03 October 2014

Research: weight loss makes you feel terrible, no surprises there

Research evidence is often presented in fat activism as part of the armoury to be used in fighting fatphobia. It's an important resource for those who are interested in debating with institutional fatphobes. I tend not to report mainstream stuff because that's not where my interests lie, and because I find most research (except that modelled on Research Justice) dull to read and largely irrelevant to my daily life.

Today I am making an exception! This is partly because I was so surprised to see this particular study from the UK get reported by a professional organisation, of which I am a member, that frequently supports fatphobia.

The piece appeared in PLOS ONE, an open access academic journal that charges people to be published. It has the catchy title of 'Psychological Changes following Weight Loss in Overweight and Obese Adults: A Prospective Cohort Study' and has been produced by a team consisting of Sarah E. Jackson, Andrew Steptoe, Rebecca J. Beeken, Mika Kivimaki and Jane Wardle.

At first it looks like a pretty conventional examination of 'obesity': the language, research methods, dissemination of results and general feel of it are extremely trad. they are interested in psychological aspects of weight loss because there is conflicting research evidence about it. But the study has come up with a less-than conventional result.

These researchers reported some health benefits to weight loss in their sample (large but limited to older white people), but also found that weight loss offers no psychological benefits.

"However, there was no evidence that weight loss was associated with improved psychological wellbeing. In fact, significantly more of the weight loss group than the groups who were weight stable or gained weight had depressed mood at follow-up, and at least in some of the adjusted analyses, more had low wellbeing."

There are important limitations to this study. The tools the researchers used to asses people's psychological status are, in my opinion, quite clumsy and don't account much for people's contexts and shifting subjectivities. I don't know who funded this research, which would have important implications for its interpretation; was it funded by the weight loss industry, for example? The authors also concede that their results are correlational, so it's also possible that weight loss does not cause low mood, that the correlation is just one of those things.

The authors discuss some of the reasons why they think they got these particular results, but for the most part seem quite surprised. My assumption would be that the main psychological benefits of weight loss are about becoming normative: literally being able to fit in and avoiding the spectrum of disapproval to hate that is directed towards fat people. This is likely to have health benefits. I did find one comment interesting, the authors remark: "One possible explanation for the difference is that the mood improvements in clinical trials are a consequence of the supportive treatment context rather than weight loss per se." It's not the weight loss that helps you feel good, it's being treated as a legitimate person, or even being treated nicely, which weight loss proponents are now adopting (eg, see interest in 'weight stigma' by those still invested in a weight loss paradigm for health).

I don't know if the authors of the study have any involvement at all with fat community or know any fat people, or are fat themselves. The language of the piece makes fat people very distant from the research, we are here as the usual passive, abstract entities. It could be that the researchers are flying under the radar and want to publish something quite radical without arousing too much suspicion. Yet they write: "We had expected that by restricting our a sample to participants who were overweight or obese at baseline, evidence of adverse psychological effects of weight loss would disappear." They fully expected weight loss to be a good thing. This implies to me that they have little knowledge of critical approaches to weight loss, indeed they don't cite anything that would demonstrate their understanding that a critical body of work exists. To me, this makes it interesting that they should make these findings, they're not influenced by a critical body of work. At the same time, they refer to a study that uses the concept of "community obese," which might imply that they know that we group together!

As usual, it is really maddening to this reader that obesity researchers don't actually talk to and work with the people they are researching. Fat people have powerful lived experience that would make this study, and all the others, come alive if only we were regarded as legitimate producers of knowledge. Hey research squares! We're the ones with the answers! Coo-ee! Pay attention to us!

Perhaps this study reveals that, despite the hard sell of transformation embedded in weight loss, there is no pot of gold at the end of the rainbow when you have lost weight, especially if you're getting on a bit. Samantha Murray has spoken publicly about becoming more aware of how much fat people are hated when you lose weight; there may be the reasonable fear of regaining what you have lost; your body might not look like you hoped it would when you had lost weight; you might experience problems associated with weight loss (gall bladder illness, for example); you may have lost fat community; your problems remain.