When Doctors Lie: The Guidelines That Recommend Diets They Know Don't Work

In 1992, a room full of weight loss experts admitted diets don't work and that weight regain is almost inevitable within five years. Then they recommended diets anyway. Fast forward to 2025, and the UK's NICE guidelines acknowledge weight cycling causes harm, that the evidence is overwhelmingly poor quality, and that people will likely regain the weight. Yet they still recommend 800-calorie diets, even for people with eating disorders. 

In this episode, I expose how medical guidelines have become a masterclass in institutional lying—where committees acknowledge the evidence shows diets fail, cause harm, and offer no long-term benefit, yet recommend them regardless. Because the industry's already doing it, the government's already funding it, and admitting the truth would be too expensive. This isn't medicine. This is willful harm dressed up in clinical language, and the people writing these guidelines need to be held accountable. 

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Transcript

Hello, and welcome to the Fat Doctor podcast. This is episode 4 of season 6. I'm your host, Dr. Asher Larmie. I am delighted to be with you again this fine Wednesday. It's February already! Blimey! That went quick.

A friend of mine sent me a message a little while ago saying, congratulations, you've survived the 10 darkest weeks of the year. And I was like, oh, nice! Good to know, especially in this particular time where things are very much up in the air. Yeah, the world is a dumpster fire, but I'm busy editing my book, and focusing on something that I have some control over.

Chapter 2 of my book is all about how diets don't work. And I'm guessing that if you have been following me for a while, or not necessarily me, but anybody in the fat liberation space, or in the weight-neutral space, or the anti-diet space, then you know full well that diets don't work. And even if you are not familiar with that, you've probably experienced it over your lifetime, because you've probably been on several diets, and you know they don't work. Maybe they work in the short term, but they don't work in the long term.

What I really have been focusing on in the book is, if diets don't work, why are we recommending them? That's the bit that I don't get. There's so much evidence that diets don't work. Why do we still recommend something that doesn't work? I don't recommend other treatments that don't work. As a doctor, I've never seen a doctor go, do you know what, this tablet, absolutely useless, but have it anyway. That doesn't happen. We don't go, surgery is a complete waste of time, but let's do it anyway.

Why are we, and by we I mean doctors and other healthcare professionals, why are we recommending something that doesn't work? Doesn't make sense. But oftentimes, it's because, well, the guidelines say to do it. So, of course it works. There's a real disconnect between what is actually true and what we are being told is true.

And so, in this podcast episode, I am going to analyze two separate conferences or collaborations, separated by decades, between a bunch of experts who are getting together and writing the rules.

One was in 1992, it was the National Institutes of Health Consensus Development Conference on voluntary methods of weight control. Voluntary methods. I mean, I suppose there could be involuntary methods as well, couldn't they? Yeah, so that was 1992, quite some time ago, this was in the States.

And then, more recently, in January 2025, the National Institute for Health and Care Excellence, or NICE for short, which is the NIH equivalent over here in the UK, published or updated its guidance on overweight and obesity management. Now, if you listened to last week's episode, you'll know there's no such thing! But there is an entire NICE guideline, in fact, without doubt the biggest NICE guidelines I've ever come across in my life, that is dedicated to the management of this non-existent fictitious disease. And part of it, as you will not be surprised, recommends diets!

So, I'm going to be looking at these two very individual collaborations, separated by time and space, but similar in many respects. Basically, doctors got together and decided to lie to the world. That's the long and short of it. If you can't be bothered to listen to the whole episode, that's the summary. I'm giving the secrets away. Spoilers.

So, in 1992, this group of people got together, lots of doctors from different specialties, it was a 3-day conference, I think you could claim 15 CME credits for it, really quite a sort of standard thing. At the end of the conference, they had got together to write a statement, and then they opened it up to the press to have a press conference afterwards, which is really interesting.

And yeah, so you can actually look at the entire 1992 document, which I have, including all of the evidence that was presented at the conference. Loads of different speakers. You could do all of that, which I have done, but you probably don't want to, because it's kind of a waste of your time. All you need to know is that the people at this conference, the vast majority, the clinicians, the researchers, there was even somebody who was a newspaper columnist or a magazine columnist, all of these people were really quite invested in the concept of weight loss.

Part of their job description, they'd publish papers on it, they're experts in the field. It would be really weird for them, it'd be really weird if they turned around and went, do you know what? Diets don't work. But that is exactly what they did. They came together at the end of the conference, they wrote their statement, and in their statement, they said one third to two-thirds of weight loss is regained within one year, and almost all is regained within 5 years.

So in 1992, a group of clinicians who were absolutely invested, whose professional lives kind of revolved around weight loss, these were not skeptics, these were not members of the anti-diet community, they got together and said, yeah, no, do you know what, diets don't work, they just don't, that's what the evidence shows us.

They went on to say in the statement, successful weight loss, but they just said it's not a thing. But anyway, successful weight loss improves several cardiovascular risk factors and diabetic control. Effects on mortality are not clear. Several epidemiological studies have found that weight loss is associated with increased mortality. But the reasons for weight loss were not known.

So, diets don't work. Supposedly, in spite of that, successful weight loss, whatever that means, improves cardiovascular risk factors and diabetic control, but somehow people seem to die sooner. There's an increased mortality. I'm not quite sure what's going on there, but in spite of that, we're just gonna recommend it. That is essentially what they said.

So I went and had a little look at all of the information they showed, and honestly, I suppose it was 1992, so I had to stop, because I was looking at a lot of the research, and I was like, well, this is shit. And where's this study, and where's that study? And I was like, oh no, wait, that happened after 1992. So, to be fair, they were basing a lot of their findings on evidence that's quite old now, and probably not evidence that we would consider up-to-date enough to make recommendations from. There were studies from the 1950s, from the 1970s. I think they're bad, although they were bad. Methodologically, they were bad studies, but some of the stuff that they were looking at is outdated now, is what I want to say.

And in spite of that, they had evidence from the Framingham study, and I don't know if I've mentioned Framingham before, I probably have. Framingham is a town in Massachusetts. And since the 1940s, we've been following a cohort of individuals, just following them over their lifespan, taking a whole bunch of measurements, and then following them and seeing what happens to them. This is what we call a prospective study. And it's one of the biggest studies to have existed ever, I think, in the history of medicine.

A lot of our data about chronic disease and heart disease and stuff like that comes from Framingham. But the Framingham study, and this was even back in 1992, showed that, actually, when you compare people who are weight-stable to people who lost weight, to people who gained weight, the people who gained weight had the lowest risk. Not the people who lost weight. In some cases, it depends on how quickly you measured it. But in many cases, the people who gained weight had the lowest risk of all-cause mortality or cardiovascular mortality.

But even those who remained weight-stable, much, much healthier than those who lost weight. And before people say, yeah, well, of course, you lose weight because you're sick, and so of course you're gonna die, because that's a sign. These studies accounted for that. They said, okay, we're not going to count the first four years of weight loss, because that could just be a sign that you're really sick. So, we're going to look at the long-term data, 6 years, 10 years, etc. So they found that people whose weight was stable and people who gained weight steadily over that period of time actually had the lowest risk.

That was Framingham, and then there was the CARDIA study, and I forget what CARDIA stands for now, but it's something to do with long-term heart risk. It did show, as they said, improvements in cardiovascular risk factors. To be fair, it did show that. What did it show? Sustained weight loss over a period of 5 years, so it measured at baseline at 2 years and at 5 years. Sustained weight loss over a period of 5 years resulted in 0.5 millimeters of mercury improvement compared to weight stability.

So, not a millimeter of mercury. 0.5mm of mercury. That was the difference between people who'd lost weight and people who'd maintained their weight. 0.5mm mercury. To put it into perspective, a normal blood pressure is between, you know, 100 and 140 millimeters mercury systolic. 0.5 is not really clinically relevant.

Same goes with cholesterol. People who lost weight actually did have on average, a lower cholesterol. But that was 2 milligrams compared to those who were stable weight, but it was 2 milligrams per deciliter. And again, to put that into perspective, an average cholesterol would be around 200 milligrams per deciliter, so 2mg per deciliter, it's not really anything to write home about, is it?

So when they said that weight loss improved cardiovascular risk factors, they were lying. Because it didn't. Weight loss doesn't improve cardiovascular risk factors. Not compared to people who are weight-stable. Even if you compare it to people who gained weight. We're talking a couple of millimeters of mercury. It's not exciting. It's not anything to write home about. It's not clinically relevant.

I didn't look at the diabetic control, I couldn't find the information for the diabetic control, so I can't speculate, but even in 1992, they said if you lose weight, it'll improve your health, but they didn't have the science to back that up. They didn't have the evidence. Not even then.

Also, as I said, they found that people who lost weight, died quicker. People who've maintained weight or gained weight over their lifetime live longer.

So that was 1992. We knew that diets didn't work, we knew that successful weight loss wasn't possible, we claimed that it improved your health, but it doesn't. Even then, we knew it didn't. And then, we knew that it was dangerous, because people seemed to be dying. And we didn't care, because we still recommended weight loss. Isn't that amazing? That was 1992.

And I just, for those who aren't clear, I just want to remind you that your body is designed to defend its weight. I'm gonna go into this in great detail in Chapter 2 of my book, really explain why this happens. But it's important that you understand your body does not know the difference between intentional starvation and unintentional starvation.

Starvation is when you are consuming less energy than you need to exist. At rest and or when you're active. A lot of times when we calculate how many calories you need, that's literally how many calories you need if you are doing nothing. Just laying in a bed and breathing. And ideally, sleeping. If you're actually moving, which we all are, then you actually require even more energy than the calculations.

So, when we sort of say, oh, well, the average human being needs 2,000 calories, that's at rest. That is not when they're moving. And so, you know, we really are starving you when we tell you to drop down to 1200 calories, or drop down to 800 calories, or whatever we're recommending that you do.

Your body doesn't understand that a doctor prescribed that. Your body thinks you're starving. It can't tell the difference. And so, there's a fail-safe in your DNA. And that fail-safe exists as a result of hundreds of thousands of years worth of evolution. It is not a fail-safe that you can somehow overcome with sheer willpower.

Your body will interpret energy restriction as an assault that it has to defend itself against. And it does it in two main ways. The first is to lower your metabolic rate, second is to increase your appetite. And so you require less energy to perform basic tasks. And you get hungrier and hungrier and hungrier the more weight you lose.

We call this an energy gap. There's now a gap, a big gap, between how much you want to eat, how much you actually need to eat, versus how much energy you're receiving. It's a big gap.

In an ideal world, you want to eat, your appetite is telling you to eat as much energy as you need to eat on that given day. And this is really important, because we just walk around, and we're like, you need 2,000 calories a day. The body is not that basic. We are not that basic. We need different amounts of energy every single day, depending on the weather, depending on what we're doing that day, depending on what mood we're in, like, there are so many different reasons for why our energy requirements vary day by day by day.

So in an ideal world, our body, and the systems are in place, our body already knows how much we need, and will tell us you need to go and eat that much food. Yes. In an ideal world. If you're neurodivergent, that becomes a little bit harder, because you can't always pick up your interoceptive cues. And this is all part of interoception, so that can be a bit of a problem.

But in people who aren't neurodivergent, and that doesn't mean you can't overcome these things. In an ideal world, you are consuming as much energy every day that you require. So you're net zero. That is what your body wants.

When your body has been starved, your body's like, oh crap, we need to fix this, we're losing our energy stores. Something has gone wrong. We have to build our energy stores back up, and the only way to do that is to increase your appetite. Now you want to eat more food than you actually need in order to gain back the stuff that you've lost, the long-term storage that you've lost.

And at the same time, your body's panicking, because your body's like, well, hang on a minute, we're not getting enough energy. And in order to survive, literally, in order to survive, your metabolic rate has to reduce.

The idea that you can just suddenly magically turn all of your fat into energy is bullshit. That's not how it actually works. You need 5 times the energy deficit to burn fat versus lean mass. So, first things first, you're going to burn a lot of lean mass, you lose water, you're gonna lose skeletal muscle, you're gonna lose bone, because you need five times the energy deficit to burn fat compared to lean mass.

And as a result, generally when you go on a diet, 25% of the weight that you lose is lean mass. And that in and of itself is problematic, because we don't want you losing muscle mass, we don't want you losing water, we do not want you losing bone mass.

But on top of that, the process of turning your fat storage into energy, it's not instant. It doesn't happen like that. And so your body, instead of going, oh, we've got plenty of fat stored, your body's like, no, we're not letting go of that, that's what's keeping us alive, we can't live without that.

So your body reduces its energy requirements, it reduces your metabolic rate. You slow down, is what I'm trying to say, and you notice it. You know it's happening, you feel it in your body, you become slow. And the parts of your body that really are deemed to be less essential basically stop receiving the nutrients and the energy that they need.

That's why your hair thins, it's why your skin changes, it's why you're tired all the time, and you feel fatigued. That's why your immunity sucks when you're on a diet. All of these things, because your body's just like, well, right now we need to focus on, prioritize the heart, the lungs, and the kidneys, and the liver.

So, we really do some damage, and what's really annoying is that when you stop starving yourself, it doesn't change. It's not like your metabolism just goes, oh, cool, and then returns back to normal. Thumbs up, let's go back. It doesn't happen that way. It's long-lasting, possibly permanent, but certainly long-lasting.

And there's even some evidence, and this is evidence in rats, so you want to take this bit with a pinch of salt. There's even some evidence that with each diet you go on, you create new fat cells. So, we used to think that all that happens is your fat cells, when you gain weight, your fat cells just get bigger. Because they fill up with fat. And then when you lose weight, your fat cells shrink, they get smaller.

But there's some evidence that actually we might be creating new fat cells as opposed to them just shrinking and growing. So yeah, your body is designed to defend its weight, is designed to defend its fat storage. And it will do whatever it takes.

And that's why, when you're on a diet and your appetite goes up, and your metabolism goes down, not only do you regain the weight, which is the whole idea, the whole purpose. But quite often, you end up heavier than when you first started.

In fact, dieting is the most effective way to gain weight in the long term. Like, if you want to get fat, if that's your desire, if that's the main goal, the main objective is to get fat, then go on a diet. Go on lots of diets. Best way to get there. It's not to eat lots and lots of food. That's not the most effective way to get it, is to go on a diet. That's the most effective way to get there.

Dieting makes you fat, and there is a study, a Finnish study, and that's why I like the sort of bluntness of it. I've got a friend who's Finnish, and I've got to ask whether this kind of reflects the entire population and the sense of humor of the people of Finland, because it basically is a study that is entitled, Does Dieting Make You Fat? Very blunt. To the point. Does dieting make you fatter?

Finnish study from 2011, they looked at over 4,000 twins who were born between 1975 and 1979. And they found that those who went on just one diet, one diet during the time that they were studying them, were 2 to 3 times more likely to be quote-unquote overweight. And the more you dieted, the higher the risk was of being fatter than your twin.

So the identical twin pairs who started at the same weight, and remember, if it's an identical twin, not only do they share the same genetics, but they also share the same environment for the most part. And so, these are perhaps some of the most useful studies when it comes to ruling out a lot of the potential confounding factors that can skew our data.

If you're looking at identical twins who were raised in the same home, same environment, same genetics, the fact that identical twin pairs who start at the same weight, that if one dieted and the other didn't, the dieting twin was heavier by the age of 25. Like, that says a lot, right? We've controlled for genetics, we've controlled for environment, chances are the dieting is at least one of the main reasons that they ended up heavier.

And we have recent studies, a meta-analysis that I found of 25 studies that found that dieting significantly predicted future weight gain. That confirmed that short-term weight loss is typical. But long-term weight restoration is almost inevitable. And this is just consistently demonstrated throughout studies.

So, in 1992, we knew that dieting was unsustainable. Weight loss was unsustainable. And since then, we know dieting makes you fat. And all the studies sort of support the same thing. Dieting significantly predicts future weight gain. That's what the studies are showing us, over and over again.

Let's fast forward to 2025. The National Institute of Health and Care Excellence in the United Kingdom recently updated their guidelines on overweight and obesity management.

And here is part of what they recommend. Point one, Article 1.16.3 reads: Ensure that dietary approaches for adults to support overweight and obesity management keep the person's total energy intake below their energy expenditure, also called an energy deficit or calorie deficit. This could be done by lowering specific macronutrient content, for example, low-fat or low-carbohydrate diets, or using other methods to limit overall energy intake.

So, they are recommending a calorie deficit, or an energy deficit, either go for low-carb, or low-fat, or another method, unspecified. That's a recommendation.

Article 116.3, Recommendation Number 116.8. Consider low-energy diets, that's 800 to 1200 calories per day, also known as low-calorie diets, only as part of a multi-component overweight and obesity management strategy with long-term support within a specialist overweight and obesity management service for people who are, and I hate this term, living with obesity, in other words, living with fat. What a... just say fat.

So for people who are fat, with or without diabetes, or for people who are just overweight, not actually fat, and have type 2 diabetes. You know, whenever you're diabetic, no matter how, like, at the moment, you'll have a BMI over 25, that's it. You need to starve yourself, because you're special, you're diabetic. We sort of lump you in with the fatties.

But anyway, so they're recommending low-energy diets of 800 to 1200 calories a day, only within a weight management service. Most of the weight management services in the UK are privately funded, private companies. They are part of the private sector, not the nationalized health service. So the NHS is paying these private companies to perform, to do this job. Just worth noting that they're private companies.

And then they even go on in Article 116, Part 9, consider very low-energy diets, that's under 800 calories, as part of a multi-component strategy, blah blah blah. But this is for people who are living with obesity, and have a clinically assessed need to lose weight rapidly. For example, to make surgery safer and more feasible.

Alright? So, they recommend a calorie deficit, they recommend, in some cases, as long as you're being supervised by these private corporations that are making a lot of money out of the NHS, a low-energy diet, 800 to 1200 calories a day, or even a very low-energy diet, under eight hundred calories a day, if you're trying to lose weight rapidly.

But before starting someone on a low-energy or very low energy diet, they do recommend in part 12, explain that this is a restrictive diet with a specific health goal, such as improvement in diabetes, and risks such as weight cycling, weight regain, and potential adverse events, and for very low energy diets, also the risk of constipation, fatigue, and hair loss.

Hmm. So, the benefits, improvement in diabetes is one that they've suggested. They also mentioned earlier on to make surgery feasible. And there are risks. So you've got to mention them, because it's the law. Weight cycling, weight regain, potential adverse events, and possibly even constipation, fatigue, and hair loss. There's a very specific, you might be wondering, why not any of the others? We'll get to that part.

Also explain this is not a long term overweight or obesity management strategy in its own right, and it must be followed by lifelong dietary energy intake control and appropriate physical activity levels.

Discuss, they say. The weight regain is likely to happen, and if it does, it is not because they or their healthcare professional have failed. We want to put the healthcare professional in there, so this healthcare professional doesn't get sued.

Discuss reintroducing a wider range of foods after a low energy or very low energy diet. Don't keep them on a low-energy diet forever, is what they're saying. No meal replacements forever. They have actually specifically said you can't do that.

Discuss the options for long-term weight loss maintenance support or therapies including nutritional advice, physical activity, medicines or surgery, if weight regain happens. What do you mean, IF? Weight regain happens. Weight regain IS going to happen. We knew about this in 1992! We've known about this the whole time!

They also want you to offer assessment and counseling. This is the bit that I find hardest, it's quite upsetting. Offer assessment and counseling, if they may have eating disorders or other mental health issues, to ensure the diet is appropriate for them. They don't say, it's not a good idea to put someone with an eating disorder on an 800-calorie diet. They don't say that. They're not explicit about it.

They say offer assessment and counseling. Assessment and counseling. Anyone who's sort of existed in the UK for the last 30 years, and understands the nature of assessment and counseling in the NHS, will tell you that that's a joke, to start with.

But if they may have an eating disorder or mental health issue, maybe they're suicidal, maybe they're depressed, offer them counseling first, before you stick them on an 800-calorie diet. That's the recommendation.

Alright, so in order to make these recommendations, the National Institute of Health and Care Excellence got together a big committee of people. And they have to produce a literature review, where they look at all of the literature out there, all of the studies out there. They'll have inclusion and exclusion criteria. So only certain studies make it in, they have to be high-quality studies. Well, they don't have to be high-quality studies, but they have certain criteria, like, we're only going to be looking at these studies when they do a big, massive search, they get all the literature together.

They analyzed the literature, they specify what outcomes they're looking for, like does an 800-calorie diet improve health? Like, they specify all of these things. And then they analyze the evidence, and they come together, and they meet, and they discuss what the evidence shows, and then they make recommendations based on that evidence, right? That's what's supposed to happen.

And so I had to go look at the evidence review, evidence review F. What does it actually say? Here's what the evidence showed. So, first of all, only 4% of the outcomes that they measured had high-quality evidence. Only 4%. These 4% of outcomes with high-quality evidence showed absolutely no benefit to going on a diet. Didn't matter what diet it was, they specifically looked at these ones, these high-quality evidence papers were looking at low-calorie diets and intermittent fasting. No benefit. Didn't work.

80%, 78% of the outcomes had low or very low quality evidence. In other words, inadequate methodology, too biased, too poor quality to inform recommendations. So that's 80% of the evidence already useless. 4% is high quality, the rest is moderate quality.

There was zero evidence beyond 3 years for any intervention. We already know that weight regain usually only happens in the first year. And that it's 2 to 5 years before we see full, we see the full picture. So if they're not looking beyond 3 years, and literally almost all the studies stopped at 1 year, but if you're not looking beyond 3 years, you're not actually getting the full clinical picture, are you?

As the follow-up duration increased, the evidence quality decreased. The longer, more rigorous studies found far less benefit. So, it's only the very short, less, more biased, poorer quality studies that showed any benefit to going on any diet of any kind.

They also didn't track adverse events. Adverse events is like, complications, risk factors, that kind of stuff. They didn't track them. So they hate talking about, do you remember there was a point where I was, like, you know, warn them that there are potential adverse events? Potential? They put the word potential in there. Because they didn't bother to track them, they don't know what they are. What if some of the adverse events are death? We don't know, this is not even in there, like, it's terrible, they don't even track them.

There was one study that showed constipation and hair loss and fatigue. That's why they put it in, but that's it. Terrible! How are you not properly tracking? If you're going to make a recommendation, you have to look at the benefits and the harms. Otherwise, you have no business making a recommendation.

They didn't look at the adherence in the study, so they didn't look at the dropout rates. So all these studies that they were looking at, 50% of people could have dropped out, they didn't know. Well, they weren't looking for it.

They did, to be fair to them, acknowledge weight regain. So it wasn't like they pretended it wasn't happening, they knew it happened, they just didn't care about it. They did acknowledge that weight cycling causes harm. They said weight cycling's not a good idea, it causes harm. And yet.

One of the things that the NHS, or that NICE is interested in, is the cost-effectiveness of a treatment recommendation. You can't just recommend a treatment, it has to be cost-effective, because we're pinching pennies in the NHS. So, they used really crappy method to prove that it was cost-effective. It wasn't cost-effective. They basically looked at the two-year results from the trial, and assumed that that was going to apply to your entire lifetime.

So, extrapolated lifetime consequences based solely on 2 years' worth of data. So that's insufficient, that's not accurate, that's completely, and they acknowledged that is insufficient and inaccurate. We know that there's a, the chances are there'll be long-term weight regain, and we have no idea what that's going to do to, whether you're gonna have the remission rates of diabetes, for example, they're claiming, oh, you're going to have remission for your diabetes.

That was based on one particular study, which actually I'll talk about at a later date, and I have spoken about before, the DiRECT study. But, yeah, it's only 2 years worth of data. If you go to the 5-year data, or beyond, it's not actually cost-effective at all. Short-term cost-benefit, not long-term cost-benefit.

And this, I think, is the most damning quote from the entire evidence review. Although the evidence provided by published studies and the original economic evaluation suggests that low energy or very low energy diets were likely to be cost-effective in these populations. The committee were aware that sometimes weight regain could occur rapidly and be harmful if people experience weight cycling. Therefore, a weak recommendation was preferred to a strong one. In certain cases, a low-energy diet may not be the most appropriate intervention.

How can you acknowledge weight regain almost certain? Weight cycling harmful, you know, rapid weight gain can be harmful, weight cycling can be harmful, we're not really tracking the adverse events so we don't actually know whether that's the case, because we didn't even bother to look. We know all of these things, it's not really cost-effective anyway, but yet we're still going to recommend it, we're just gonna downgrade from strong recommendation to a weak recommendation. Like, how do we do that?

How do we say we know it's gonna cause harm? But you can even offer it to people with eating disorders, as long as you get them counseling first. What the fuck is going on here?

You might be asking yourself, what the fuck is going on? I was asking myself, what the fuck is going on here? And so, I looked through the paper, like, defend yourself, explain yourselves, NICE Guidelines Committee.

And they did! They didn't try to hide. They said the committee noted that further guidance around the use of low-energy diets were required, as these diets are already being used in practice.

Translation, we're doing it already! So now we need to find evidence to justify it. Not the other way around. So they're saying, like, you know, we can't, it's already been done, we can't just say no now, we're just gonna have to say yes and hope for the best.

They also talk about the political pressure, because there was this thing at the time, at the start of this, at the time when they were doing the guidelines, was the NHS Type 2 Diabetes Path to Remission program. It's this program, again. A lot of money to be made from this program. Where they basically put people on a very low-calorie diet who had just been diagnosed with diabetes in the hope that they can put their diabetes into remission.

Well, this is like a nationalized, like, government-backed scheme. So they're like, not only is the NHS already doing it, we've got this government-backed scheme going on! We can't just say no now.

They also spent a lot of time talking about two particular trials, the DROPLET trial and the DiRECT trial. The DROPLET trial is funded by the Cambridge Weight Plan, it's a meal replacement company, a private organization. And the DiRECT trial, using Counterweight products, there was industry involvement as well going on.

It makes me really mad, you know? The evidence was overwhelming. There was an official admission in 1992 by the National Institute of Health that weight loss was unsustainable, right? It didn't work. Diets don't work. We've known for a really long time that our biology, our human biology, ensures that we defend our weight, defend our fat stores in any way possible. We've got studies that prove that dieting makes you fatter, high-quality evidence. Dieting makes you fatter.

When we actually look at the evidence that diets work, it doesn't exist! It's either really low quality, or the high quality evidence shows that they don't work in the long term, they stop working, even if they work in the short term, they stop working. We're not tracking adverse effects. We're not interested in how, like, actually, weight cycling could be making this situation so much worse in the long term. We don't care!

We're making recommendations that are actually genuinely dangerous. And we don't care.

How, I'm still baffled. How can doctors prescribe diets when they know that they don't work. Because even if you don't know all of the evidence, like, your clinical experience has taught you, that even your patients that lose weight, they go away, they lose weight, like, ooh, you've lost a lot of weight, and then they come back a year later, and you're like, oh, you gained it all.

We know this. It's obvious, it's our own clinical anecdotal experience. So, why do we recommend them?

First things first, doctors will tell you it's all about your health. We care about your health. We're doing this for your health, it's in your best interest. And, you know, you know this is not true, I've talked about it before, I will absolutely be talking about it more over the coming months, and it is going to be a big part of my book. There's a huge part included throughout the book, but part 3 basically proves that dieting doesn't benefit your health in any way, shape, or form. So it's not about your health. It's never been about your health.

But doctors will also say, well, the guidelines recommend it, and that's when it gets tricky, isn't it? Because the guidelines do recommend it. But the guidelines can't be trusted. So what do we do when the guidelines can't be trusted?

And the reality for you and I is that they will blame you when the diet doesn't work. When you go on that 800-calorie meal replacement shake, because you were just diagnosed with diabetes, and you go off, and you do the weight loss, and you lose lots of weight, and then, like, 2 years later, you're right back where you were, probably fatter, and your diabetes is no longer in remission.

When that happens, even though the NICE guidance say that actually, you shouldn't blame yourself or your healthcare professional, because it's just something that happens. You WILL be blamed. You will be blamed by everybody.

People around you will use it as a means of punishing you, as a means of denying you access to healthcare, all sorts of things. I mean, they are recommending that people starve themselves for 12 weeks in order to lose enough weight to have surgery.

There is no evidence that this actually improves surgical outcomes. In fact, there is evidence that this worsens surgical outcomes. NICE had zero evidence, ZERO evidence that going on an 800-calorie diet was going to improve your surgical outcomes. But they recommended it anyway.

They put that in there, they used those exact words because no one is going to question them. That's why they got away with it. Because no one is going to question them. Because probably no one's bothering to read what they've written. They're not reading any of the evidence analyses and stuff like that.

But there is, this is dangerous. This is not just negligent, this is fucking dangerous. We are harming people. And it's not even the individuals, it is the people in charge who are making the rules and creating the guidelines. They are doing this intentionally. It is willful and deliberate. They saw the evidence, they knew the evidence was very clear. Diets don't work, and they recommended them anyway. They should be held to account.

There is a list of people who are in that room, and they need to be held to account. As far as I'm concerned, they need to defend their actions, because their actions are harming you and I.

So, maybe one day I'll name and shame them. I don't think there's any point at the moment. I hope you've enjoyed this particular episode. I did get very ranty towards the end.

There'll be lots more incidents of me telling you how the guidelines committees lied and cheated, and intentionally, willfully provided disinformation to the public that is actually going to harm them. And they did so with full knowledge.

Next week, I'll be talking a little bit more about what controls your weight.

Yeah, I am very grateful for all of you who've been emailing me, talking to me, a few of you have just been like, hey, I'm really looking forward to the book. That's really exciting, thank you very much. Those of you commenting on my YouTube videos, keep coming.

Yeah. Not sure what else to say, really. See you next week!

If you're enjoying this season and want an exclusive early look at the book as I write it, I'm reading No Weigh aloud chapter by chapter in my Book Club – exclusive to members of The Weighting Room community.

Here's the thing: most online communities - even fat liberation spaces - are not designed for burned out neurodivergent folks. They rely on social media apps that feel overwhelming and overload the senses. They require you to perform engagement or mask your way through small talk. You find yourself scrolling through hundreds of unread messages wondering if you missed something important and worrying that people are judging you for it. Or your posting into the void and spiralling when nobody responds. And if it’s a paid community, there’s the added pressure of feeling like you need to participate enough to justify the cost. 

I've recently redesigned The Weighting Room specifically for people with brains like mine. Perfect if you’re Fat, traumatized, neurodivergent, and burned out. You get predictable structure that supports executive dysfunction. Immediate dopamine hits from completing tasks alongside others. No FOMO because each session is self-contained. No ongoing risk of rejection and  zero social debt.

So what does that look like? Each week there are four virtual sessions that you can turn up to if and when they suit. There’s two body doubling or coworking sessions that you can use to focus on a project, practice some self-care, tackle a task that you’ve been putting off – whatever you need. I’ll be using it to fold my laundry or working through the emails that I’ve been avoiding. Cameras off. No small talk. No obligations. Just a safe space to feel less alone without any requirements to perform or mask. There’s also a crafting circle, stargazing sessions for spiritual exploration, and, of course, Book Club where you hear each chapter of No Weigh first. Plus a Signal group for peer support but with very clear boundaries. Show up when you can, skip when you can't. No pressure. No judgement. 

It's £15 a month. And honestly? If you've been looking for a way to support the work I’m doing while getting community that actually works for how your brain functions, this is it. You get community that actually works for you, and I get to keep writing, keep fighting weight stigma, and keep showing up without worrying about how I’m going to pay my bills.