Preaching Beyond the Choir

“A lot of people have anti-racist groups. They get together and meet and have a diverse group and all they do and sit around and talk about how bad discrimination is. Then someone says ‘there’s a Klan group across town. Why don’t we invite them to come and talk to us?’ and the other person says ‘Oh no! We don’t want that guy here!’ Well, you’re doing the exact same thing they are. What’s the purpose of meeting with each other when we already agree? Find someone who disagrees and invite them to your table.”

– Daryl Davis

Joanne and I certainly have company among many practitioners across the globe who have abandoned weight-centered models of care for health-centered approaches. We congregate virtually in communities like Health at Every Size® and the Association for Size Diversity and Health. While these resources are important for building support and sharing best practices, we run the risk of only preaching to the choir if we confine our communications to people who are already on the same page as us.

Many practitioners and activists, like Ragen Chastain, Aaron Flores, Ellen Glovsky, Kerry Beake, and Linda Bacon, just to name a small handful, have been putting themselves out there, subjecting themselves to everything from ridicule to blatant hate, as they share research and perspectives that run counter to widely-held beliefs about weight and health.

As for me, while I do not consider myself part of any sort of crusade and prefer to influence change on a one-on-one basis with the patients who come to meet with me, I increasingly feel an obligation to step up to the plate when opportunities to share my perspective arise. Silence is easier, but I fear that it comes across as support for the status quo, so in essence my passivity makes me part of the problem. I need to change that.

A sales rep emailed me in August trying to get me to use his company’s product at our practice. He made some statements about weight that sounded ridiculous, but I ignored his email. In September, he emailed me a second time, and once again I did not write back. When he emailed me for a third time last week, my conscience compelled me to engage him in conversation and confront him about his statements. An email exchange ensued. Following are some excerpts.

Sales rep: “Take a moment to consider all that you can do with [product name] as your tool. You are given a list of the top 5 foods in 7 different categories that will allow an individual to reach their goals the faster than any other foods. This means losing 6 lbs a week and not 2 lbs. Or gaining 5 lbs a muscle the first month of training, instead of a mediocre 3 lbs. If your clients were able to see this amount of increased results and you were able to make more money in the process, don’t you think you would be interested?”

The underlined passage, which I underlined for emphasis, set off my BS alarm.

Me: “Thank you for your email; however, our businesses seem to be on different pages so I do not envision us working together. If you have any research to support the claims that [company name] is making I would be interested in taking a look at it.”

Sales rep: “I would be happy to provide you with literature on the claims our diet plans make if you would like. We have scraped from thousands of published articles.  Is there any specific topic that would be of interest to you?”

Honestly, at this point I was fairly certain that no such research existed, as I probably would have heard about it by now if it did, but I wanted to keep an open mind, and I also felt like this guy was George Costanza lying about a house in the Hamptons and I wanted to see how far he would go.

Me: “Thanks for your email. In your previous email, you talked about weight loss/gain results with [product name] versus without it. I’d love to take a look at that research.”

Sales rep: “Well as you know, weight loss and weight gain is majorly dependent on the amount of Calories consumer and burned over a given amount of time. What we have done is scraped many articles that claim increased weight loss or weight gain when matching a SNP to a certain macronutient profile of a food. We have also analyzed research that observed increased energy levels and increased activity levels in people who ate a majority of the food we recommend. If you’re referring to clinical trials where [product name] users and blinds are closely observed over a period time, we have not conducted a controlled study. One reason being the difficulty that diet research usually has with compliance. The second reason is we believe we can access enough data from the people using [product name] and we will be able to quantify all our results. I personally have lost over 30 lbs in the last 2 months since I started to flow a [product name] approved diet plan.”

Did you catch that? Despite the specific claims that he previously made about the weight-change results that his company’s product supposedly creates and despite his offer to provide me with the research to back up said claims, when pressed he admitted to having no such research.

Me: “Thanks, I appreciate the explanation. It is important for us to remember though that losing weight is relatively easy. Virtually any kind of restriction will create it. Data presented at last year’s Cardiometabolic Health Congress, for example, compared the results of over 20 different diets and showed that all of them resulted in the same weight loss pattern. The problem though is that all of them also resulted in the same weight regain pattern as well. Most studies that look at weight loss only look at the short term, but those that look at least five years out show that approximately 95% of people regain the lost weight and most of them end up heavier than they were at baseline. Sure, some of that is due to people not maintaining the behaviors that created the weight loss, but what I find very interesting is that many of the people who do maintain the behaviors experience weight regain as well. My clinical experience mirrors what the research indicates, as I have certainly had individuals who are so frustrated because they are working so hard to keep off lost weight, and yet it slowly creeps back on. For all of those reasons, we take the focus off of weight and instead focus on behaviors, which research shows are better predictors of health outcomes than weight anyway. Although the public is generally still hyperfocused on weight, we are seeing a slow shift in the medical community away from a weight-centered model of care to a health-centered model of care as more and more practitioners are becoming aware of the research.”

Sales rep:

That’s right, he did not write back, at least not yet. For the sake of fairness and completion, I will update this entry if and when he responds, although I am not holding my breath waiting for a reply. Most likely, he crossed me off his list when he realized he would not get any business from me and he has moved on to other sales leads without giving my latest email a second thought.

On the other hand, perhaps – even for a brief moment – I got him to rethink his stance and consider another point of view. Either way, at least I did not exacerbate the problem by staying silent.