Last week, my fellow Skepchick writer Olivia wrote this post about fatphobia, and how people who claim they fat-shame people out of concern for their health are, generally, full of it.

I agree with that central tenet, but I took issue with a number of scientific claims Olivia made. She kindly went back and edited in some of her sources, and so I’ll take those into consideration when rebutting a few of her statements:

Juice cleanses do nothing to actually cleanse and put the body into a starvation state because they give too few calories.

I agree with Olivia that “juice cleanses” are marketing pseudoscience, often pretending to rid the body of toxins that are never defined and don’t actually exist. That said, I’m calling this out because of the use of the term “starvation state.” This is a nebulous and frequently misused phrase, sometimes referring to the idea that eating too few calories will actually cause you to gain weight, which of course is utter nonsense. If you eat fewer calories than you expend, you will lose weight. It is physically impossible to gain weight while eating at a deficit. If your goal is to lose weight, you must eat at a deficit.

It is possible to eat too few calories to maintain a healthy lifestyle, and this can lead to serious problems, which is why most science-based weight loss regimens will suggest that you only lose about 2 pounds per week (so eating at a deficit of about 1,000 calories per day, give or take), unless you’re morbidly obese.

Depending upon what juice you’re drinking and how much of it you’re taking in, you can easily consume nothing but juice and not starve. I can’t imagine why you would, though.

People still use the BMI scale, despite the wide knowledge that it’s based on a statistician’s attempts to understand large populations, not individual health.

I’m one of the people who uses the BMI scale (for myself). It’s true that it was created as a statistical tool, and one that is used often and to good effect in studies like this one showing that pregnant women with obese BMI experience a higher risk of complications. But of course there are other studies showing that while very high BMIs are unhealthy, there are sometimes better methods for gauging mortality, like large waist circumference.

So BMI doesn’t apply to every individual, but it’s also true that it does apply to most individuals. If you’re not a body builder or other elite athlete, BMI is a much better way to gauge whether you’re at a healthy weight then just looking at your weight alone, for the simple reason that it takes into account your height.

New guidelines for doctors treating overweight patients even promote weight loss before treating whatever complaint the patient may have come in for (unsurprisingly, the doctors who worked on these appear to have close ties with pharmaceutical companies that market weight loss drugs).

This one is probably my biggest concern and was the main impetus for me asking Olivia to link to her sources, as this was something I had never heard of. And it turns out, I’d never heard of it because it’s simply not true.

Olivia links to Dances With Fat, the blog of Fat Activist Ragen Chastain. I want to stress, here, that I very much agree with activists who fight against the unhealthy beauty standards that are forced on women every day, and I agree with those (like Olivia) who push back against people who think it’s their place to mock and shame people who are overweight.

It doesn’t do anyone any good, though, to publish dreck like Chastain’s post. The guidelines in question were published by a task force of researchers for The Endocrine Society, and they most certainly do not recommend doctors “promote weight loss before treating whatever complaint the patient may have come in for.”

Instead, these recommendations are, by the researchers’ own words, for doctors treating three kinds of patients:

1. Patients who are overweight or obese and who are seeking weight loss solutions

2. Patients who are overweight or obese and currently taking medications to treat obesity-related diseases like Type II Diabetes

3. Patients who are overweight or obese and are currently taking medications for non-obesity-related diseases that are known to increase weight gain

The researchers strongly recommend that doctors talk to patients and engage in “shared decision making in terms of improving patients’ knowledge, reducing decisional conflict and regret, and enhancing the likelihood of patients making decisions consistent with their own values.” (Emphasis mine.)

The guidelines are there to help patients who want to lose weight but who are having trouble making the necessary lifestyle changes; patients who are essentially treating the symptoms and not the cure, offering doctors suggestions for actually curing Type II Diabetes (with weight loss) instead of managing it with drugs; and patients who are at risk of going on certain medications for disorders like epilepsy and mood disorders that could lead to more weight gain, which in turn will lead to more health complications and a decrease in compliance, which is a further threat to the patient.

Nowhere in those recommendations does the task force recommend ignoring a patient’s complaints and forcing them to lose weight instead. In fact, it’s just the opposite: the recommendation is for doctors to use all the tools they have to help a patient achieve the results they want with as few drug-related adverse side effects possible.

And regarding one of the task force’s ties to pharmaceutical companies: The Endocrine Society is rigorous about declaring conflicts of interest, which is how Ragen even knew what one researcher’s background consisted of. Here are their rules for the task force that created these guidelines:

Participants in the guideline development must include a majority of individuals without conflicts of interest in the matter under study. Participants with conflicts of interest may participate in the development of the guideline, but they must have disclosed all conflicts.

As I’ve stated repeatedly in the past, disclosure of conflict of interest is important, but it is not the thing that discounts research. In fact, these guidelines are all based on other researchers’ studies, all of which are cited in the article along with confidence ratings for each recommendation and suggestion.

That’s enough digging into Chastain. Back to Olivia’s post for one final remark:

Basically every restrictive diet ever rests on the principle of putting the body into a starvation state so that it will start to eat away at its own fat. In the long term this doesn’tgenerally lead to weight loss (it changes the metabolism such that the body tends to gain back the weight plus some), and it’s simply not very healthy.

Again we have the nebulous scare-phrase “starvation state.” It’s simply untrue that (moderately) restricting your calories leads your body to do anything unhealthy. Millions of people do it every day. I did it two years ago when I realized that I had pudged up a bit more than was good for me during a long Buffalo winter. I cut my calories down to about 1,200 per day, which, yes, is fewer than my body was using. That’s how I lost about 20 pounds over the course of about 10 weeks. When I was at my desired weight, I bumped up my calories very slightly so that I stopped losing weight. My current caloric intake is still a “deficit” from where I was before, but obviously now I am maintaining weight instead of losing it because I lost weight and my body doesn’t need as many calories.

This won’t work for me in the long term, if I go back to the lifestyle I was leading when I was fatter. That’s why, as Olivia’s first link states, “diets are not the answer.” Lifestyle change is. The lead author of that study is quoted as saying that she thinks the answer is eating right and exercising, which is exactly what the science has told us for ages. And for many people, like myself two years ago, I wasn’t eating right. Eating right meant eating at a deficit.

Of course, not everyone is psychologically able to do that on their own, especially if they’re morbidly obese and the changes they need to make are severe and complicated by other health issues and medications. That’s why doctors develop guidelines like the ones from The Endocrine Society, to figure out the best ways to work with patients to achieve the results they want.

As for “metabolism,” see my earlier point about how I now eat fewer calories to maintain myself at my current weight compared to my weight two years ago. Yes, your metabolism will drop a bit as you take in fewer calories and lose weight. That’s normal and healthy. As Olivia’s citation shows, it will go up again if you start gorging. That’s how metabolism works.

Again, I want to stress that I agree with Olivia’s primary point: fat shaming is not about secretly wanting a person to be healthy. Additionally, it most likely doesn’t work as a way to motivate people to lose weight or to get healthy.

But again, that message gets lost when those fighting for the overweight and obese use bad science and bad arguments to make their points.