Why aren’t diets dead?

If you’ve been paying attention to social media lately, you might have seen the rise of a movement known as ‘health at every size’ (HAES). This is the idea that it’s possible to be healthy and fit, even if we are not slim.

Proponents, often associated with the related ‘fat acceptance’ movement, also believe the diet industry exploits and brainwashes people, and society pressures us, into believing we should lose weight in order to be healthy. There’s some merit to that idea. Certainly, the multibilliondollar diet industry has made, and continues to make, huge profits from vulnerable people caught in the unhealthy diet cycle of weight loss followed by weight gain followed by another diet to lose weight… and on it goes. It’s easy to see how this type of weight cycling is unhealthy and potentially damaging, both physically and mentally.

At an individual level, it is possible to be technically overweight or obese and, yet, still be physically fit and not suffering from any of the problems associated with being overweight. And, it is also possible to be what’s technically classified as ‘normal’ weight, or even underweight, and be quite unhealthy. We’ve all heard of ‘TOFI’ – thin on the outside, fat on the inside.

There’s also evidence that for older people, it may be better to be slightly overweight than to be thinner.

But it’s also hard to ignore the bigger picture here: obesity is associated with a raft of negative health effects that can span our whole lives. For instance, babies whose mothers have gestational diabetes, prevalent in obese women, have greater risk of developing metabolic syndrome as adults. And in New Zealand, high body mass index (BMI) has overtaken tobacco as a risk factor attributable to health loss: higher BMI accounts for 9.2 per cent of all health loss, compared with 8.7 per cent for tobacco.

In Australia, higher BMI is attributable to 7 per cent of health loss, greater than the risk associated with alcohol, physical inactivity and high blood pressure.

A study published in the UK in 2017 looked at the GP records of 3.5 million people and concluded the idea of being healthy and obese was ‘a myth’. The results showed that, compared with healthy people of a normal weight, those regarded as healthy and obese still had a 49 per cent increased risk of coronary heart disease, a 7 per cent higher risk of stroke and a 96 per cent increased risk of heart failure.

There’s good evidence to suggest weight loss for overweight people, even a small amount, can lead to significant health benefits. A modest weight loss of 5 to 10 per cent of body weight can improve a range of conditions, including high blood pressure, type 2 diabetes, insulin resistance, sleep apnoea and joint pain.

All of that said, no one should ever feel pressured into losing weight. If you feel great and are healthy, then size really should not matter. Doctors are urged to think this way. In fact, the recent Evidence Review on Obesity, from the Royal Australasian College of Physicians, while acknowledging the benefits of weight loss, calls for an end to ‘weight bias’ among physicians, and encourages them to work on the associated conditions: metabolic syndrome, sleep apnoea, etc, rather than on weight

“People with overweight and obesity, particularly those who have experienced repeated unsuccessful attempts at weight loss or weight cycling must be supported by physicians and all health practitioners to achieve the most optimal level of health, irrespective of their weight”, it says.

If you do want to lose weight, and it seems Kiwis are still pretty interested in weight loss despite the HAES movement, it’s important to not do it by drastic, crash-diet methods. These are not likely to be sustainable and just set us up for damaging weight cycling. Sustainable weight loss is hard to achieve and is best done slowly.