The BMJ: An Unexpected Ally?

Last week I got a tipoff from CIHAS community member Cat about an article in the BMJ. Now, in my head, the BMJ is synonymous with bad feeding advice and strong anti-fat bias, so I was expecting the worst but it was... pretty good, actually?

Beyond body mass index: rethinking doctors' advice for weight loss was the cover story (spy the intermittent fasting story inside lol). The paper isn't original research, but an 'analysis'; essentially a synthesis of the literature by experts in that area.

Is it a perfect paper? No. I suspect the authors had to make a few concessions to get past the BMJ editors. Is it anything new? Also no. But it still feels significant.

We are in a cultural moment where the assumption seems to be that we are nearing the end of fatness, and by extension, the end of fat liberation. This has pushed the conversation about weight-inclusive healthcare further to the margins. Surely there's no need for concepts like Health at Every Size when there's no more fat people?

Except of course, there will always be fat people, even if weight-loss injectables never get pulled from the market and are freely available to anyone who wants them on the NHS. And as long as there are fat people, we need to fight for their liberation. Part of that means accessing medical care that prioritises the need(s) of the patient, doesn't automatically blame health concerns on their weight, and doesn't prescribe weight-loss for any and all symptoms. Yet medicalised anti-fatness is rampant, and although I haven't seen any hard data on this yet, I'd wager GLP-1RAs are only going to make it worse.

That's why the paper that Cat sent me – although nothing new or particularly radical – is really important. 54% of UK GPs and 43% of UK hospital doctors access the BMJ in a typical month. To have an article challenging the weight-normative paradigm in a mainstream medical journal is a BFD at the best of times, but feels especially important right now.

Here are the five key takeaways from the paper - they won't be new for most of you, but I think it's helpful to have a refresher in amongst all the 'Ozempic noise'.

Key Messages:

1) On average, people with high weight will not be able to sustain a clinically relevant weight loss with lifestyle interventions