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Op-Ed: No evidence weight loss improves health, says nutrition expert Special

By Ernest Dempsey     Mar 16, 2013 in Health
San Francisco - Is there really any scientific evidence proving a solid causal connection between weight loss and good health? An expert in the field says there is no such evidence.
For decades, we have been told and we still see daily on all media sources the connection between diet, weight loss, and health. Generally, weight gain is considered the direct result of diet and weight loss is associated with and suggested for better health. However, a recent article by nutrition professor and researcher Linda Bacon, published in Discover Magazine (December 2012), rejected this usually accepted view. Weight loss does not improve health and can even be dangerous, says Linda Bacon, author of the book Health at Every Size. Let’s learn from her some more about weight, diet, and health.
Ernest: Linda, let’s take it from your article about the counterproductive effect of the generally accepted view on weight and health. How is this conventional view counterproductive?
Linda: The war on obesity is causing untold damage to fat people and thin people alike. By stigmatizing fat and fat people, it’s creating stress and supporting discrimination. By inducing us to invest in so far useless efforts at weight control, it has resulted in rampant preoccupation with food and weight, disordered eating habits, and billions in wasted dollars. And, by focusing the medical community on fat over other factors, it’s causing us to overlook more pernicious – and more curable – sources of disease.
My goal is to see an end to this war, through the peace movement called Health at Every Size®. The premise behind Health at Every Size, commonly referred to as HAES, is simple: HAES advocates switching the focus from weight to health. This simple reframing will have profound implications for billions of people who are, right now, victims of the war on obesity.
Ernest: In your article in Discover magazine, you present the contrary view that weight is a baseless measure for health. Do you believe we don’t have enough scientific evidence to prove a strong link between weight loss and better health?
Linda: Unfortunately, we have no evidence that weight loss prolongs life. It’s worse than that, actually – most studies find an association between weight loss and increased mortality, even when the weight loss is intentional and the studies are well controlled for confounders like hazardous behavior and underlying diseases.
I’m not the only one noticing this. When the National Institutes of Health convened a conference to review the scientific literature, they concluded: “Most studies, and the strongest science, shows weight loss . . . is actually strongly associated with increased risks of death—by as much as several hundred percent.”
If that’s true, you might ask, what explains all the upbeat results from weight loss studies? Well, those results are from short-term interventions. There are confounding factors to consider: In just about every weight loss trial, participants make lifestyle changes to achieve the weight loss, like changing their diet or exercise patterns. These changes alone could account for improved health results, whether or not weight was lost.
So the studies don’t prove that weight loss itself is improving health. What they may be showing is something I agree with: that lifestyle changes – like eating more nutritious foods and getting regular physical activity – lead to better health.
Ernest: So what are the real parameters determining one’s health?
Linda: My main goal is to take weight out of the equation, recognizing that its value has been exaggerated as a health indicator, and that we’ll get much better information from attentiveness to other, better-established, health indicators, such as glucose sensitivity. I’d rather re-frame your question to put our focus on supporting everyone in adopting good health behaviors. This would be of great benefit to everyone, regardless of whether one is big or small, has trouble with glucose regulation or not. If our focus is on fat, we miss diagnoses in thinner people, who may suffer from the diseases we blame on fat, and we pathologize fatter people, despite the fact that many of them are not, nor will they be, sick.
Ernest: Do you agree that obesity results mainly due to diet? If so, we would expect dieting to work in reducing weight. Theoretically that sounds correct.
Linda: Absolutely not. We don’t have research that supports that fatter people consume any more calories than thinner people. And if you examine the well-established physiologic mechanisms, even that doesn’t support that dietary restriction should result in weight loss. Sure, it’s true that if you eat less than your body spends, you lose weight, assuming water remains consistent. But that doesn’t mean that if you eat less than someone else, you will lose weight. Many people have the experience of diets initially being effective, but after a while, the body compensates for the decreased calorie intake by slowing metabolism, thereby reducing calorie expenditure. When that happens, dieting can actually result in weight gain.
Ernest: What about workouts? How effective are they in preventing obesity?
Linda: We also don’t have research to support that exercise is effective for maintained weight loss. Similar to diet studies, exercise studies show initial weight loss, followed by eventual regain, even when the exercise is maintained.
Ernest: You mention in your article the role of “biological feedback loops” in preventing people from maintaining weight loss. Would you please tell or readers about what these loops are and how they fail efforts to lose extra fat?
Linda: We have many redundant feedback systems, but here’s one example. Leptin is a hormone released from fat cells. For most people, when fat cells decrease in size, they produce less leptin, signaling the hypothalamus to do what it needs to do – to increase your eating, decrease your activity level and metabolism, and return your fat cells to their previous size.
Ernest: Fear of weight and anxiety about one’s weight measure can also be damaging to health; this is what we learn from your article. What are some of the most damaging effects of anxiety about one’s weight?
Linda: There are many potentially detrimental effects of worrying about one's weight, some obvious and some more subtle. Research clearly demonstrates that excessive fear of weight gain can lead directly to eating disorders. Even for those who don't develop full-blown eating disorders an obsession with weight can cause an antagonistic relationship with one's appetite and food, making it very difficult to simply enjoy and appreciate food or to honor one's hunger. There is also a growing body of evidence that shows that any kind of stress can contribute to serious health problems like hypertension and depression, so consistent anxiety about one's weight can take a much greater toll on health and happiness than may be initially obvious.
I encourage people to stop worrying about their weight and instead to focus on their internal cues of hunger, fullness and appetite as the most reliable, appropriate guides for when, what, and how much to eat. Trusting one's own body to know what it needs will help people live healthier, happier lives.
Ernest: Would you say much of this anxiety and fear is the doing of media including entertainment channels and films, given the way they have demonized obesity?
Linda: I would definitely implicate the media in perpetuating anxiety about one's weight and one's body as well as encouraging discrimination against fat people. You can't stand in line at the supermarket or turn on a TV without being bombarded by images that are shaming of fat people and promises of diets that will save you from becoming fat.
And then there are shows like "The Biggest Loser," which are damaging in so many ways. They humiliate and vilify their obese contestants, encouraging the same kind of discrimination from its viewers toward fat people, whether it be themselves or others. They also make it seem possible for anyone to lose weight if only they try hard enough. I can't tell you how much hard scientific data there is that disputes this, not to mention countless personal experiences of dieters around the world who just can't manage to keep it off. Our biology works to undo the effects of dieting, so if your attempts to diet don't result in the kind of weight loss you're hoping for, it is not your fault! Shows like "The Biggest Loser" trick people into blaming themselves for failed diets, adding to the long list of reasons to hate oneself for being fatter than society tells us we should be.
But the problem is certainly much, much bigger than the media. Even the supposed “good guys” that are supposed to be acting in our best interests are implicated in fear-mongering, spreading false information, and perpetuating anxiety: the government, non-profit agencies, health professionals…
Ernest: So the solution near you is just dump the weight focus?
Linda: I would encourage people to shift their focus from losing weight, which for the vast majority of people is impossible to sustain anyhow, and turn their attention toward improving their physical and emotional health by adopting new lifestyle habits and exploring new ways of feeling happy and alive in their bodies. It's really quite simple: stop worrying about the numbers on the scale and start focusing on what makes you feel good in the body you have right now. There is a tremendous difference between eating an orange instead of a gallon of ice cream because it tastes so sweet and feels better afterwards than because our diet plan tells us we have to. Your body knows much better than Jenny Craig what helps it feel strong and healthy; you just need to listen to it.
Once you detach from these external restrictions and tune in to how good it feels to go for a bike ride or go on a family hike, you're on the path to better health. My research in which I taught this approach to groups of women really did work; their health measurements, such as blood pressure and hypertension, improved – whereas the women in a control group who followed a conventional diet and exercise plan didn’t sustain any improvements in the long run. And the women in the Health at Every Size group felt great about themselves and had much healthier, relaxed attitudes toward food and eating. They didn't lose weight, but they didn't care. They discovered the freedom of letting go of our culture's obsession with weight and got back to living a full, happy, healthy life. You can too.
Ernest: In closing, please tell us a little about the focus of your current work?
Linda: Right now, I’m putting the focus on training health care practitioners in supporting their clients in adopting Health at Every Size, and training them to gather data so we can learn more about its impact and how to improve HAES programs. I’m also writing and am soon to publish my second book, this one a guidebook to eating well. Readers who want more information about what I’m up to, and to find past writings can visit my website: Scientific references to support everything in this article can be found in the peer-reviewed article I co-authored with Lucy Aphramor, entitled Weight Science: Examining the Evidence for a Paradigm Shift, and/or in my book, Health at Every Size: The Surprising Truth About Your Weight.
Ernest: Linda thank you very much for sharing your expertise with our readers!
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
More about Weight loss and health, weight and mortality, Linda Bacon, Discover magazine, Health at Every Size
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