Many believe lifestyle change is a “privilege” enabled by high income

Yet:

Weight loss works similarly across income in RCTs
Obesity is evenly distributed by income
People with higher income work more, vice versa

This myth is not based on evidence and hurts poor people

People are getting feisty. Let us look at the evidence.

NEJM RCT: "Weight Loss in Underserved Patients — A Cluster-Randomized Trial"

Underserved = low-income, less access to medical care.

Similar weight loss as other trials with similar design.

Conclusion: Income doesn't impair WL when treatment is received https://twitter.com/kevinnbass/status/1374771474502979589

Next up. Does low socioeconomic status associate with obesity? Yes, a little but the difference is small (at least in America). https://twitter.com/kevinnbass/status/1374771480555360256

To be sure, while results from NEJM were comparable with other similarly designed RCTs, weight loss in NEJM study was about 1% bodyweight less. This might reflect impact of SES. But it is a small impact and low-income folks still respond similarly to WL intervention.

Finally.

Hours worked vs. income.

If being poor meant being run down by long working hours, then a high income would be a privilege that could translate into more time to focus on health.

But the opposite is true.

In this respect, people with lower income have more privilege.

Myth that low-income people are impaired to lose weight because of their income is harmful because it suggests we shouldn't concern ourselves with WL for low-income people.

That's bad.

(Reality: Most people struggle with WL, & this is roughly equally distributed across income.)