Pushing Weights with Two Arms

Forget Weight? Focus on It? Or Meet in the Middle?

To say that our culture obsesses about weight and body image is possibly an understatement. Athleisure togs serve to emphasize it. People dress to look like they’re going for a run, to the gym, or a yoga class. And yet, this obsession divides us. Two new publications today offer a sharp contrast on this subject. How shall we deal with obesity? Forget weight altogether? Or instead focus on helping people with weight loss?

These extremes help us think about the question. But, as usual, the extremes don’t resolve it.

American Heart Association: Let’s Do Better with Weight Loss

The first and the most important of these two is a scientific statement from the American Heart Association. It’s all about obesity treatment and high blood pressure. Make no mistake, it is a good step forward. AHA came right out and told an obvious truth. Treating obesity by telling people to rearrange their lives and lose weight doesn’t accomplish much:

“The long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited.”

So the AHA is recommending healthcare providers take medical and surgical strategies for obesity more seriously. Anti-obesity meds “can be useful,” says the statement. It goes on to say:

“Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity.”

The only trouble with this statement comes right up front, in the title. It labels this statement as a recommendation of “Weight Loss Strategies for Prevention and Treatment of Hypertension.”

While it’s true that weight loss results from these treatments, the more important outcome is the maintaining better health over time at a lower set point for weight. Weight loss is a short term milestone on the way to better health.

Forget About Weight

At the other extreme, we have a new paper from exercise physiologist Glenn Gaesser and Siddhartha Angadi, telling us to forget about weight altogether in treating obesity. Weight loss is futile, they say. They claim that it only causes more weight gain, through something called weight cycling. Nevermind that scientific evidence doesn’t support that claim.

The recommendation to pursue the health benefits of physical activity is solid. The assertion weight loss is almost never helpful is not. But Gaesser has a book to sell – Big Fat Lies – so it’s clear enough that he really believes in this concept.

Meeting in the Middle

The truth about obesity is that one size does not fit all. Body sizes and shapes are diverse. They always have been, they always will be. But excess adiposity does harm health and it’s happening more frequently than ever. When people have excess adiposity, they tend to weight more. When people lose weight, they tend to lose some of that excess that’s causing health problems.

However, not all weight loss is helpful and everyone doesn’t have the same goals. So a better approach for health professionals dealing with obesity is to put health first, ahead of weight. The best articulation of this orientation is in the Canadian Obesity Clinical Guidelines released last year.

Weight loss can be a help, but it’s never the whole story for pursuing better health.

Click here for the new scientific statement from AHA and here for the new paper from Gaesser and Angadi. For more on the Canadian Obesity Clinical Guidelines, click here.

Pushing Weights with Two Arms, painting by Eugène Jansson / WikiArt

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September 21, 2021