Greg Bruce talks to the doctor who wants to dismantle the diet industry.
Strictly speaking, Dr Joshua Wolrich hasn't written an anti-diet book - he's written an anti bulls*** book - but it's fair to say he and diets aren't friends. Diets he attacks, either in the book, or in the interview I recently conducted with him, or both: The Keto diet, low-carb diets, intermittent fasting diets, the raw vegan diet, Michael Mosley's diets, Jordan Peterson's meat-only diet and juice fasts.
"The assumption that weight defines our health is not only untrue but incredibly disempowering," he writes. "Let it go."
Wolrich's thoughts about weight in his new book, Food Isn't Medicine: Challenge Nutrib*llocks & Escape The Diet Trap, are especially pertinent and publishable because he established himself as a notable weight loss advocate and influencer, a fitness bro and trainee doctor charting his "weight loss journey", with hundreds of thousands of followers on social media. Then, in 2018, he got into a life-changing exchange with a nutritionist who attacked his favourite "guilt-free" icecream. Now, less than three years later, he's written a book testifying to the subsequent reversal in his thinking. It's likely to get him in a lot of fights with a lot of people who have a lot of money invested in the things he thinks sucks, which, to be clear and to repeat, are diets.
On the phone from his home in the United Kingdom, he says: "The only ways that diets, in quotes, 'work' - how people lose weight - is because they are taking in less energy than they are expending. But the question isn't an argument against that physically taking place, the conversation is what does that leave us with? Why do we regain the weight again afterwards? Why does it impact our relationship with food? Why does it make us unhappy? Why does it make us stressed around food? Why does it not improve our health?"
The book covers a lot of ground, and sees Wolrich dismantling all sorts of food-related stupidities including "dairy causes inflammation", "eating eggs is as bad as smoking", "vegetable oil is toxic" and "milk contains pus" - but weight is the one that sells books.
What he's trying to do is get readers to go on the same journey he's been on for the past three years, which requires us to consciously uncouple the concepts of weight loss and health. He writes: "Our weight fluctuates – this is completely normal. If you want your choices in life to be based around health, stop ranking your options based on how much weight it's going to make you lose. Weight loss is not synonymous with health… because not all weight gain is unhealthy."
Furthermore, he writes, society's fixation on weight loss is unhealthy, causing physical and psychological damage. Weight stigma, society's prejudice against fat people, has been linked to heart disease risk, increased blood pressure, inflammation, depression, anxiety, eating disorders, suicidal behaviours and … weight gain.
Finally, studies have shown it to be almost inevitable that dieters will regain weight. He presents research that looked at 27 weight loss studies, which found that two years after the studies ended, more than 50 per cent of the lost weight had been regained and after five years, the figure was more than 80 per cent.
Although Wolrich is a junior doctor working in the NHS, he's not afraid to lay much of the blame for current attitudes about weight at the door of many of his doctor colleagues. He writes: "There's less overlap with nutrition than you might immediately think and an ignorance of the fundamental differences between the two disciplines has resulted in a truly terrible slew of books being written and published by doctors way out of their lane."
He says: "We are taught medicine in a very weight-centric manner. The way that we learn about health globally, we learn that weight is the be-all and end-all of our health and it's the first thing that should be addressed when it comes to health. That leads to really, really bad healthcare."
People who get into medical school and graduate as doctors, he says, are generally from more well-off backgrounds and, given the link between body size and socio-economics, there are more doctors who have never dealt with body size issues than doctors who have. As a result he says, many of these doctors don't understand the complexity of weight gain and weight loss, particularly the fact it can't be reduced simply to diet and movement.
"They don't necessarily understand that, because for them, it's been very simple. They've never had to worry about it. They've never had to think about it. And this is just something that is ingrained."
The energy in/energy out equation is deficient, he says, because it fails to take into account the many factors that influence both eating and activity. He cites a report, commissioned by the UK Government, which identified more than 100 factors affecting the energy balance equation. A fraction of them: metabolism, level of appetite, childhood growth, childhood activity, cultural valuation of food, exposure to food advertising, cost of food, pressure to cater for different tastes, occupational activity, transport use, safety of walking, employment and access to physical exercise.
He says: "This personal responsibility rhetoric that we have is based on lies. Again, when it comes to health, it's based on the lie that our health is completely under our control. That's not true."
The concept of the ideal body, he says, changes every decade, and there is no such thing as a "beach body". In the 2000s, he says, the female ideal was Kate Moss and heroin chic, then the Kardashians came along and made it okay to be fat - but only "on your bum". But going back through history, he says, being larger was hugely desirable.
"It's just we have this so ingrained in society now, where we believe people should look a certain way, no matter what that belief is, at the time in the decade that we're living in. But that translates into discrimination when it comes to healthcare, it translates into discrimination when it comes to job security. It's not okay. But the solution to the discrimination isn't to force everybody to look the same. The solution to the discrimination is to challenge it and to start changing what's going on."
Wolrich focuses a lot of attention in the book on how much harder it is to be healthy when you're poor. He cites a statistic showing that the poorest 10 per cent of UK households would need to spend 74 per cent of their disposable income on food to meet the country's healthy eating recommendations, while the country's richest 10 per cent would need to spend only 6 per cent.
Poorer areas, he says, have a higher concentration of fast food outlets and a lower concentration of supermarkets, and the supermarkets they do have don't stock the same food as in the wealthier areas, meaning the ability to make healthy choices is much harder.
He says: "If the main thing that comes out of the book is we start talking about social injustices, that's fine. I think there are lots of conversations to be had around this stuff and I think a lot of the conversation around health and weight and food does boil down to inequity and inequality.
"If I wrote a book about nutrition and about weight and about health and I didn't mention social inequality and the impact it has, that would be completely missing in my opinion and I think it's really telling that the vast majority of these books, when it comes to talking about weight and talking about food, don't mention it because it makes the conversation harder. But it's accurate.
In place of our societal fixation on weight, Wolrich advocates for what is called a "health at every size" approach, which emphasises the multifaceted nature of health and de-emphasises the link between health and weight.
He says: "I used to think weight was health and it's so freeing to come to the realisation that there are much better ways of doing this."
In the book, he writes: "We, as doctors, have to stop indiscriminately advising weight loss to our patients when we have no guarantee that it's going to improve health or be sustainable over the long term."
He says now: "There was a policy paper written by the House of Commons in the UK only last week, recommending that the NHS stop using the BMI as a measure of individual health, and, I quote: 'Start using a health at every size approach.' Which was amazing to see written in a government policy paper.
"It's not going to change overnight but it just goes to show this isn't something that's just pseudoscience that we're just spouting because we want fat acceptance. We need fat acceptance because that is who we are as human beings and it's what the current state of the world is at, and we need to start treating it seriously, because it's causing people harm."
He says: "Nobody likes to be wrong. We don't like to admit that healthcare discriminates against women. We don't like to admit that Black people get worse healthcare. We don't like to admit that because it makes us feel like we're doing something wrong. And we are. But we can't just ignore the facts - for example, that fat people get worse healthcare and weight stigma impacts healthcare massively. We can't ignore that just because we don't want to admit it."
Food Isn't Medicine: Challenge Nutrib*llocks & Escape The Diet Trap is available now.