For decades, weight loss has been one of the most coveted lifestyle goals for people of all shapes and sizes.
Largely, this is because of societal beauty standards that often glorify smaller, leaner bodies type, but a lot of moralising exists around weight loss and how it pertains to health.
In fact, in one global study, nine in 10 overweight and obese people globally said they have experienced weight stigma from their family and nearly three-quarters say they have received ‘fatphobia’ from healthcare professionals, with many people stating doctors have told them unrelated issues are because they are overweight.
The general consensus is that ‘fat’ cannot be synonymous with ‘healthy,’ and that fatness is inherently bad.
But a new scientific review disputes this entirely.
Published in the iScience journal today, a review titled Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks, reviewed and analysed thousands of studies on the link between weight loss, exercise and mortality in overweight and obese people.
It concluded that a weight-neutral approach to obesity treatment ‘may be as, or more, effective than a weight-loss-centred approach’ and that, essentially, weight loss is not always synonymous with health.
Instead, the paper disputes claims that a high Body Mass Index (BMI) is inherently linked to a high mortality risk caused by cardiovascular disease such as heart failure – and vice versa for lower BMIs.
The review found that ‘the mortality risk associated with obesity is largely [decreased] or eliminated by moderate-to-high levels of cardiorespiratory fitness or physical activity,’ and that weight loss, ‘even if intentional, is not consistently associated with lower mortality risk.
It also found that weight cycling (when someone loses and regains weight over and over, commonly known as yo-yo dieting), which is often the result of weight-loss-centred approaches, is associated with a higher risk of all-cause mortality as well as cardiovascular-related mortality.
‘The increased prevalence of weight loss attempts in the United States has coincided with the increased prevalence of obesity,’ the review said. ‘Thus, a weight-centric approach to obesity treatment and prevention has been largely ineffective.
‘It is unlikely that continued focus on weight loss as the primary metric for success will reverse the trends in obesity prevalence or result in sustainable weight loss.
‘In fact, chronic weight cycling is the norm for millions of adults and is likely to remain so for as long as weight loss persists as the cornerstone of obesity treatment.
‘Weight cycling is associated with health risks that are very similar to those associated with obesity, including higher all-cause mortality risk, and may contribute to weight gain.’
So, what’s the solution?
The authors recommend a weight-neutral approach to treating obesity-related health conditions, which ‘may be as, or more, effective than a weight-loss-centred approach, and could avoid pitfalls associated with repeated weight loss failure.’
Such an approach would see patients focusing on their cardiorespiratory fitness and physical activity.
The review said: ‘Many obesity-related health conditions are more likely attributable to low physical activity and cardiorespiratory fitness rather than obesity per se.
‘Epidemiological studies show that cardiorespiratory fitness and physical activity significantly attenuate, and sometimes eliminate, the increased mortality risk associated with obesity.
‘More importantly, increasing physical activity or cardiorespiratory fitness is consistently associated with a greater reduction in risk of all-cause and cardiovascular disease mortality than intentional weight loss.’
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