There's no "right" way to lose weight (says the person who did it "right")

On moralizing how people practice bodily autonomy.

iStock, Oleksandr Paltsev

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In the relentless march into hell that is the weight loss drug conversation right now, you might come across the opinion that people who take drugs like Ozempic, Wegovy, or Mounjaro to lose weight (I’m not talking about already-thin celebrities who really want to lose three pounds, I’m talking about fat people) are “cheating” or “taking the easy way out” or are “too lazy” to do weight loss “right.” Doing it right, they say, is eating less and moving more, getting up off the couch, having a little discipline, etc. These are the same little and loud judgements such people have lobbed at weight loss surgery patients for years.

It’s without question that we should consider the risks [*see below] of semaglutide and tirzepatide, the active ingredients in these drugs, just like we should consider the risks of weight loss surgery. But these critics don’t care about risks or health, they care about what they see as the weight loss moral high ground. They believe that any approach other than getting into a calorie deficit via the eat-less-move-more directive (let’s call it ELMM) is suggestive of an unprincipled, negligent, craven personality.

Regarding ELMM, I don’t argue against the fact that being in a calorie deficit causes weight loss, but this directive is not the end of the conversation. It’s barely the start. It’s an entirely useless, unrealistic, and unempathetic command when it does not 1.) give a person an actual game plan for doing those things that takes into account their lifestyle, environment, health, history, barriers to success, etc., and 2.) consider all the things that can contribute to higher weight and difficulty losing it — obesity scientists have pointed to thousands of potential contributors but have “an implicit understanding of what obesity is not: a personal failing.”

How it feels when you say ELMM, like it’s just soo00oooo easy for everyone!

ELMM might be what your general practitioner (who might have very little nutrition education) says during your seven-minute interaction they were 38 minutes late for, but it’s not what obesity specialists see as meaningful advice, so certainly we Average Joes should stop saying it like we’ve cracked the case for every person alive.

I can’t embed tweets anymore because Elon Musk is a callow fuckhead with an axe to grind about Substack, sorry!

My man Ben Carpenter puts it brilliantly once again:

Ben Carpenter

Ben Carpenter on Instagram: ”“Eat less, move more” isn’t helpful advice. To clarify, when I (and many other people) say this, we are not denying that reducing your calorie intake relative to your expenditure is the way to facilitate weight loss. What we are *actually* saying is that this isn’t the bit most people are struggling with. Are there people who don’t realise weight loss/gain/maintenance hinges on how many calories you consume? Absolutely, 100%. But, there are *many, many* people who do know this, and that isn’t the issue. To give you an idea, a majority of people who diet will regain some or all of the weight that they lost. Long-term success rates are notoriously poor and this is especially true in diets with no continued support. So why do people think that we can just give someone a diet plan, or say “eat less, move more” kick them out the door and expect it to work? It is an oversimplification and completely ignores many of the barriers of long-term success. Weight loss looks simple on paper, but it is not equally easy for everyone. We aren’t saying “eat less, move more” isn’t correct. We are saying that this advice is useless unless someone is going to pair it with something actually actionable. I am not someone who struggles to lose weight when I want to and even I find lots of weight loss advice on the internet patronising as fuck lol.
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#caloriedeficit #flexibledieting #iifym #myfitnesspal #caloriecounting #insulin #calorie #calories #thermodynamics #fatloss #weightloss #fatlosstips #weightlosstips #fatlossmyths #weightlossmyths #personaltrainer #intermittentfasting #timerestrictedfeeding #timerestrictedeating #keto #lowcarb #lchf #nutritionscience #eatlessmovemore”

June 1, 2023

And here’s where my take on this issue could surprise you:

I’m someone these critics might uphold as the gold standard for “natural,” “healthy” weight loss. I’m an example of how losing a lot of weight sensibly and keeping it off for a long time is possible — I went to therapy to deal with binge eating disorder, developed a long-term plan of action with my therapist, adjusted my habits and behaviors over the course of many months, started eating mostly nutrient-dense food without bingeing, started losing a few pounds a month, and eventually lost around 70 over nearly two years. I didn’t take any medications or supplements or undergo any procedures. I didn’t go on a crash diet. I changed my eating and my exercising in ways that persist to this day, 10 years later, so I lost a lot of weight and kept it off.

You know why I could do all of that? Because everything about my life made it all way easier and more accessible than it would be for a lot of people.

When I started seriously exercising and changing my eating habits I was in my early 20s, with minimal responsibilities or obligations and boundless energy. I went to a $10/month, 24-hour gym 200 feet away from my house. I worked irregular hours, often from home, so I could go to the gym whenever. The grocery store was right down the street. I could spend hours watching YouTube videos about how to lift weights and cook nutritious food. I had time to meal plan and prep. I could walk or bike everywhere. I had abundant free time and no kids. I had no physical issues or genetic conditions that made weight loss harder. I had health insurance that covered therapy.

Now I live in one of those “fittest” cities in the country, with trails and sports fields everywhere, and a “Walker’s Paradise” walk score. There are multiple gyms and grocery stores within a 15-minute walk of my building. There’s a gym in my building. My husband likes to exercise and cook too, so our lifestyles are in sync; he was essentially my free personal trainer in the early days. And perhaps one of the most-overlooked factors of dedication to exercise and nutritious eating: I just really like to exercise and cook nutritious food. I got group fitness instruction and nutrition certifications through the American Council on Exercise years ago. But that’s just me — not everyone’s into this shit!

This isn’t to say my weight loss process was without challenges and the need for perseverance, commitment, and focus, but everything about who I am and how I live is supportive of regular exercise, abundant nutrition, and weight loss if I want to pursue it, and it’s been that way for years. I’m not a weight loss success story because weight loss is easy in general, it was just easier for me, because I live a cushy, DINK-y, privileged-ass life and I’m a particular kind of person. I think most people who really want to make changes to their habits or bodies can do so to some degree no matter their circumstances, but it might be way harder! It might take way longer! It might be way more miserable and stressful! It might add a lot of sturm und drang to their already highly-stressed lives! Their degree of success might be way less than mine for myriad reasons, and this might be incredibly discouraging!

I would not expect a person who isn’t me to be able to follow my exact weight-loss game plan, because weight loss is incredibly nuanced, specific, and personal. I think everyone needs to be honest with themselves about whether the body change obstacles in front of them are actual obstacles or if they are, in fact, just being kind of lazy (which is normal and human, I’m lazy all the time). But I also think that if someone has been struggling for a lifetime with their weight, running themselves ragged trying to make the exercise and the eating and the steps and the meal prep work while they deal with health conditions, multiple kids and jobs, a food dessert, a gym that’s 35 minutes away, and they’re seeing no results and it’s making their life miserable — I’d never begrudge them exploring whether a shot or a pill or a surgery could be right for them.

Of course I implore that they do so under the care of a responsible doctor who is helping create a continued plan for eating and moving well — these weight loss drugs, after all, are meant to be an adjunct to diet and exercise — and first addressing any disordered-eating issues. I beg of them that they educate themselves and understand all risks. After that, as is my ethos in this newsletter: If you want to do something with or to your body and you can do it in a way that’s as sane, safe, and sustainable as possible, go for it. That’s your prerogative. You have bodily autonomy.

I’m not a cheerleader for the use of weight-loss meds or surgery, I just accept them as an option. Medications and surgeries have side effects and risks. Ideally, no one would have to explore the use of any of this. But also ideally, we’d live in a world where moving often and eating well was easier and more accessible. We’d live in a world that wasn’t so godawful-difficult for fat people.

@DearSplenda made points.

I don’t expect anyone who’s struggling mightily with their weight and against constant anti-fatness— as I once did — to sit around waiting for the twisted American food system, an environment that breeds sedentary behavior and an overreliance on cars, capitalism’s obliteration of work-life balance and free time, or fat-hating cultural attitudes to get better before they can live their lives more easily in their bodies. I’m fine with whatever they want to do to achieve that, even if it’s different from what I did.

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*Selected articles about risks:

Peer-reviewed article on safety of semaglutide that details its adverse effects, published in Frontiers in Endocrinology. It concludes: “Given the beneficial metabolic and cardiovascular actions of semaglutide, and the low risk for severe adverse events, semaglutide has an overall favorable risk/benefit profile for patient with type 2 diabetes.”

General primer on semaglutide (in Ozempic and Wegovy), its safety, who should not use it, common side effects, published in Forbes Health. It concludes: “The most common side effects are gastrointestinal in nature: nausea, vomiting, diarrhea and constipation … Taking Ozempic may cause other less common, but more serious, side effects,” [listed within].

“An Extreme Risk of Taking Ozempic: Malnutrition,” published in The New York Times. “Severe cases like Ms. Lavach-Savy’s are rare, experts say. But some people taking Ozempic can experience such intense lack of appetite that they do become malnourished.”

“The pregnancy risks of Ozempic and Wegovy need more attention,” published in Vox. Animal studies are the basis for the FDA’s warnings that Ozempic and Wegovy use should be discontinued at least two months prior to a pregnancy. Follow-up studies are ongoing.

Comprehensive report on a double-blind, randomized, controlled, 72-week tirzepatide trial, published in The New England Journal of Medicine. It concludes: “Overall, 78.9 to 81.8% of participants treated with tirzepatide reported at least one adverse event that emerged during the treatment period, as compared with 72.0% of participants in the placebo group. These were transient and mild to moderate in severity, and occurred primarily during the dose-escalation period.”