Yes, blaming individuals for living in larger bodies–the way Weight Watchers* and frankly most health care providers have done—may thankfully be changing. It’s a long overdue shift. The weight-centric healthcare model — in other words, ‘if you’re sick, it must be because you’re fat’ — is finally starting to shift. But not in ways this Registered Dietitian finds acceptable.
While the introduction of the GLP1s has helped move some providers from blaming their patients–acknowledging that yes, there really are metabolic and genetic and medication based explanations for weight gain–the public is still pathologizing individuals that live in larger bodies. The sentiment is that larger bodies still need to change–just with medications.
Stop there. Just because there are associations between higher #BMI and several diseases, does not mean causation. In my 35 years in practice I can tell you that I have seen glucose and hemoglobin A1c levels normalize well before and regardless of any weight change. For individuals struggling with a long history of an unhealthy relationship with food — perhaps impacted by #weight bias and #fatshaming, and striving to be at weight that their body isn’t created to be at, the food restriction that comes from the GLP1s, such as slowed digestion and nausea is not the answer for their health and wellbeing.
For healthy individuals with no #eating disorder that are at a high BMI, being labeled as “‘diseased” because they are “living with obesity” perpetuates the problem. And directing them to reduce their intake, whether by diets or injection or bariatric surgery, is simply inhumane.
I am not against GLP1s. As a Certified Diabetes Care and Education Specialist, I see their merit for individuals with diabetes for sure. And given the cardiac risk reduction, for those at high risk who are also directed to eat adequately and are supported by a Registered Dietitian, there may be a place. But not without assessing and addressing any underlying eating disorder and providing support to ensure they eat adequately — without a directive to be losing weight.