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