A client recently asked me how to handle it when someone reports losing weight to try to manage a health condition. If you don’t celebrate intentional weight loss for any other reason and know that weight does not 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 that explain why.
To save them future shame
Most people who intentionally lose weight regain some/most/all of that weight, regardless of their motivation. Losing weight “for your health” is no more likely to make you a unicorn who keeps the weight off than if you lose weight to “look better”, have fun shopping for clothes, or have an easier time getting on a plane and theater seating.
If you’ve ever lost weight only to gain some / most / all of it back, you know how frustrating that feels. Maybe you even felt deep shame because you “failed.” (A quick note that weight regain is not a failure, it is your body’s attempt to protect you from what it perceives as starvation.) Probably the only thing that feels worse than this “failure” is knowing that other people knew you lost weight (and quite possibly applauded and even celebrated your hard work). and then they realized you found it again, because they have eyes.
So when someone you know loses weight for whatever reason, don’t comment on it or congratulate them on it.* That way, when they start putting weight back on, they’ll be less likely to worry about it are you judging them, thanks to your previous neutrality on the subject.
*Yes, they may be temporarily upset that you didn’t congratulate them because unfortunately weight loss celebration is normal in our society, but those feelings will pass.
Because weight does not equal health
I know I already mentioned this at the beginning of the post, but it bears repeating. The whole health care party line that losing just a little weight can make a big difference in blood sugar/blood pressure/cholesterol levels is kind of unacceptable.
First of all, any number thrown around to represent “clinically significant” weight loss, usually 5-10%, but sometimes as little as 3%, is completely arbitrary. A few years ago, I read a research paper (which I can’t find right now, and it murder me) that for a long time 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 winning it back, see above), so they started suggesting 10%, then 5-10%, then increasingly 3%…or even less (keep reading) .
In 2013, a panel of experts formed by the National Institutes of Health concluded that losing just 3% of weight could improve blood sugar and triglycerides, while 5% may be necessary to improve blood pressure and of cholesterol. However, they were only talking about weight loss, not necessarily changes in diet and physical activity.
For example, in the Diabetes Prevention Study, Participants who increased their physical activity by about 150 minutes per week were 44 percent less likely to develop diabetes, even though they did not achieve “clinically significant” weight loss. This may be because physical activity is an effective way to reduce excess visceral fat—the fat found in and around your abdominal organs—and increase muscle mass, both of which are associated with lower cardiovascular risk. diseases and type 2 diabetes.
A 2016 magazine article Portliness said that unfortunately, most doctors will likely stick with the idea that their patients who have a BMI in the “obese” range should achieve at least a 5 percent weight loss. Why unfortunately? Because this level of weight loss may be neither achievable nor sustainable — and When people try and fail to lose weight or keep it off, the resulting frustration makes it all too easy to give up the very health-enhancing eating and exercise habits themselves.
Because health care exists within the culture of food
Doctors, nurses, dietitians, and other health care providers are human, and we all exist within the diet culture, whether we like it or not. (I’m voting no.) This means that ideas about who “looks” healthy and what is required to achieve health become entangled in body size.
When you have a chronic health condition like type 2 diabetes or a condition that increases your risk of heart attack or stroke, like high blood pressure or high cholesterol, and your doctor recommends weight loss, you’ll likely try to comply. Especially if you haven’t already done the work to break away from diet culture. Because doctors are authorities, you are probably worried and even a little scared about your diagnosis and want to be a “good patient”.
Congratulating or applauding weight loss in someone with a genuine health concern reinforces the idea that weight loss is an evidence-based treatment strategy, which in most cases it is not. Again, behaviors like…
- Physical activity
- Eating a diet that supports health
- Make time for adequate sleep
- Stress management
- Taking any medications as directed
- Adhering to preventive and follow-up health care
…health benefit regardless of current body size or any changes in body size. And not only are these 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 if you, yourself, have done the work to break away from diet culture and find yourself upset by other people’s health-related comments about their weight. It may be relatively easy for you to ignore conversations about weight loss that focus on appearance, but draw a blank on 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 some tips:
If you don’t know the person well. You could ignore the comment (easiest if the comment is to a group and not to you personally). Or, you can ask a simple question like, “Do you need to take medicine?” or “How long ago were you diagnosed.” (They opened the door to discussing their health, so in that context, these questions wouldn’t be invasive or overly personal.)
If you know them well. If a family member, friend, or colleague you like is the one commenting that they’ve lost weight due to diabetes or blood pressure, you can leave out the weight loss part of their comment and instead Ask them questions about what really matters most: how well they are managing their health condition and how they feel about having a health condition that needs to be treated in the first place. In addition to the above questions, you can:
- Ask how they’ve been since their diagnosis (especially if it’s a relatively recent diagnosis).
- Ask how they adapt to the need to manage a health condition.
- Ask what changes they have made (in terms of behavior). If they say they exercise more, ask them what they do for exercise and if they enjoy it. If they say they’ve made dietary changes, ask them how it’s going (he likes changes, it’s hard to dine out).
- Ask if they are happy with where their blood sugar / blood pressure / cholesterol levels are (if any).
- If they report making diet and lifestyle changes to avoid taking medication, ask them what concerns they have about taking medication.
Basically, be a curious, compassionate and supportive friend or family member!
Carrie Dennett, MPH, RDN, is a registered dietitian nutritionist based in the Pacific Northwest, freelance writer, intuitive nutrition consultant, author, and speaker. Her superpowers include; debunking nutritional myths and empowerment of women feel better about their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute personalized nutrition or medical advice.
Looking for 1 on 1 nutritional advice? Carrie offers a 6-month Food & Body program (intuitive eating, body image, awareness, self-compassion) and a 4 month IBS management program (How-FODMAP diet coaching with an emphasis on increasing food freedom). Visit the links to learn more and book a free introductory call to see if the program is a good fit and if we’re a good fit!
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