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A client asked me recently how to handle it when someone mentions that they lost weight to try to manage a health condition. If you’re not celebrating intentional weight loss for any other reason, and you know that weight doesn’t equal health, should you congratulate someone for losing weight to try to, say, manage their diabetes or high blood pressure?
In a word, no. And here are more words explaining why.
To spare them future shame
Most people who intentionally lose weight regain some/most/all of that weight, regardless of their motivations. If you lose weight “for your health,” you are no more likely to become a weight loss maintainer unicorn outlier than if you lose weight to “look better,” have more fun shopping for clothes, or have an easier time fitting into airplane and theater seats.
If you have ever lost weight only to regain some/most/all of it, you know how frustrating that feels. You may have even felt deep shame because you “failed.” (A quick note that weight regain is not a failure, it’s your body’s attempt to protect you against what it views as starvation.) Probably the only thing that feels worse than this “failure” is the awareness that other people were aware you lost weight (and quite likely applauded and even celebrated your hard work) and then were aware that you regained it, because they have eyes.
So when someone you know loses weight for whatever reason, don’t comment on it or congratulate them about it.* That way, when they start to regain, they’ll be less likely to worry that you’re judging them, thanks to your previous neutrality on the subject.
*Yes, they might be temporarily miffed that you didn’t congratulate them, because celebrating weight loss is so sadly normalized in our society, but those feelings will pass.
Because weight doesn’t equal health
I know I already mentioned this at the beginning of the post, but it bears repeating. The whole healthcare party line that losing just a small amount of weight can make a big difference when it comes to blood sugar / blood pressure / cholesterol levels is kind of a crock.
First of all, whatever number is thrown out to represent “clinically meaningful” weight loss, usually 5-10%, but sometimes as little as 3%, it totally arbitrary. A few years ago, I read a research paper (which I can’t find right now, and it’s killing me) that said for ages doctors would recommend that their “overweight” or “obese” patients lose 20% of their body weight. But no one could do that (at least not without gaining it back, see above), so they started recommending 10%, then 5-10%, and then increasingly 3%…or even less (keep reading).
In 2013, an expert panel formed by the National Institutes of Health concluded that as little as 3 percent weight loss could improve blood sugar and triglycerides, while 5 percent may be necessary to improve blood pressure and cholesterol. However, they were talking about weight loss alone, not necessarily changes in nutrition and physical activity.
For example, in the Diabetes Prevention Study, participants who increased their amount of physical activity by about 150 minutes per week were 44 percent less likely to develop diabetes, even though they didn’t achieve “clinically significant” weight loss. This may be because physical activity is an effective way to reduce excess visceral fat — fat located in and around your abdominal organs — and increase muscle mass, both of which are associated with lower risk of cardiovascular disease and type 2 diabetes.
A 2016 editorial in the journal Obesity said that unfortunately, most doctors will likely stick to the idea that their patients who have BMIs in the “obese” range need to achieve at least a 5 percent weight loss. Why unfortunate? Because that level of weight loss may be neither achievable nor sustainable — and when people try and fail to lose weight or to keep it off, the resulting frustration makes it very easy to abandon the very nutrition and physical activity habits that in and of themselves improve health.
Because healthcare exists within diet culture
Doctors, nurses, dietitians and other healthcare providers are humans, and we humans all exist within diet culture, like it or not. (I vote “not.”) This means ideas about who “looks” healthy and what is required to achieve health are tangled up in body size.
When you have a chronic health condition such as type 2 diabetes or a condition that increases the risk of heart attack or stroke, such as high blood pressure or high cholesterol, and your doctor recommends weight loss, you are probably going to try to comply. Especially if you haven’t already done the work to divest from diet culture. Because doctors are authority figures, you’re probably worried and even a little scared about your diagnosis, and you want to be a “good patient.”
To congratulate or applaud weight loss in someone with a real health concern reinforces the idea that weight loss is an evidence-based treatment strategy, which in most cases it’s not. Again, behaviors such as…
- Physical activity
- Eating a health-supporting diet
- Taking time for adequate sleep
- Managing stress
- Taking any medications as prescribed
- Keeping up with preventive and follow-up healthcare
…benefit health regardless of current body size or any changes in body size. And not only are those behaviors evidence based, but we have direct control and autonomy over our behaviors, and weight and weight loss are not behaviors.
Now, back to the original question
So what DO you say if you, yourself, have done the work to divest from diet culture, and find yourself flummoxed by others’ health-related comments about their own weight. You may find it relatively easy to ignore weight loss talk that’s appearance focused, but draw a blank about what to say or how to react when someone says something like, “I have diabetes, but I recently lost X pounds, so that’s good.” Here are a few tips:
If you don’t know the person well. You could ignore the comment (easiest if the comment is made in a group, rather than to you personally). Or, you can ask a simple question such as, “Do you need to take medication?” or “How long ago were you diagnosed.” (They opened the door to discussing their health, so in that context, these questions would not be invasive or overly personal.)
If you do know them well. If a family member, friend, or co-worker you’re fond of is the one commenting that they lost weight for their diabetes or blood pressure, you can let the weight loss part of their comment slide right past, and instead ask them questions about what really matters most: how well they’re managing their health condition, and how they feel about having a health condition that has to be managed in the first place. In addition to the questions above, you could:
- Ask how they’ve been since their diagnosis (especially if it’s a relatively recent diagnosis).
- Ask how they’re adapting to needing to manage a health condition.
- Ask what changes they’ve made (behavior-wise). If they say they’re exercising more, ask them what they’re doing for exercise, and if they enjoy it. If they say they’ve made nutrition changes, ask them how that’s going (do they like the changes, does it make it challenging to dine out).
- Ask if they are happy with where their blood sugar / blood pressure / cholesterol levels are at (if applicable).
- If they mention they are making nutrition and lifestyle changes to avoid taking medication, ask them what concerns them about taking medication.
Basically, be a curious, compassionate and supportive friend or family member!
Carrie Dennett, MPH, RDN, is a Pacific Northwest-based registered dietitian nutritionist, freelance writer, intuitive eating counselor, author, and speaker. Her superpowers include busting nutrition myths and empowering women to feel better in their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute individualized nutrition or medical advice.
Seeking 1-on-1 nutrition counseling? Carrie offers a 6-month Food & Body program (intuitive eating, body image, mindfulness, self-compassion) and a 4-month IBS management program (low-FODMAP diet coaching with an emphasis on increasing food freedom). Visit the links to learn more and book a free intro call to see if the program is a good fit, and if we’re a good fit!
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