COMMENTARY

End the War on Obesity: Make Peace With Your Patients

Linda Bacon, MA, PhD

Disclosures

November 27, 2006

 

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Your patients are desperate to lose weight. Given the presumed health imperative, you feel justified in supporting their goal. You encourage calorie restriction and/or exercise.

The "weight problem," however, never goes away.

Face the facts. We're losing the war on obesity. The "common sense" approach just isn't working. Weights are increasing, particularly among dieters, and weight preoccupation and eating disorders are also on the rise.

Challenge your assumptions.

1. Weight has been greatly exaggerated as a health risk.

Consider mortality. Except at statistical extremes, BMI only weakly predicts longevity. Many studies indicate "overweight" people live at least as long as "normal" weight people.[1,2,3] "Overweight" may even be ideal for longevity.[2]

Consider morbidity. Epidemiological studies rarely acknowledge confounding factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status. Studies that do control for these find increased morbidity disappears or at least is sharply attenuated.[4]

2. Sustained weight loss is not a practical goal, nor is it well established to improve health.

The vast majority of people regain lost weight, regardless of whether they maintain their diet or exercise programs.[5] And no one has ever proved that losing weight prolongs life. Some studies actually indicate that intentional weight loss increases the risk of dying early from certain diseases.[6,7,8,9,10,11]

3. Health improvements can result from improved health behaviors, regardless of whether weight is lost.[12]

Improvements in insulin sensitivity and blood lipids have even been documented to occur in people who actually gained body fat during an exercise program![13,14]

There's an alternative to the war. The new peace movement is called "Health at Every Size," and it acknowledges that health habits are more important than the scale.[12]

Participation is simple. Quit hassling patients about their weight. Stop prescribing weight loss. Encourage people of all sizes to change focus from weight to health. Support everyone in appreciating their bodies and incorporating healthy lifestyle habits.

That's my opinion. I'm Dr. Linda Bacon, Nutrition Researcher, University of California, Davis, and Nutrition Professor, City College of San Francisco.

 


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