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The Downside of Weight Loss?



Yesterday, I posted about the debate on whether or not doctors should stop telling their patients to lose weight published in this months edition of Canadian Family Physician.

Today’s post is about an article by John Bosomworth from the Department of Family Practice at the University of British Columbia in Vancouver, BC, published in the same issue of CFP, looking at the potential downsides of promoting weight loss for all.

Based on his review of papers published over the past ten years, Bosomworth comes to the following conclusions:

“Sustained weight loss is achieved by a small percentage of those intending to lose weight. Mortality is lowest in the high-normal and overweight range. The safest body-size trajectory is stable weight with optimization of physical and metabolic fitness. With weight loss there is evidence for lower mortality in those with obesity-related comorbidities. There is also evidence for improved health-related quality of life in obese individuals who lose weight. Weight loss in the healthy obese, however, is associated with increased mortality.”

Thus,

“Weight loss is advisable only for those with obesity-related comorbidities. Healthy obese people wishing to lose weight should be informed that there might be associated risks. A strategy that leads to a stable body mass index with optimized physical and metabolic fitness at any size is the safest weight intervention option.”

Bosomworth also goes on to emphasize that the first goal of obesity management is to stabilize and prevent further weight gain.

“Prescribed weight loss as a target for all-cause mortality reduction among the overweight and healthy obese is a failed concept both in terms of evidence for benefit and in terms of implementation. Weight reduction among obese individuals with comorbidities or diminished weight-related quality of life can be of demonstrated benefit. In all cases, the aim should be to avoid initial weight gain, prevent ongoing weight gain, and realize physical and metabolic fitness at any size.”

As I have said before, obesity management should be about improving health and well-being and not about simply reducing numbers on the scale. Fortunately, in most cases, the former can be achieved without the latter.

AMS
Edmonton, Alberta

6 Comments

  1. I wonder if the increased mortality in the healthy obese who lose weight is due to some sort of psychological/stress/body image discontent relationship? There must be a physiological theory proposed for what you are discussing. If so, what is it?

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  2. Derek — I’m no researcher or scientist, but I’m going to throw out a few possibilities for discussion. Some may be off the wall, but just brainstorming. I’m not going to the mat for any of these — these are more my questions than answers.

    The “nocebo” effect — opposite of the placebo effect. You’re perfectly healthy, just at a larger body size. Your doctor tells you you’re going to drop dead and you believe him.

    Fewer micronutrients — I’ve used the government food recommendations a time or two to reel myself back in when I’m getting out of balance, including the daily nutrient calculators. It’s pretty easy for me to get the RDA on pretty much everything with a balanced diet of healthy foods of 2000 calories or so. I’m not so sure I could pull that off at 1200.

    Stress — food obsession, “failure” to get your body to the “correct” size, over-exercising, being told you’re a walking heart attack.

    Weight cycling — it’s my understanding the science on this at this point is pretty equivocal, but I can’t believe it’s terribly good for you physically or emotionally.

    Loss of muscle mass — weight loss tends to hit both muscle and fat, while regain tends to be in fat.

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  3. If I had to guess, I’d suppose it’s from the bats**t way most people seem to think one goes about losing weight. Extreme diets, dropping whole classes of macronutrients, overexercising, processed low-fat/low-cal meals, self-denial, rigid eating plans. Most “quick weight loss” attempts are not healthy.

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  4. Wow, this is interesting take on weight loss and over all health. Not sure exactly what is meant by the “healthy obese”. It seems to me that obese people who do not have apparent life threatening health concerns at the moment are still unhealthy. Being obese creates too much stress on the muscles, bones, joints and organs so eventually an obese person would end having some sort of life threatening health problem wont they. Also, being obese is already a symptom of some underlying concerns such as abnormal insulin or leptin balance or something. Right? I am obviously no doctor or scientist but I think it is important for an obese person to lose weight but the approach must be healthy and holistic in the approach as to not cause even more damage.

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  5. Fatchick,

    Agreed with all. I plug stuff into Fitday every now and again, and you’re right, without meticulous thought, eating 1200 calories per day is a great way to be broadly deficient in just about everything.

    Julie,

    I too find it frustrating how people approach weight loss. One day they are doing there thing, the next they aren’t eating anything but poached eggs and tuna;)

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  6. Lulu — that is the assumption, but it is not necessarily correct. It’s a little more complicated than that.

    Even if it were .. what is the solution? Weight loss — whether through batsh*t methods or not — has an overwhelming tendency to fail, and healthy lifestyle changes do not necessarily result in weight loss. I am currently making some healthier lifestyle changes, but I do not expect it to change my body weight. I do expect it to improve my overall health and well-being, and it already has. I will take my chances with my body size.

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