which is the virus that gives you mono, pretty much causes everything, including psoriasis, liver cancer and bowel disease. To top it off, he claims that celery juice cures EBV.
There are two big things wrong here:
- EBV doesn’t cause any of those things
- We have no evidence that celery juice does anything to help EBV
Something that commonly happens in the medical world is confirmation bias. This is essentially what happens when you’re told that something is going to happen, and it happens (for example, drink celery juice and your skin condition will get better). That’s not magic- it’s the placebo effect.
What’s really going on is you’re drinking more liquid in the morning, you’re having more vegetables, and that’s all fine and good. Do whatever you want with celery, but stop believing the pseudoscience that comes with celery juice. That’s what Joshua has a problem with. It’s a quick and fast slippery slope. Pseudoscience is much easier to believe if you already believe the easy stuff, like celery juice. Joshua addresses celery juice because he doesn’t want everyone just believing what they’re told. If there’s one person that doesn’t go down the rabbit hole of alkaline diets to cure their cancer, or essential oils to cure their diabetes, and there’s one person that doesn’t die because they’ve taken that advice, then his job is doing what it’s intended to.
Talking to Doctors About Weight Loss & Health At Every Size
One of the things I recommend people do if their doctor consistently recommends weight loss is go with some research about health at every size if they have no other options. Joshua says this could be a good approach, but it depends how- and when.
General practitioners have a very limited amount of time with patients. When someone comes into the doctor’s office with something printed off the Internet, it’s usually because they’ve Googled their symptoms and they come in saying they have a specific illness. It sets the whole consultation back half an hour, which is time the doctor just doesn’t have.
Being a doctor requires a lot of understanding, seeing a lot of different things within an examination and bringing everything together to come to the most likely diagnosis. If you come in with research, Joshua says that as a doctor, instantly his guard goes up; he thinks you won’t do anything he says from now on. In the end, doctors are humans too.
Doctors would take it the best by having a conversation with them around health.
If during the consultation they bring up weight loss that you feel isn’t relevant, let it go. He says he knows that’s a hard thing to do, but let it go till the end of the consultation. Interjecting and stopping at that point is not conducive to a good conversation. Even if you feel you know more about health and weight than your doctor, that’s really freaky for the doctor- they don’t want to admit that. If you come at them and tell them they’re wrong, the trust is gone. It’s better to talk about it at the end of the conversation, after you’ve thanked them for seeing you, and then they’ll be more likely to hear what you have to say.
Ask if you can leave them with the research and reassure them you’re not trying to be patronizing, but you would love to get their opinion on it. Even if you know more about it than they do, use that knowledge wisely. There are certain techniques you can use to make the conversation go better.
If you want to check out Dr. Joshua Wolrich’s work, head over to his Instagram @drjoshuawolrich. He also has a podcast called Cut Through Nutrition that’s all about debunking nutrition myths and fads!
About Dr. Joshua Wolrich
Dr Joshua Wolrich has had a bit of a journey on social media. Working as a surgical trainee in London, he originally started his Instagram as a weight loss account by the name @unfattening. Over the past few years he has become acutely aware of the problematic nature of both losing weight and also encouraging it. He now focuses on improving one’s relationship with food through addressing #nutribollocks and reminding us that there is so much more to health than our weight on the scales.
Mentioned in this episode:
- The Cut Through Nutrition Podcast
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This post was transcribed and edited by Brittany Allison, Intuitive Eating Counsellor. You can find her on Instagram @thefoodfreedomlife.