How Did Vance Lose 200 Pounds?

Dr S.,

This is a video about a dude named Vance who lost 200 pounds, and his methods seem pretty simple: accept help from friends, be accountable, change diet. I know you dislike diet culture, so I am curious how you view his story.

-MG

Dr. S: I like some things about this story:
– He speaks about deciding on his own to make a difference in his health (albeit through weight loss, the gains in health from increased social interaction, dietary moderation and exercise aren’t mentioned)
– He doesn’t at any weight seem to judge himself negatively or as morally bad. 
– He really debunks “all or nothing” thinking. One day of “fucking up” is part of the journey. I like the self-accepting part of the journey. 
– I don’t know what the data is on the role of shame in accountability (if you don’t lose one week) or as a motivator, but it didn’t seem to bother him or give him an eating disorder. 

That’s the good news. But what makes me want to fucking howl at the stupid moon are the people who glorify weight loss as a noble pursuit. I think I have to go run to burn off how angry that makes me. It is 100% toxic diet culture (as if there is any other kind of diet culture). It is eating-disorder-o-genic attitudes that weight loss and thinness are more than neutral descriptive actions or facts, but as things any thinking person who “has to lose weight” (as defined by… unrealistic internalized beauty standards) would obviously do. If you have extra weight, nothing you do while carrying that weight means anything, because it was done by a worthless, disgusting, lazy fat person. 

Now, the video did not say 90% of what I just wrote. But anyone who has learned to the point of automaticity (ie everyone) the thought process is actually an entire cascade that can be set off by the simple act of praising weight loss generally, as the thing that OF COURSE you are working on doing. 

This guy really needed to lose weight in order to move and breathe. And good for him for essentially ridding himself of half of himself. He’s got two more years to keep it off to be one of the 5% of dieters who are successful over a 5-year period. I genuinely hope he does it.

I wonder what his family’s relationship with food and weight and body was. I wonder if he’s genetically prone to live in a larger body (not 400 pounds large, but overweight by BMI). If so, I wonder how many times his pediatrician and later his PCP told him to lose weight. Who else in his family was eating disordered? He got to 465 or whatever it was somehow. 

So I’m psyched for him. I’m angry at the world for sustaining and fanning the flames of diet culture, which is killing people. Every hour of every day in every year, someone dies as the direct result of an eating disorder. That’s cool. Let’s keep making our NewYear’s Resolutions to get skinny.  (My vitriol is not directed at the video. It’s directed at everyone who refuses to hear that weight is an unreasonable metric of health and weight loss is a self destructive waste of mental energy.)

I wish everyone could be at 75% of their ideal body weight for an hour, and then see how they feel about propping up a system that condemns a percentage of people to eating disorders and a larger percentage to lifelong body loathing and disordered eating.

Ah. I feel better now that that’s not canned up. Thanks for sharing this thought-provoking video. 

MG:, I am going to counter your rant here. This guy who weighed 465 pounds was going to go paws up way before his natural biological time. His healthy weight was not 465 pounds. There has to be a way to help people lose weight without triggering thousands/millions of eating disorders and diet-related health problems and deaths.

There’s a difference between showing people images of skinny half-naked bodies in ads and implying that this is the proper way to look, and letting people know that there are health risks to carrying around a basketball-sized belly. We need to solve that problem.

Dr. S: This 465 pound dude did a lot of hard work and seemed to have a mastery of non-self-judgment, but I’d still love to interview him about the times in his life he was publicly called out because of his weight, and how he felt each time a doctor said “You’re a fat man walking. If you don’t want to be a dead man walking, stop overeating and exercise”

The unintended message being not “this extra mass is depriving you of the joy of deep breaths, more energy and facile movement. Let’s work together to get those things back into your life” but rather “the solution to your wrong and disgusting body is willpower, fatty. What the fuck have you been doing in this last year?”

Because people almost universally ascribe laziness, uncleanliness and lack of willpower to fatness without even knowing it. The bias is very strong. And the care avoidance as a result can cause its own problems. 

Weight is a symptom of regulation gone awry in some system in the body– self-soothing, hormonal hunger snd satiety cues, hypothalamic and thalamus issues, thyroid issues–and we need to address the problem in the system, not just address a symptom. 

When someone has a cough from pneumonia, we don’t just give them a cough suppressant. We treat the underlying pulmonary dysregulation, ie the pneumonia to ultimately effect a cure. 
There are so many layers to this: early detection and, even better, prevention, which means educating parents about body-shaming and diet culture. 

Yes, most people who are told to lose weight do not get an eating disorder that rises to clinical criteria. Many develop a dysfunctional relationship with food and a reinforced body-loathing, the shame of which prevents heavy people from exercising or returning to see the doctor because it’s humiliating. 

Most importantly, telling someone to calorically restrict in order to lose weight is setting 95% of them up for failure over five years. 

Why recommend a medical intervention that DOES NOT WORK and harms the majority of people who get that advice?