How Much Weight Loss Really Matters?
How much weight loss, if any, is essential to good clinical care for obesity? This question consumes an incredible amount of energy, in our opinion, for relatively little in return. A pair of recent studies and a new commentary in Obesity add to the volumes that have been written on this subject. With a commentary in Obesity, Robert Ross sums up some of the current thinking on this subject:
A revised approach would be to target the causal behaviors – physical activity combined with a healthful diet. Given the plethora of health benefits associated with increasing physical activity regardless of weight loss, and that sustained weight loss is unlikely to occur without increasing physical activity, changing the focus for effective obesity management from the bathroom scale to the adoption of healthy behaviors is an idea worth considering.
Ross is reflecting upon a study published with his commentary by Damon Swift and colleagues that found significant benefits in metabolic health (insulin resistance) for minimal (3-5%) weight loss in combination with physical activity – benefits that were entirely comparable to what was seen in people achieving higher rates of weight loss.
A separate study by Magkos et al in Cell Metabolism finds good clinical benefits for modest (5%) weight loss on metabolic health, along with further, stepwise benefits for additional weight loss of 11-16%.
So where does all this back and forth about weight loss goals leave us? Folks in the Health at Every Size community are quick to tell us that our culture is way too stuck on equating weight with health and they certainly have a point. The best advice we’ve heard on this subject comes from Arya Sharma, who says:
Stop setting weight goals. Healthy behaviors are something you do, weight loss is something that happens.
Sharma’s point is to focus on things that are under your control: behaviors that contribute to health, like staying active, healthful patterns of eating, and plenty of sleep. Your body will respond, but the specifics of that response – like a specific weight outcome – are not completely under your control.
Broad generalizations about weight simply don’t hold up well in the face of reality. One size truly does not fit all.
Transcendental Trade Weights, photograph © Meena Kadri / flickr (Weights are anointed with holy powder at Grant Road Market in Mumbai daily. Just one of the many intersections of creed and commerce to be observed across India.)
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March 5, 2016