Scientific American July 2020 pp23-31. Health and Medicine “Treating Patients without the Scale”. “Focusing on weight loss isn’t making people healthier. Some doctors are trying a different approached” By Virginia Sole-Smith.
The Focus on Body Weight Rather Than Lifestyle is Flawed
Interesting article highlighting two papers, one from 2012 and one from 2018. The thesis is that being either slightly lower or slightly higher than optimal body-mass-index (BMI), a crude and sometimes flawed surrogate for body fat, does not affect your likelihood of dying especially if you are focused on controlling four lifestyle habits. Controlling these behaviors helps reduce mortality for individuals at the extremes of BMI as well.
“Research has shown…it is the behaviors people practice---not the size of their bodies---that have the biggest impact on mortality”. Investigators report “that regardless of their weight class, people lived longer when they did not smoke, drank alcohol in moderation, ate five or more servings of fruits and vegetable daily and exercised 12 or more times per month”. According to Eric Matheson (Matheson et al. Journal of the American Board of Family Medicine January 2012), “If you’re obese and you have a healthy lifestyle, you are no more likely to die early that a person of normal weight”.
The article also delves into weight stigma and the related real stress imparted by bias that impacts one’s ability to form friendships, have career success, and even get appropriate medical treatment. Interestingly, physicians in evaluating patients that are overweight or obese often first suggest weight-loss for resolving health issues like type-2 diabetes, hypertension and depression. Why is focusing on weight-loss alone considered an outdated approach? First, we now know that weight loss is rarely sustained beyond nine to twelve months as most patients regain most or all of the weight lost within two years. Second, medical experts now believe that jumping to weight-loss as a knee-jerk solution deprives these patients of a thorough medical examination. A proper assessment, afforded to normal weight patients, includes dialog regarding of all factors affecting health; stressors at home and at work, lifestyle habits-smoking, drinking alcohol etc., nutritional norms and active life-exercising and socializing. Unless another definitive medical diagnosis is discovered, focusing a treatment plan on improving the four lifestyle habits rather than weight loss is best.
More challenges for Black Women
As reported by Sabrina Strings and Lindo Bacon in a highlighted report “The Racist Roots of Fighting Obesity” pp26, “Compared with their rates in other racial groups, chronic cardiovascular, inflammatory and metabolic risk factors have been found to be elevated in black women, even after controlling for behaviors such as smoking, physical exercise or dietary variables”. Four of five black women are classified as either overweight or obese. They suffer even more weight stigma and much is attributed to unfounded ideas along stereotypical lines. Black women face greater challenges in resolving underlying health issues when they live in financially strapped communities. Living in these areas adds more stress and further challenges healthy living due to substandard air quality, substandard water quality, insufficient access to nutritional food and fewer opportunities for exercise. “The most effective and ethical approaches for improving health should aim to change the conditions of black women’s lives: tackling racism, sexism and weightism and providing opportunity for individuals to thrive”.
From the Matheson et al. (Note the full paper is available free, search PUBMED by typing Matheson, Eric [AU] 2012). Legend vertical axis hazard ratio-higher the greater hazard and horizonital axis 0-4 healthy lifestyle habits. If participants in this large study, maintained four healthly lifestyle habits their hazard ratios were similar if they were normal BMI 25-29.9 lower or high. Note the Scientific American article has additional charts that help illustrate the findings from both papers cited.