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Rethinking health and weight

Recently on TV, there was a piece looking at the rise of plus-size models promoting diversity and body acceptance. But not everyone was a fan. One doctor interviewed believed the plus-size model industry promotes obesity, which is as damaging as promoting smoking.

I don’t believe so. It’s well ingrained into our minds that being overweight or obese is a major health risk and the only answer is weight loss. But I think differently. Here’s why.

There is no evidence that any diet works long term for weight loss

Dieting may work in the short term, but fast-forward five years, and no matter what attempt is made to try and lose weight, the majority of people return to their original weight or more. The evidence for this is very clear, yet I feel like it’s something that’s ignored.

The Australian National Health and Medical Research Council released a report in 2013 on the management of overweight and obesity. In that report is the following statement: “Weight loss following lifestyle intervention is maximal at 6-12 months. Regardless of the degree of initial weight loss, most weight is regained within a two-year period, and by five years the majority of people are at their pre-intervention body weight.” The evidence level of this statement is grade A, meaning this is the highest possible standard of evidence available. Diets just don’t work!

Studies also show that dieting is a significant predictor of future weight gain, and while identifying as ‘overweight’ does lead to attempts at weight loss, it actually predicts weight gain over time. Dieting is also related to disordered eating patterns, binge eating and stress.

So, if dieting doesn’t work long term, what should we do?

Think health not size

Healthy behaviours count, no matter what size you are. However, healthy eating and weight loss seem to be so tangled together that if someone isn’t losing weight, they think they’re doing healthy ‘wrong’. I’ve had many conversations with people who have ‘given up’ with healthy eating because they didn’t lose weight. I wonder if the outcome would have been different if the world focused on health, not weight. Healthy habits are beneficial regardless of size, and there are plenty of studies confirming this.

This 2013 study found that those with seven healthy lifestyle habits had a substantially reduced risk of cardiovascular disease and death, regardless of their BMI. Similarly, this 2011 study found that healthy behaviours such as consuming fruit and vegetables, not smoking and engaging in physical activity also substantially reduced risk of mortality (meaning death), regardless of BMI. With four healthy habits, those classified as ‘overweight’ and ‘obese’ had almost the same risk as those at ‘normal’ weight.

Fitness has also been found to be an important predictor of health, regardless of size.

When we KNOW weight loss doesn’t work long term, I think it makes complete sense to focus on what actually does work to improve health. Some people may lose weight by changing their lifestyle, others won’t – weight regulation is complex, but that’s beside the point. However, taking the pressure off the numbers might just help us focus on what does make a difference – health-promoting behaviours.

Finally, focusing on body weight as a health issue increases weight stigma, in itself a risk factor for poorer health outcomes.

People of all shapes and sizes get chronic diseases such as diabetes and heart disease. If someone in a small body has a health condition, though, they’re far less likely to be judged for it. People don’t look down on their food choices or exercise habits – often it’s put down to just their genetics. But someone in a larger body suffers daily stigma and judgement because of the way they look, and this can affect health and well-being.

For example, adolescents who identify as overweight are at higher risk of major depression than those who BELIEVE they are of normal weight (even if they are overweight).

Research suggests that weight stigma can affect the quality of healthcare received by those in larger bodies, and is damaging for physical and psychological health.

There’s much more to talk about on the harmful effects of weight stigma, but focusing on weight isn’t helpful when encouraging healthy behaviours and is counterproductive to health.

We KNOW that behaviours such as eating vegetables and fruit, and physical activity improve health, regardless of size. We KNOW weight stigma is real and harmful. When the evidence shows permanent weight loss is unachievable for the majority of the population, isn’t it time to do something different? I think so.