Tag Archives: weight-loss

Advocacy Masquerading as Evidence: A Systematic Critique of GLP-1 Misinformation

On April 6, 2026, the journal, Fat Studies – The Interdisciplinary Journal of Body Weight and Society published the article, “GLP-1 medications for weight-loss: a triumph of marketing over patient care.” Written by Regan Chastain, Angela Meadows and Louise Adams, it is best understood not as a neutral clinical review but as an activist driven critique shaped by explicit ideological commitments.

This is not a baseless observation. It is disclosed within the paper itself and reinforced by the authors’ professional backgrounds. None of the three authors is a medical doctor, endocrinologist, cardiologist, or specialist in obesity medicine. Instead, the contributor statements identify them as a patient advocate and health writer (Chastain), a psychologist specializing in weight stigma (Meadows), and a clinical psychologist and weight inclusive health advocate (Adams). These are legitimate perspectives. But they are not equivalent to clinical trialists or physicians managing cardiometabolic disease.

More importantly the paper explicitly states that the authors “reject weight loss as a valid goal for individual or population level health promotion.” That declaration establishes a prior normative commitment that materially shapes the analysis. This is also known as “confirmation bias.”

When a paper begins by rejecting the primary therapeutic endpoint of the drugs under review, its conclusions are necessarily constrained by that premise. The result is not an open evaluation of evidence, but a framework in which any observed weight loss is either discounted, reframed as harm, or treated as irrelevant to health.

This foundational stance informs one of the paper’s most conspicuous factual distortions, the characterization of weight loss as a “side effect” that is intentionally “magnified” through high dosing. In the context of FDA approved obesity treatments such as semaglutide (Wegovy) and tirzepatide (Zepbound), weight loss is not an unintended side effect; it is the primary therapeutic objective.

Clinical trials are designed with weight reduction and related health outcomes as endpoints, and dosing is titrated based on efficacy and tolerability, not arbitrarily maximized to induce harm. Reframing the intended therapeutic effect as a “side effect” is not merely imprecise language. It is a rhetorical maneuver that allows the authors to imply that the treatment paradigm is inherently perverse. This constitutes a category error that undermines the paper’s credibility at the level of basic pharmacological description.

The paper’s treatment of clinical evidence further reflects a pattern of selective skepticism. The authors repeatedly emphasize industry funding, conflicts of interest, and pharmaceutical marketing as reasons to distrust the underlying evidence base. While these concerns are legitimate and important, they are deployed in a way that amounts to a genetic fallacy. The validity of clinical trial results is implicitly questioned based on their origin rather than their methodology, reproducibility, or regulatory scrutiny. At no point do the authors engage meaningfully with the fact that these trials undergo independent peer review, regulatory evaluation, and in many cases, replication across multiple studies and populations. Instead, financial entanglements are used as a proxy for unreliability.

This asymmetry becomes more pronounced when contrasted with the authors’ own evidentiary standards. While clinical trials are scrutinized for bias, the paper itself relies heavily on non-systematic sources, including journalism, activist materials, and even “personal communications.” The result is a double standard in which high evidentiary thresholds are applied to opposing evidence and substantially lower thresholds to supporting claims.

A similar pattern appears in the paper’s interpretation of major clinical trials, particularly the SELECT cardiovascular outcomes study. The authors criticize the widely reported 20% risk reduction as misleading because it represents relative rather than absolute risk, noting that the absolute difference was approximately 1.5%. While it is true that relative risk can be rhetorically amplified, presenting absolute risk in isolation is equally capable of minimizing clinically meaningful effects. Both measures are standard in medical reporting and are intended to be interpreted together.

By framing relative risk as exaggeration and absolute risk as trivialization, the paper engages in selective statistical framing rather than balanced analysis. This issue is compounded by the authors’ reliance on subgroup analyses to argue that benefits are not broadly applicable. They note that certain subgroups did not show statistically significant results but fail to acknowledge that such analyses are often underpowered and not designed to establish definitive absence of effect. Treating non-significant subgroup findings as evidence that benefits do not exist is a well-known statistical error.

The paper’s handling of trial attrition and long-term outcomes further illustrates a tendency toward speculative inference. For example, the authors suggest that high attrition rates in the SELECT trial imply that results overestimate long-term efficacy, and they hypothesize that participants with poorer outcomes were more likely to withdraw. However, this claim is not substantiated with evidence demonstrating the direction or magnitude of attrition bias. Modern randomized controlled trials routinely employ intention-to-treat analyses and other statistical methods to mitigate such biases.

Without demonstrating that attrition systematically favored positive outcomes, the authors’ conclusion remains conjectural. Similar questionable reasoning appears in their discussion of weight regain, where findings from withdrawal studies and historical dieting literature are extrapolated to predict long-term failure of GLP-1 therapies. While weight regain after discontinuation is well documented, projecting this pattern onto long-term continuous pharmacotherapy without sufficient longitudinal data constitutes an overextension of the available evidence.

The paper’s treatment of adverse event data is particularly problematic from an epidemiological standpoint. The authors cite large numbers of adverse events and deaths reported in the FDA Adverse Event Reporting System (FAERS) and suggest that these figures indicate significant risk. However, FAERS is a passive surveillance system that collects voluntary reports and does not establish causality. It also lacks a denominator, meaning the total number of users is not accounted for.

As a result, raw counts of adverse events cannot be used to infer incidence rates or comparative risk. Presenting these figures without appropriate context creates a misleading impression of danger. The claim that GLP-1 drugs “exceed the death toll” of prior withdrawn weight-loss medications is especially flawed, as it fails to normalize for vastly different exposure levels and durations of use. This is a classic example of an apples-to-oranges comparison that inflates perceived risk.

Methodologically, the paper’s analysis of pharmaceutical marketing practices is also weak. The authors acknowledge that their evidence was drawn from a “convenience sample of Google search results” and selected examples from journalism and public sources. This approach is neither systematic nor reproducible and is highly susceptible to selection bias and confirmation bias. Nevertheless, the authors generalize from these examples to characterize a global, coordinated campaign shaping the narrative around obesity and GLP-1 drugs. While there is ample evidence that pharmaceutical companies engage in aggressive marketing, the paper’s methodology does not support the breadth of its conclusions. The critique may be directionally valid, but it is not methodologically rigorous.

The paper repeatedly conflates sociocultural critique with clinical evaluation. Extended sections discuss weight stigma, body image, and the cultural meaning of fatness, often framing the use of GLP-1 drugs as part of a broader “anti-fat” or “eliminationist” narrative. These are important sociological considerations, but they do not directly address the clinical question of whether the drugs improve health outcomes for patients with obesity related conditions. The implicit argument, that because weight stigma exists, medical interventions targeting weight are suspect, does not logically follow. This conflation allows normative concerns about social justice to substitute for empirical evaluation of efficacy and safety.

In sum, the article raises several legitimate issues including the influence of pharmaceutical marketing, the prevalence of conflicts of interest, the challenges of long-term adherence, and the importance of informed consent. However, these valid concerns are embedded within a framework characterized by pre-committed ideological assumptions, selective interpretation of evidence, misuse of statistical and epidemiological data, and methodological weaknesses.

The authors’ explicit rejection of weight loss as a legitimate health goal, combined with their non-clinical backgrounds and advocacy oriented positioning, reinforces the conclusion that this is not a balanced medical review. Rather, it is a perspective piece that critiques GLP-1 therapies from within a specific ideological paradigm, and its conclusions should be evaluated with that context clearly in view.

Which brings us to the final point. The current discourse surrounding GLP-1 medications particularly within the eating disorder community has become increasingly polarized, with positions often shaped more by ideological alignment than by balanced clinical evaluation. Competing camps advance claims of authority over a complex and evolving area of medicine, responding to one another not with constructive engagement, but with entrenched rebuttal. This dynamic does little to advance patient care. Instead, it reinforces fragmentation, inhibits meaningful dialogue, and ultimately leaves patients and families navigating uncertainty without the benefit of a coherent, multidisciplinary consensus.

This pattern is neither new nor unique, but its consequences are particularly acute in a field as clinically sensitive as eating disorders, where nuance, individualized assessment, and careful risk-benefit analysis are essential. When discourse devolves into parallel monologues rather than genuine exchange, [see, Terminal Anorexia] opportunities for progress are lost. The absence of collaboration among stakeholders, clinicians, researchers, and advocates creates an environment in which important questions remain insufficiently examined and practical guidance remains underdeveloped.

By contrast, there are models for a more constructive approach. Recent clinical discussions led by experienced physicians underscore the value of measured, evidence-based engagement with this issue. For example, presentations by clinicians such as Dr. Anne O’Melia reflect a balanced perspective grounded in decades of experience treating eating disorders. Such perspectives acknowledge that GLP-1 medications when appropriately prescribed and carefully monitored, may offer benefits in certain contexts, while also recognizing that they may pose significant risks in others. Similarly, clinicians like Dr. Wendy Oliver-Pyatt have emphasized the importance of rigorous risk-benefit analysis and fully informed consent particularly in vulnerable populations. These are not absolutist positions; they are clinically grounded, context-sensitive frameworks.

One can readily envision this type of productive discourse in which such perspectives are brought into direct, professional engagement. Where clinicians with differing views examine the same body of evidence, interrogate assumptions and refine understanding through structured dialogue. A forum characterized by medical rigor, intellectual honesty, and mutual respect would yield far greater insight than the current pattern of isolated advocacy and reactive critique.

As with many areas of contested medical practice, progress will not emerge from unilateral assertions of certainty but from sustained, interdisciplinary collaboration. The complexity of GLP-1 therapies, spanning metabolic, psychological, and behavioral domains demands precisely this kind of engagement. A more integrated approach would better serve not only the advancement of clinical knowledge, but also the patients and families who depend on it.

The best way to embrace the future, to increase our understanding of eating disorders, to reach enlightened consensus … is through collaboration.

When Science Fiction Seeks to Replace Science

2025 Weight Stigma Awareness Week (“WSAW”) is upon us. Much of what it stands for was clarified in 2023. That year, WSAW produced a white paper entitled, Impact Council White Paper (“ICWP”).

Click to access _%5BWSAW+2023%5D+Impact+Council+White+Paper.pdf

The ICWP states it, “… hosted an Impact Council roundtable with advocates, educators, clinicians, and leaders in healthcare, non-profit organizations, and media to discuss the greatest roadblocks to accessibility and inclusivity, as well as goals for the future.”

The ICWP has two major premises:

Premise 1 — “The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”

Premise 2 — “Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”

These are foundational, core premises at the heart of the weight stigma awareness movement. If these premises can be objectively proven to be accurate, then the corresponding recommendations and information arguably have more substance and merit and need to be thoroughly explored by a collaboration of organizations and professionals.

However, if the foundation, the core premises collapses, so does everything built upon them. The corresponding recommendations would be grounded in science fiction, not science, and if ever adopted, would inevitably result in doing greater harm to patients.

So, let’s explore more closely these two premises.

Premise One

“The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”

There is no dispute that weight stigma is itself harmful to health. Stigma increases stress, social isolation, depression and anxiety, and can worsen cardiometabolic outcomes through behavioral (avoidance of care, disordered eating) and physiological (stress-axis) pathways. When clinicians stigmatize patients, it reduces trust and adherence and discourages preventive care (fewer screenings, delayed care).

Certainly, focus on BMI alone oversimplifies risk. BMI is an imperfect proxy for health; it doesn’t capture fitness, fat distribution, socioeconomic drivers, or comorbidities. Over-reliance on BMI can miss metabolically healthy people who need care and wrongly pathologize others.

Social determinants and structural drivers matter. Emphasizing individual “weight control” can obscure food access, economic inequality, built environment, racism, trauma, and other upstream determinants that shape both weight and health.

Even with this reality, the obvious flaws in the first premise are legion.

First, the medical and scientific communities without exception embrace the reality that there are measurable health risks associated with higher adiposity for many people. Epidemiologic studies link higher BMI (particularly when accompanied by central adiposity) to type 2 diabetes, osteoarthritis, some cancers, and cardiovascular disease. Discounting these risks wholesale would be irresponsible.

Further, there is a false dichotomy risk at issue. Framing this issue as “either stigma is the main harm or obesity is” sets up a false binary. In reality, both can be true: stigma causes harm and excess adiposity can increase risk for some outcomes. Policies must address both.

There is the aspect of public-health communication challenges. Minimizing messages about risk could reduce motivation for preventive behaviors in those who would benefit. Public health must balance non-stigmatizing language with clear information about risk and actionable steps.

There are other factors involved. There is heterogeneity of evidence and population differences. The magnitude of adiposity-related risk varies by age, sex, race/ethnicity, and metabolic profile. Broad absolute statements risk ignoring subgroups with high absolute risk.

One of the biggest flaws and drawbacks from the ICWP, is that the people behind the ICWP represent that the medical community has caused more damage by emphasizing that obesity is a greater risk to health than weight stigma and anti-fatness. They have phrased this issue using an absolute criterion while needlessly pointing fingers to assess blame. They have placed their own beliefs and interpretation of their own life experience at the forefront of this issue. They erred.

There are different study designs and evidence strength. The obesity→mortality evidence includes very large pooled prospective cohorts and individual-level meta-analyses (GBMC/Di Angelantonio et al.) with millions of participants and long follow-up that estimate dose–response relationships and cause-specific mortality. That level of evidence supports an accepted causal inference for some outcomes.

Contrarily, much of the stigma literature is smaller, newer, and more heterogeneous: cross-sectional studies, smaller cohorts, and observational work using self-reported stigma measures. Even the stronger longitudinal analyses are far smaller in scale than the pooled obesity cohorts. This difference in scale and design limits how directly you can compare effect magnitudes.

Second, there are measurement differences and misalignment of outcomes. Studies of obesity typically measure objective exposures (BMI, waist circumference, body composition) and hard outcomes (incident diabetes, MI, cancer, all-cause mortality).

Studies of stigma usually rely on self-reported experiences (e.g., “have you experienced weight discrimination?”) or internalization scales — valuable but inherently subjective and vulnerable to recall bias and reporting differences. Outcomes often include psychological measures, behavior change, intermediate biomarkers, or, in a few cases, mortality. These are not directly isomorphic to the obesity literature’s end points.

Third, there are confounding and directionality / causality problems. People who experience weight discrimination are, unsurprisingly, often higher weight; disentangling whether worse outcomes are caused by stigma per se or by the underlying higher adiposity (or by shared upstream causes) is difficult. The study conducted by Sutin et al. adjusted for BMI and some covariates and still saw an association, but residual confounding (socioeconomic factors, comorbid illness, lifetime exposures) and reverse causation (illness leading to both weight change and discrimination) remain plausible. Further, establishing causality (stigma → disease → mortality) requires randomized or natural-experiment evidence or sufficiently rich longitudinal mediation analyses; those are scarce.

Fourth, population attributable burden has not been estimated comparably. To claim, “stigma causes more harm than obesity,” we need comparable population-level metrics (e.g., population attributable fraction of mortality or years of life lost due to stigma vs due to elevated BMI). Those metrics exist for BMI (GBMC estimated mortality burden across BMI categories), but do not exist in a comparable, robust form for weight stigma.

The study by Sutin et al. reports an HR for mortality but translating that into population attributable mortality would require representative exposure prevalence estimates, reliable adjustment for confounders, and replication across populations.

What the best current evidence shows: Weight stigma is independently associated with worse mental health, adverse behaviors (disordered eating, activity avoidance), physiological stress markers, and — in at least two cohorts — higher mortality after adjustment for BMI and some covariates.

What the evidence does not show: There is no robust, widely accepted, population-level set of criteria demonstrating that weight stigma causes more total harm to population health (e.g., more deaths, more DALYs) than obesity itself. The obesity→mortality/evidence base is far larger, multi-cohort, and quantifies dose–response relationships; stigma literature is convincing in signaling independent harm but is currently smaller, less consistent, and lacks comparable population attributable estimates.

Clearly, the goal should be to move clinicians toward respectful, trauma-informed care; strengthen social-policy responses (food access, housing, anti-discrimination); and develop interventions that improve health without weight stigma.

So, should we be asking with this shared goal, why would the people behind the ICWP frame this issue as an absolute? Especially when they have no reputable, scientific, medical or socio-economic studies to support their position that an emphasis on obesity has caused more harm than anti-fat bias?

Without any reputable, third-party studies, they framed this issue as an absolute to fit their narrative. The tragic, unfortunate reality is the solution was right in front of them. All they had to do was rephrase this issue in a strong, evidence-based, factual manner … such as …

“Weight stigma and anti-fatness are inextricably intertwined with obesity and should be collectively classified as a public health issue. This would require the medical and scientific research communities to increase their research, study, understanding and treatment of these serious health issues on an equal basis.”

What is there to disagree with in that phraseology? This would have removed the finger pointing blame game perpetrated by the ICWP and would have provided a collaborative way forward together. But that was not to be. And the reasons for that lack of vision are set forth in our analysis of Premise No. 2.

Premise No. 2

“Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”

The second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into witch doctory and personal storytelling. This is not a serious framework for healthcare; it is activism dressed up as evidence.

The problems with this premise are legion.

There are obvious methodological problems. Anecdotes do not constitute medical evidence. Individual stories can be powerful but lack controls, generalizability, and statistical rigor. Treatment guidelines based on lived experience risk being skewed by outliers or vocal subgroups.

There are also bias and recall issues. Patients may unintentionally misreport causes, timelines, or treatment responses due to memory bias, emotional interpretation, or secondary gain.

We are also required to consider over-representation of advocates and activists. Those most active in advocacy or online discourse are often not representative of the broader patient population, creating sampling bias.

Then there is the risk of undermining evidence-based care. There is “treatment drift.” Prioritizing anecdotes could encourage clinicians to substitute “what worked for one person” for protocols validated across thousands in trials.

The medical community must also consider neglect of biological mechanisms. Obesity and eating disorders involve complex neurobiological, metabolic, and genetic components. Patient narratives may not reflect these dimensions.

There is also false equivalence. Equating lived experience with systematic research elevates subjective impressions over reproducible science, undermining evidence hierarchies critical for patient safety.

For obesity, some narratives reject all weight management as “harmful,” ignoring evidence that structured interventions improve metabolic outcomes. This can fuel distrust of effective therapies.

The medical and scientific research communities would inevitably experience ethical and legal challenges and concerns.

There is standard of care liability.  If guidelines deviate from established evidence to favor lived experience, clinicians risk malpractice exposure when outcomes are poor.

There are also equity gaps. Vocal groups whose experiences get prioritized, may dominate marginalized, silent or less empowered populations.

Potential conflicts of interest exist. Patient advocates with financial or ideological agendas could influence treatment norms, displacing objective science.

The systemic consequences of this misguided belief are obvious and notorious. This belief would lead to an erosion of research investment at a time when research grants have been eradicated. If lived experience is placed on equal or higher footing, incentives to conduct rigorous trials would diminish, weakening long-term scientific progress.

It would also result in fragmentation of care standards. Different doctors, clinics and treatment centers might prioritize different anecdotal narratives, leading to inconsistent, non-comparable practices.

Most alarmingly, obesity and eating disorders already carry high morbidity and mortality; steering care away from empirically validated interventions risks worsening public health outcomes.

Again, we should be asking why would the people behind the ICWP frame this issue as an absolute? Especially when they have no scientific, medical or socio-economic studies to support their position?

The ICWP had the ability to reconcile both premises into a practical clinical and policy approach. They chose not to. Perhaps one of the co-founders of Weight Stigma Awareness Week gave us the reason for this ill-fated, Quixotic position when she said, “It bothered me that all the air was taken by a white perspective … This is no space for white, straight and thin folks to jump in … Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.” … Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”

These people are not embracing science. They are embracing science fiction.

Perhaps the answer to all legitimate questions asked above is simply … to maintain their voice, to assuage their feelings of pain, self-loathing and anger, the maladjusted, militant fat activists must embrace their own reality because society will not.

The ICWP fails

The ICWP fails at the starting line. Its first major claim—that medicine has caused more damage by warning about obesity than by neglecting weight stigma—is not just wrong, it is reckless. It is divisive. It dismisses decades of clinical evidence linking obesity to disease and early death, replacing science with ideology.

Its second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into guesswork and personal storytelling. This is not a serious framework for healthcare; it is radical advocacy dressed up as evidence.

Beyond the flawed premises, the rhetoric in the ICWP itself gives the game away. The authors rely on moralizing language and sweeping accusations, framing the medical community as a monolithic villain rather than engaging with the nuance of scientific debate. Raw emotion is substituted for data, using anecdotes and identity politics to demand deference in place of proof. This kind of rhetorical sleight of hand may stir outrage, but it does not withstand scrutiny.

When the core assumptions collapse, so does everything built upon them. The ICWP is not grounded in science but in science fiction. Far from being an authoritative white paper, it is merely a manifesto masquerading as scholarship, and it deserves to be treated as such.

Tragically … it did not have to be like that. But, when so-called leaders place the manifestations of their own mania before reputable, medical and mental health based criteria, their message is lost. The Power of the Message is lost.

And all that is left is chaos, shattered dreams, and the final, weak beats of a Tell-Tale Heart.

BMI … Barely Medically Important

In the past few years, the State of Colorado and the American Medical Association reviewed the use of BMI, (Body Mass Index, or perhaps it should be known as Barely Medically Important) as a tool to measure health.

The Colorado legislature implemented a new law. 

The AMA adopted a new policy on how BMI should be used as a measure in medicine.

Both instances represent a more thorough understanding of health, eating disorders and medical and mental health issues. And they are both good starts. But as in all things, there are issues.

American Medical Association

In June 2023, the AMA adopted a new policy clarifying the role of BMI as a measure of medicine.  Aspects of the policy can be found here:

https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure#

In short, the policy states, “Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations. Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors. The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level.”

The AMA also modified existing policy on eating disorders calling on the AMA to:

Encourage training of all school-based physicians, counselors, coaches, trainers, teachers and nurses to recognize abnormal eating behaviors, dieting and weight-restrictive behaviors in children and adolescents and to offer education and appropriate referral of adolescents and their families for evidence-based and culturally informed interventional counseling, and;

Consulting with appropriate, culturally informed educational and counseling materials pertaining to abnormal eating behaviors, dieting and weight-restrictive behaviors.

Interesting and somewhat forward-thinking policies which have been debated for quite some time in the eating disorder community.

The Colorado Law

According to data sourced from the Center for Disease Control, Colorado ranks as the second healthiest state in the United States. Its high ranking is attributed to its active lifestyle culture, abundant outdoor recreational opportunities, and a strong focus on healthy eating. It is also known for having a number of tree hugging, Birkenstock wearing, pot smoking, hippie libruls. [I kind of respect that last aspect.]

With its liberal politics and lifestyle and focus on health, it should come as no surprise that Colorado politicians wanted to do away with the much criticized BMI as an indicator of health. And so, the Colorado legislature passed a bill which greatly limited the use of BMI

This bill can be found here:

Click to access 2023a_176_signed.pdf

If you can work your way through this bill and then reach a place of partial understanding, there is much to embrace.  And much which provides confusion.

On the one hand, the some of the substance of the bill states, “… SHALL NOT UTILIZE THE BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER, INCLUDING BUT NOT LIMITED TO BULIMIA NERVOSA, ATYPICAL ANOREXIA NERVOSA, BINGE-EATING DISORDER, AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER, AND OTHER SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS.

But then, the next part of the bill states, “SUBSECTION (1)(a) OF THIS SECTION DOES NOT APPLY WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE; HOWEVER, BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED BODY WEIGHT MUST NOT BE THE DETERMINING FACTOR WHEN ASSESSING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE.”

Ok, so I am a reasonably intelligent human being. But, what in the blue hell does the language of the bill mean? On the one hand, BMI, ideal body weight or any other standard requiring an achieved weight can only be applied to anorexia nervosa – restricting subtype and binge-eating/purging subtype so long as they are not the determining factor? Well, that doesn’t seem too vague, confusing and subject to interpretation!

It would also appear as if the bill, albeit well intentioned is having adverse effects.  Dr. Elizabeth Wassenaar, the Regional Medical Director for the Mountain and West regions at Eating Recovery Center and Pathlight Mood & Anxiety Center was interviewed by an NBC news local affiliate. This interview can be found here:

https://www.9news.com/article/news/health/doctor-warns-law-designed-to-expand-eating-disorder-treatments-creating-barrier-to-care/73-9ac527d4-9d38-4d67-b212-6067fe53d714

In the interview, Dr. Wassenaar stated:

“On face value, I 100% agree with this legislation,” Wassenaar said. “I absolutely want to see every person who needs eating disorder treatment be able to access it.  And I never want to see someone be discriminated against because of the size of their body, especially when it comes to receiving care for their eating disorder.”

“Unfortunately, what we are seeing is that patients who are in small bodies who are malnourished are actually being excluded from care or being asked to step down before they are ready because we can’t consider their degree of malnutrition as a part of their degree of severity of illness.”

“And the reality is when you have a statute that makes this sort of determination, then it takes the decision out of the hands of the medical providers who are taking care of people with these patients.”

Indeed.

Which brings up the seminal question …

The Question

With BMI being an incredibly troubling issue regarding its use (or non-use) with eating disorders, why hasn’t a definitive policy or statement been released from experts in the eating disorder community? A unified, collaborative statement so strong, so authoritative, that legislatures, organizations and health insurance providers alike adopt it as THE definitive word on BMI.

After all, the research, study and treatment of eating disorders are the raison d’être for our experts’ existence.

Shouldn’t the continued existence of BMI, or the genesis of its demise lie with the recognized experts in the eating disorder community? Those who study it and either use it or decry it as a diagnostic tool.

Envision if you will, some of the most renowned experts worldwide in the field of eating disorders coming together to brainstorm, to share research and ideas. And then issuing a comprehensive study supported by all of the eating disorder organizations and treatment entities. Including representatives from the health insurance industry.

If ever a time existed for this wisdom, this type of collaboration, this coming together as one, that time is now.

And so, the last question is … who is going to step to the plate and turn this into a reality?

Why HAES is Dead in the Eating Disorder Community and … Crossing a Sacred Boundary.

Why is HAES dead in the eating disorder community? Because the ASDAH wanted it that way by taking HAES in a different direction.

Some people opined that ASDAH does not involve eating disorders. And yet, weight stigma and individualized eating are certainly part of the eating disorder realm. So, to that extent, yes ASDAH was formerly involved in the eating disorder community.

Some people attempted to argue that HAES was not part of the eating disorder lexicon. And yet, there are therapists, marketers and third parties who naively seek, “HAES aligned doctors, therapists, nutritionists” for people who suffer from eating disorders.

Certainly, the abandoned HAES principles align with some aspects of the eating disorders community. These principles included:

  1. Weight Inclusivity– Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  • Health Enhancement– Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  • Respectful Care — Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  • Eating for Well-being — Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  • Life-Enhancing Movement — Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

When viewed through an intelligent, rational lens, who can argue with those principles? I certainly agree with them.

If HAES still embraced those noble principles and was being conveyed in an intelligent manner, there would be far fewer issues and HAES would be further on its way to being respected, if not adopted by more medical and mental health professionals. Sadly, it is not.

In 2022, ASDAH (the entity which owns the HAES trademark) had a seismic shift in its vision and mission. As was its right. Now, ASDAH is attempting to redefine health through a sociopolitical construct and is openly stating that it is aligning with other social justice movements. [their words] Again, any organization has the right to pivot in the direction it deems best for its members and donors. But as it pivots, to the extent that ASDAH and HAES were once part of the eating disorder narrative, they no longer are. With regard to eating disorders, HAES is dead.

ASDAH seeks to “dismantle the medical industrial complex.” [their words] ASDAH does not say how it intends to undertake this dismantling or what it seeks to substitute in its place.  ASDAH also states, “One of the main roots of the current Health at Every Size® community was a group of fat activists known collectively as the Fat Underground who began questioning their healthcare experiences and the advice they received from healthcare professionals.”

ASDAH also states, “We remain committed to the ongoing learning from liberation thought-leaders in Black liberation, fat liberation, crip/disability justice, queer liberation, womanism, intersectional feminism, and many more known and not-yet-known movements working towards the liberation of all people.” [Nothing about eating disorders.]

That is truly what ASDAH is about. Fat activism. The liberation of all people who it perceives as being victimized. Social justice issues. So long as ASDAH stays out of the eating disorder community, I say, “Best of luck to you, knock yourself out and do what you believe you must do.”

Especially since I agree that lack of access to medical and mental healthcare for minorities, the poor, the disenfranchised is a huge societal issue and needs to be addressed. We clearly do not have enough people of color who are medical and mental healthcare professionals. Research studies in the past have disproportionately focused on white persons. BMI as an accurate, modern measure of health is lacking. Medical and mental healthcare providers in minority communities are grossly lacking.

But what is also lacking are workable, logical, fact and science-based solutions to these very real problems.  ASDAH is not providing them. HAES activists are not providing them. Real life workable solutions, with greater knowledge and wisdom of medical and mental health care issues are not being proposed nor debated.

It is one thing to illuminate issues to be addressed. It is something very different and far more complex to illuminate workable solutions to those problems which do not violate the Constitution or require wholesale revolution and overthrow of the US government.

Nonetheless, with its pivot exclusively to social justice activism leaving eating disorders behind, there are still some therapists and third parties who continue to use the now outdated term, “HAES aligned.” Third parties do not have the luxury of using the term “HAES” to fit whatever narrative they wish to use. In fact, should you wish to utilize the trademarked term HAES in a way that does not align with ASDAH’S militant vision, it has the right to demand you cease and desist from further use of this term. ASDAH has the right to protect its trademark to ensure it is being used in compliance with its extremist vision. In fact, if it does not protect its trademark, it can waive its rights to exclusively use the term HAES. ASDAH can legally prevent any mental health provider from utilizing the HAES trademark if that provider does not adhere to ASDAH’s current vision and mission.

Based upon some of the past tactics utilized by the ASDAH Militant Fat Activists and their cronies, ASDAH will undoubtedly resort to that tactic.  Its current tactics include excessive bullying on social media directed against therapists and others who disagree with their views on Palestine and other ASDAH mandated issues. Harassment. Making those who disagree with them feel afraid, unsafe and minimized.  There can be no rational debate. No intellectual exchange of ideas or views. They bully those who they perceive are weaker than them. But they are cowards.  They will not directly and openly confront those who oppose them. Those whom they perceive are stronger than them. They hide behind their keyboards.

But then they erred. In the most egregious manner possible. After my last post on this issue, on the Facebook page of one of their advocates, they came after me.  Oh, certainly not directly since it is far easier to block those who disagree with your views and as such, live in an echo chamber. All manner of slurs and slanders were directed at me.  And quite frankly, I am ok with that. Attorneys live with that type of derision every day.

But there is one line that no civilized person ever crosses. One sacred line. And that is when a child dies as a result of eating disorders, you never, never state nor even imply that a parent subjected that child to substandard medical treatment and as a result, was even partially at fault for her tragic death. Only a subhuman monster would tread that dark path.

If that messaging appears on your social media page, you have the absolute duty to immediately remove that message, apologize to the parent and perhaps, look at your own ethics and morals.

However, that line was crossed in an intentional and malicious manner. When given the opportunity to walk back those words, or to delete the offensive messaging, not one of these activists stood up or even spoke out against that messaging.

When the Militant Fat Activists came together to blame me for “allowing my daughter to endure” alleged negligent medical care and ipso facto, blamed me for causing her death … and not one person called out that reprehensible statement, that conduct is unforgivable. This time, they attempted to bully someone who cannot be bullied. This time …

This time… for all parents whose children died from eating disorders; for all therapists and mental health care professionals who have been harassed by the Militant Fat Activists; for persons who have been bullied because they do not embrace ASDAH’s extremist political views … it is our turn now. 

And it is their time to be afraid.