Stop supporting intentional weight loss! Here’s the science to support a non-diet, weight-neutral approach

So much of what parents think they know for sure about food, diet, and weight is just plain wrong. It’s not our fault – it’s just that journalists, healthcare providers, educators, bloggers, and influencers all promote weight control and intentional weight loss (AKA dieting) as if it is good, healthy, and necessary.

Despite all the noise about controlling and reducing weight and all the pressure on parents to take measures to get their kids to be “healthy” through intentional weight loss, there is actually no evidence that intentional weight loss is healthy and substantial evidence that intentional weight loss is unhealthy and leads to higher weights and increased rates of eating disorders.

So, gather round, rebel parents, and read on for a literature review of the three most important articles you need to read about intentional weight loss, dieting, fat, “obesity” and weight epidemics that aren’t actually epidemic at all. It takes a lot of guts to go against the current cultural norms, but rest assured that science firmly supports a non-diet, weight-neutral approach to health.

1. “Obesity” isn’t an epidemic, it’s not deadly, it doesn’t cause disease, and weight loss doesn’t work

The epidemiology of overweight and obesity: public health crisis or moral panic? International Journal of Epidemiology, Volume 35, Issue 1, 1 February 2006, Pages 55–60

Highlights from the Article

  • Public health agencies across the world are searching for policies or incentives to mitigate the alleged ‘disease’ of obesity.
  • In our view, the available scientific data neither support alarmist claims about obesity nor justify diverting scarce resources away from far more pressing public health issues. 
  • Given the limited scientific evidence, the authors suggest that the current rhetoric about an obesity-driven health crisis is being driven more by cultural and political factors than by any threat increasing body weight may pose to public health.
    • False claim #1: obesity is an epidemic. An ‘epidemic’ of overweight and obesity implies an exponential pattern of growth typical of epidemics. The available data do not support this claim. Instead, what we have seen, in the US, is a relatively modest rightward skewing of average weight on the distribution curve, with people of lower weights gaining little or no weight, and the majority of people weighing ∼3–5 kg more than they did a generation ago.
    • False claim #2: overweight and obesity are major contributors to mortality. This claim, central to arguments that higher than average body mass amount to a major public health problem, is at best weakly supported by the epidemiological literature. Except at true statistical extremes, high body mass is a very weak predictor of mortality, and may even be protective in older populations. 
    • False claim #3: higher than average adiposity is pathological and a primary direct cause of disease. With the exception of osteoarthritis, where increased body mass contributes to wear on joints, and a few cancers where estrogen originating in adipose tissue may contribute, causal links between body fat and disease remain hypothetical. It is quite possible, and even likely, that higher than average body fat is merely an expression of underlying metabolic processes that themselves may be the sources of the pathologies in question. 
    • False claim #4: significant long-term weight loss is both medically beneficial and a practical goal. This claim is almost completely unsupported by the epidemiological literature. The central premise of the current war on fat—that turning obese and overweight people into so-called ‘normal weight’ individuals will improve their health—remains an untested hypothesis.

2. No evidence that diets lead to health benefits

Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer, American Psychologist, Vol 62(3), Apr 2007, Pages 220-233.

Highlights from the Article

  • There is little support for the notion that diets lead to lasting weight loss or health benefits. 
  • The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity.
  • These studies show that one-third to two-thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance.
  • In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change.

3. Non-diet approach has better health outcomes than intentional weight loss

Weight Science: Evaluating the Evidence for a Paradigm Shift, Nutrition Journal, 10:9, 2011.

Highlights from the Article

  • Randomized controlled clinical trials indicate that a non-diet Health at Every Size (HAES) approach is associated with statistically and clinically relevant improvements in:
    • Physiological measures (e.g., blood pressure, blood lipids)
    • Health behaviors (e.g., eating and activity habits, dietary quality)
    • Psychosocial outcomes (such as self-esteem and body image),
  • HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus.
  • While intentional weight loss efforts induce short term weight loss, the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality.
  • Weight focus is ineffective at producing thinner, healthier bodies, and may also have unintended consequences, including:
    • Food and body preoccupation
    • Repeated cycles of weight loss and regain
    • Distraction from other personal health goals and wider health determinants
    • Reduced self-esteem
    • Eating disorders

4. Dieting leads to eating disorders and weight gain

Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? Journal of the American Dietetic Association, April 2006, Pages 559-68.

Highlights from the Article

  • Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later.
  • A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.
  • Adolescents using weight-control behaviors increased their body mass index compared to adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight.
  • Adolescents using weight-control behaviors were at increased risk for binge eating with loss of control and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics 5 years later, compared with adolescents not using any weight-control behaviors.

5. Parents don’t need to worry about the health risks of “obesity”

The Health Risks of Obesity Have Been Exaggerated, Medicine and Science in Sports and Exercise, January 2019, 51(1), Pages 218-221

Article not currently available – read an interview with the author here.

Highlights from the author

  • The health risks of obesity, as well as the purported health benefits of weight loss, have been greatly exaggerated.
  • Yo-yo dieting, which is pretty much the norm in America, is associated with the exact same risks as obesity itself.
  • Obesity-related health markers improve little, if at all, with weight loss, but cardiovascular fitness virtually eliminates many of the health risks associated with obesity. Fitness can be improved relatively quickly in people of all shapes and sizes, and the health benefits of improved fitness outweigh the health benefits of weight loss.
  • Our weight, body fat and lean tissue mass are the result of a complex interaction of genes, behavior and environment. We actually have very little control over them.

Read more: Dieting is an unethical prescription for health

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