Dieting and other weight-loss efforts may unintentionally lead to weight gain and diminished health status, according to two researchers, a UC Davis nutritionist and an NHS dietitian, whose new study will appear in the Jan. 24 issue of the Nutrition Journal, an online scientific journal.

Rather than focusing on weight loss, the researchers recommend that people focus on improving their health status.

In the new study, co-authors Linda Bacon, an associate nutritionist at the University of California, Davis Department of Nutrition, and Lucy Aphramor, an NHS specialist dietitian and honorary research fellow at the Applied Research Centre in Health and Lifestyle Interventions at Coventry University cite evidence from almost two hundred studies.

“Although health professionals may mean well when they suggest that people lose weight, our analysis indicates that researchers have long interpreted research data through a biased lens,” Bacon said. “When the data are reconsidered without the common assumption that fat is harmful, it is overwhelmingly apparent that fat has been highly exaggerated as a risk for disease or decreased longevity.”

As Aphramor says, “This means that money would be better spent on campaigns that help people develop a healthy relationship with food and that advocate respect for every body – fat and thin.”

The researchers noted that the study findings do not support conventional ideas that:

— weight loss will prolong life;

— anyone can lose weight and keep it off through diet, exercise and willpower;

— weight loss is a practical and positive goal;

— weight loss is the only way overweight and obese people can improve their health; and

— obesity places an economic burden on society.

“The weight-focused approach does not, in the long run, produce thinner, healthier bodies,” said Bacon, who wrote the 2010 book, Health at Every Size: The Surprising Truth About Your Weight, based on previously published research.

“For decades, the United States’ public health establishment and $58.6 billion-a-year private weight-loss industry have focused on health improvement through weight loss,” she said. “The result is unprecedented levels of body dissatisfaction and failure in achieving desired health outcomes. It’s time to consider a more evidence-based approach.”

Aphramor pointed out, “It simply isn’t the case that each failed diet is just an experiment that didn’t work. There are real health risks with weight fluctuation and unintended, debilitating consequences of dieting including guilt, anxiety, preoccupation with food and body shape, reduced self esteem, eating disorders and weight discrimination.”

Health-focused alternative:

Concluding that the weight-focused approach to health is unsupported by the scientific evidence and has in fact been detrimental and costly, Bacon and Aphramor suggest that the health care community should adopt what they say is “a more ethical, evidence-based approach toward public health nutrition” –one that instead encourages individuals to concentrate on developing healthy habits rather than on weight management.

The researchers stress that evidence shows that changing health behaviors can sustainably improve blood pressure, blood lipids, self-esteem, body image, and other indicators of health and well-being, independent of any weight change and without the negative aspects of weight-focused approaches. While weight loss may result, the goal is self-care rather than weight loss, they say. This weight-neutral practice has become known as Health at Every Size (HAES).

“It is clear from our review of the data that body weight is a poor target for public health interventions,” Bacon said. “Instead, the health care community should shift its emphasis from weight-management to health-improvement strategies, for the well-being of people of all sizes.”

Dietitian Aphramor runs a HAES course, called Well Now, in Coventry innovatively funded as part of Coventry’s Health Improvement Programme an £18 million partnership programme between Coventry City Council and NHS Coventry to improve health levels of people in the city.

“It is striking what a difference this shift in emphasis makes in people’s lives”, she said, “Removing guilt and stigma around body weight and food enables people to learn to value themselves as they are right now which then motivates self-care. This includes many people who felt sure they couldn’t accept themselves until they had lost weight. Because HAES teaches people how to tune in to their body signals they begin to feel more relaxed and in control around food. Not surprisingly, it’s had a huge impact on people’s mental wellbeing as well as influencing their eating and activity patterns. One woman described it as ‘the course that will change your life.’ ”

While undertaking the review Lucy Aphramor received financial support from a WM NMAHP PhD Research Training Award.

Source: University of California