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.
Click here for the commentary by Ross, here for the study by Swift, and here for the study by Magkos.
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.)
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
March 5, 2016
March 05, 2016 at 11:37 am, Al Lewis said:
It is a close question, and thanks for presenting both sides.
As between losing weight for its own sake, and adopting healthy behaviors, I’d guess that 75% of health is the latter. And yet 90% of corporations obsess with the former.
Especially the way corporations do it (by paying or fining people to hit goals), weight loss is ironically UNhealthy, because it is done in anticipation of a weigh-in, which of course encourages weight cycling. Plus, as we often point out, if someone is doing their job, what does it matter what they weigh?
http://www.theysaidwhat.net today critiques yet another article on employers paying/fining employees for short-term weight loss. This one was in the NYT, which historically has never bought into this nonsense.
March 05, 2016 at 11:43 am, Ted said:
Thanks, Al, for your thoughtful analysis of these problems.
March 06, 2016 at 1:14 pm, Stephen Phillips said:
Regarding a healthy weight and the conundrum of finding a balance between the bathroom scale and diet and exercise …….I always follow my Grandmothers advice………..
“YOU HAVE TO BE THIN ENOUGH TO BE HEALTHY AND FAT ENOUGH TO BE HAPPY”
Stephen Phillips
Director of Public Policy
American Association of Bariatric Counselors
March 06, 2016 at 1:18 pm, Ted said:
Wisdom for the ages.