Russell Williams
Well-Known Member
[COLOR="DarkRed"]You may have read my post about my 27 year old daughters caretakers putting her on a diet. I plan to give them and quiz them about the following[/COLOR]
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 "commonsense" 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.[1-3] "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.[6-11]
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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Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eyes only or for possible publication via email: [email protected]
References
Durazo-Arvizu, R, McGee DL, Cooper RS, Liao Y, Luke A. Mortality and optimal body mass index in a sample of the US population. Am J Epidemiol. 1998;147:739-749. Abstract
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861-1867. Abstract
Troiano R, Fronqillo EA Jr, Sobal J, Levitsky DA. The relationship between body weight and mortality: a quantitative analysis of combined information. Int J Obes. 1996;20:63-75.
Campos P, Saquy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol. 2006;35:55-60. Abstract
Miller WC. How effective are traditional dietary and exercise interventions for weight loss? Med Sci Sports Exerc. 1999;31:1129-1134.
Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in never-smoking overweight U.S. white women aged 40-64 years. Am J Epidemiol. 1995;141:1128-1141. Abstract
Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in overweight white men aged 40-64 years. Am J Epidemiol. 1999;149:491-503. Abstract
Andres R, Muller DC, Sorkin JD. Long-term effects of change in body weight on all-cause mortality. A review. Ann Intern Med. 1993;119:737-743. Abstract
Yaari S, Goldbourt U. Voluntary and involuntary weight loss: associations with long term mortality in 9,228 middle-aged and elderly men. Am J Epidemiol. 1998;148:546-555. Abstract
Gaesser G. Thinness and weight loss: beneficial or detrimental to longevity. Med Sci Sports Exerc. 1999;31:1118-1128. Abstract
Sorensen TI, Rissanen A, Korkeila M, Kaprio J. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med. 2005;2:E171.
Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105:929-936. Abstract
Lamarche B, Despres JP, Pouliot MC, et al. Is body fat loss a determinant factor in the improvement of carbohydrate and lipid metabolism following aerobic exercise training in obese women? Metabolism. 1992;41:1249-1256.
Bjorntorp P, De Jounge K, Sjostrom L, Sullivan L. The effect of physical training on insulin production in obesity. Metabolism. 1970;19:631-638. Abstract
Linda Bacon, MA, PhD, Nutrition Professor, City College of San Francisco, San Francisco, California; Associate Nutritionist, University of California, Davis
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 "commonsense" 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.[1-3] "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.[6-11]
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.
--------------------------------------------------------------------------------
Sign Up now for a free monthly email that brings you the top features from MedGenMed.
Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eyes only or for possible publication via email: [email protected]
References
Durazo-Arvizu, R, McGee DL, Cooper RS, Liao Y, Luke A. Mortality and optimal body mass index in a sample of the US population. Am J Epidemiol. 1998;147:739-749. Abstract
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861-1867. Abstract
Troiano R, Fronqillo EA Jr, Sobal J, Levitsky DA. The relationship between body weight and mortality: a quantitative analysis of combined information. Int J Obes. 1996;20:63-75.
Campos P, Saquy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol. 2006;35:55-60. Abstract
Miller WC. How effective are traditional dietary and exercise interventions for weight loss? Med Sci Sports Exerc. 1999;31:1129-1134.
Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in never-smoking overweight U.S. white women aged 40-64 years. Am J Epidemiol. 1995;141:1128-1141. Abstract
Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in overweight white men aged 40-64 years. Am J Epidemiol. 1999;149:491-503. Abstract
Andres R, Muller DC, Sorkin JD. Long-term effects of change in body weight on all-cause mortality. A review. Ann Intern Med. 1993;119:737-743. Abstract
Yaari S, Goldbourt U. Voluntary and involuntary weight loss: associations with long term mortality in 9,228 middle-aged and elderly men. Am J Epidemiol. 1998;148:546-555. Abstract
Gaesser G. Thinness and weight loss: beneficial or detrimental to longevity. Med Sci Sports Exerc. 1999;31:1118-1128. Abstract
Sorensen TI, Rissanen A, Korkeila M, Kaprio J. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med. 2005;2:E171.
Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105:929-936. Abstract
Lamarche B, Despres JP, Pouliot MC, et al. Is body fat loss a determinant factor in the improvement of carbohydrate and lipid metabolism following aerobic exercise training in obese women? Metabolism. 1992;41:1249-1256.
Bjorntorp P, De Jounge K, Sjostrom L, Sullivan L. The effect of physical training on insulin production in obesity. Metabolism. 1970;19:631-638. Abstract
Linda Bacon, MA, PhD, Nutrition Professor, City College of San Francisco, San Francisco, California; Associate Nutritionist, University of California, Davis
