Obesity is the result of overweight people gaining more weight.
Severe obesity is the result of people with obesity gaining even more weight.
The first step, common to both obesity prevention and treatment, is to stop further weight gain.
In fact, simply preventing weight gain at any weight may be preferable to losing weight just to gain it back. The more often you lose weight and gain it back, perhaps, the worse the consequences.
At least that is the message of a recent paper by Anne Claire Vergnaud and colleagues from the Centre de Recherche en Nutrition Humaine Ile-de-France, Bobigny, France, who studied the relationship between weight fluctuations and the risk for metabolic syndrome (International Journal of Obesity).
Metabolic syndrome status was assessed at baseline (1994/1995) and at the end of follow-up (2001/2002) in 3553 middle-aged subjects. Weight fluctuations were estimated with four weight measures during follow-up. Risk for developing metabolic syndrome was highest in the tertile with the greatest weight fluctuations, independent of whether these subjects gained weight overall or not. Of course, subjects who only gained weight (with no recorded losses) also had a higher risk than individuals whose weight did not change at all.
As in several previous studies on this issue (cited in the paper), it appears that losing and regaining weight (weight fluctuation) is worse than not losing weight at all.
Obviously, these findings have important implications for both public health messaging and clinical management. Although in both cases we propagate and promote “weight-loss” messages, the reality is that very few people who lose weight keep it off. This is true both for self-directed attempts as well as commercial weight-loss programs.
Sadly, even with clinical treatments (including obesity surgery), a substantial proportion of patients fail to keep the weight off, but indeed, success is greater the more intense the treatment and follow-up.
Given this poor success of weight-loss attempts, I cannot but wonder whether recommending weight loss to anyone who is overweight or obese is as beneficial as it is made out to be. This would be particularly true for people with what I prefer to call Stage 0 obesity.
Perhaps, with the exception of treatments with well-documented long-term outcomes, most people are best served with preventing further weight gain (difficult enough) rather than losing weight only to gain it back.
Clearly, the onus is on weight management programs, whether behavioural, medical or surgical, to document their long-term success in weight-loss maintenance.
Programs associated with a high rate of relapse probably do more harm than good.
Individuals with a high chance of relapse should not be subjected to weight-loss attempts without ongoing medical care and close follow-up.
While we await further research on this subject, we perhaps need to be a bit less casual about simply advising everyone with a “higher-than-normal” BMI to lose weight.