Fat Talk, Part 4

If you haven’t read the earlier posts in this series, which are full of heavy disclaimers and context about why I’m weighing in on a sensitive subject with virtually no expertise, I encourage you to start there: Parts [1] ,[2], and [3]
If you have, let’s continue…

Part 4 – Outside Assistance

It is important to remember that weight loss may not be easy – or even possible – for some people on their own. One of the most important points Virginia Sole-Smith does make in her book Fat Talk: Parenting in the Age of Diet Culture [4] is that there are many factors that contribute to the ease or difficulty of weight loss, and very rarely does it simply come down to will power. Your genetics and epigenetics (factors in your environment that impact how your genes work) play a role in how and where you store fat.

Healthy Choices and Behaviors May Not Be Enough

The genetics piece is very much outside of your control, and the epigenetics piece may be largely out of your control as well. For example, lack of access to proper nutrition, exposure to pollution, or contact with certain types of chemicals over the course of your life may be related to where you live (i.e. where you can shop, what’s available for purchase, pollution sources nearby, etc.) and that also can be outside some people’s control if they’re not able to move. [5] (Note: social determinants of health, including socio-economic and accessibility factors, represent a huge can of worms for another time. I feel like I say that a lot.)

I’ve got issues with the shoes on the table… or the food on the floor in this picture. But aside from that, it’s important to remember that healthy diet and exercise are more important indicators of health than weight. But it is worth noting that in extreme cases weight can be an obstacle to healthy activity.
Image credit: [6]

I know several people who have lost significant quantities of weight, and while the reasons and circumstances of those examples vary, the difficulty of keeping the weight off is consistently high across the board. Our bodies have evolved to keep us alive through a variety of potential life-threatening situations – and they don’t know the difference between a fad diet and a famine. So, if your body thinks you are starving, it will hold onto more fat in order to keep you safe, making it harder to lose weight when you’re trying to. That’s why a lot of times people who have lost significant weight gain most, all, or more of it back – because their bodies think they need to counteract famine conditions by eating more when food is available. The result is the brain making the person feel hungrier while also slowing their metabolism. [7]

What some adult friends have sometimes described to me is a resulting regimen of intense caloric restriction and frequent exercise simply to maintain weight – behaviors that would be considered concerning if undertaken by, say, a thin teenage girl. And I want to reiterate that vanity is not necessarily an issue here. In some extreme cases (like one described in the New York Times article linked above), carrying enough weight can make it hurt to perform simple activities, such as walking. No matter what the studies referenced in Fat Talk say about fitness, not fatness, being the issue with cardiovascular health, one still needs to be mobile enough to exercise, and that is not necessarily the case for many people who are actively trying to shed pounds for health purposes.

Fad diets and products have been taking advantage of self-conscious consumers for generations and have not necessarily been healthy (physically or mentally). But as long as we’re dissatisfied with ourselves, their methods will continue to work.
Image credit: [8]

There are many reasons why someone may want to lose weight, whether for vanity, for health, or a range of reasons in between. Companies pushing fad diets, exercise equipment, and even weight loss drugs have benefited greatly over the years from our desire to lose weight – the diet industry alone represents a net worth of over $70 Billion. [9] Although I couldn’t find any numbers to back it up in my cursory internet research for this post, I think it’s fair to assume that a majority of their revenue is driven not by a desire to be healthy, but by a desire to be thin. And that’s where Sole-Smith’s argument comes in: that we shouldn’t be making ourselves unhappy and fueling eating disorders in our kids so we can achieve an unachievable and arbitrary societal standard.

Pharmaceutical Assistance

Again, I agree with that concept, but it’s a concept that does not apply to every situation and that does not account for the people who want to lose weight because they don’t feel healthy, because their bodies hurt, or because they’ve developed health conditions as a result of the excess weight they carry. I’m talking about people who are stuck between the unhealthy situation of living with weight-related diseases and the various unhealthy behaviors they might undertake to try to lose that weight and keep it off. For the people I know who have truly struggled with weight, it is a no-win scenario, which is why it’s not surprising that many turn to weight loss drugs for help.

Many weight loss drugs made available over the years have been stimulant-based. Generally, they’re designed to keep your metabolism up as your body is trying to slow it down, but there are other health risks that come with them, such as difficulty sleeping, high blood pressure, and anxiety, [10] and when you stop taking them, your metabolism slows back down again, reintroducing the risk of even more weight gain. There has been an interesting development recently that may turn the tables a bit for some in more extreme situations, and that is a new class of drugs called “GLP-1 Agonists,” which uses a different mechanism than stimulants. [11]

A quick internet search for diabetes drug “semaglutide” yielded in an interesting breakdown of results. Only two of my top returns were clearly related to diabetes, while eleven were clearly related to weight loss. (The remaining six were unclear without clicking on the links.)
*(I also recognize that my research for this post may have skewed my algorithm – thanks, Google.)*

GLP-1 Agonist drugs (notably one called Ozempic) were developed to manage type 2 diabetes, but it also happened that weight loss was a common side effect. The drug works by lowering blood sugar, telling your brain your stomach is full, and slowing digestion. [12] It was approved by the FDA in 2017, and the same company followed up with another drug using the same mechanism – but more of it – specifically meant for weight loss. The weight loss drug is called Wegovy, and it was approved by the FDA in 2021.[13]

Not being a healthcare professional myself, I really cannot speak to the risk-reward level of these drugs. They’re new enough that physical and psychological health impacts are still being studied, which might give me pause. [14], [15] Also, having taken various forms of hormonal birth control over the years and becoming acquainted with the related risks there, I personally am now incredibly cautious about any drug that affects your hormones. All that said, my weight does not impact my daily life, so neither I am in the position to say what I might or might not do in a different situation. I do, however, know a couple people taking them – not for vanity reasons – and they have referred to them as an absolute game-changer.

Next week we will get into more details about the benefits of those drugs for people who need them, as well the issues related to their use among people who don’t.
Thanks for reading!

Keep Reading –>

[1] https://radicalmoderate.online/fat-talk-part-1/

[2] https://radicalmoderate.online/fat-talk-part-2/

[3] https://radicalmoderate.online/fat-talk-part-3/

[4] https://www.goodreads.com/en/book/show/61144950

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326440/

[6] https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/5-steps-to-lose-weight-and-keep-it-off

[7] https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

[8] https://www.businessinsider.com/dieting-then-and-now-2016-6

[9] https://www.chhs.colostate.edu/krnc/monthly-blog/i-spy-a-fad-diet-your-guide-to-critically-evaluating-diet-and-wellness-trends/

[10] https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832

[11] https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/byetta/faq-20057955