I’ve been a dietitian for about 15 years so I have seen a lot of patients from private practice, long-term care to hospitals. What I haven’t seen change much in those 15 years is the message that weight loss is the answer for a multitude of conditions and diseases. This was something I was taught in school and believed myself for many years. But, science is funny like that – it changes.
Let’s start with the body mass index or BMI. This is a validated tool that was taught to me as a way to measure health risk. Just about every dietitian and many other health practitioners use this to assess a patient’s risk for disease if BMI is too low or too high. To use the BMI, we require two measurements, weight and height to yield a result. The result can classify a person as underweight, healthy weight, overweight, obese (with varying classes of obesity or morbid obesity) depending on the measurements.
There are reports that indicate BMI isn’t a terribly reliable indicator of body fatness and health risk. That is, this ratio of weight compared to height doesn’t always give us the best information if, for example, you’re looking at an athlete or someone with a very muscular build, but equally with a frail, elderly person, too.
So, why is it used everywhere? It’s a parameter that is easily measurable, and compared and provides hard data to assess a person’s health. Or so, I thought.
This is where things get sticky.
The large scale (Look AHEAD) trial published in the New England Journal of Medicine in 2013 was a big influence to what turned things upside down for me. They found that, after almost 10 years, participants who were overweight or obese with diabetes and lost weight did not lower their chances of a cardiac event (e.g. heart attack, hospitalized chest pain or stroke). This intervention group lost weight with a combination of calorie-reduced diet and exercise.
To be clear, this is not to say that exercise isn’t beneficial; on the contrary, study participants, after 4 years, showed increased fitness levels and some improved blood markers (like blood fats and blood sugar levels). The intervention group in this study was exercising for 175 minutes per week (moderate – intense), or about 25 minutes a day.
The bottom line here is that in a study of over 5000 participants, overweight or obese diabetes study subjects who lost weight did NOT live longer or have less chance of heart attacks, chest pain (angina) or strokes. In fact, they stopped the study early on the basis of “futility” since they weren’t seeing the positive results expected from weight loss.
This is where I like to introduce the notion of a non-weight focused approach to health and well being. We may have been told, chided, or even scolded for weighing a certain weight or to achieve a particular number, whether it’s realistic or not. I want to be a part of a band of clinicians that starts to change this unrealistic goal of weight loss. Let’s focus on what matters – your lifestyle, including healthy behaviours like exercising, eating healthy food, not smoking and managing your stress. Sounds simple, doesn’t it? Behaviours are notoriously hard to change, especially when you’ve done the same thing over and over again. It’s not going to change overnight, so be patient and hop on for the ride.
Let’s start with goal setting – don’t worry, I’m not getting all new-agey on you, but I want you to think about something you’d like to do better than you are doing now. It might be drinking more water, eating more vegetables, getting enough fibre or something along those lines. Keep it small, keep it realistic, keep it specific (aka SMART goal). For example, I will eat vegetables with lunch 4 days a week. Or maybe, I will bring my waterbottle to work and sip on it over the day.
Did you see what I did there? I didn’t have one weight loss goal in the mix – focus on healthy behaviour, how you feel and take the emphasis off the outcome. So, cast the weight scale aside. It doesn’t have to be an earth-shattering goal for you to be successful. Take one step at a time, and it’ll be part of your new routine before you know it.
Ahima, R. & Lazar, M. (2013). The Health Risk of Obesity—Better Metrics Imperative. Science. 341. 856-858.
Alharbi, M., Gallagher, R., Kirkness, A., Sibbritt, D., & Tofler, G. (2014). Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes. European Journal of Cardiovascular Nursing. 1–9. doi:10.1177/1474515114557222
Look AHEAD Research Group, Wing RR, Bolin P, et al. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal Medicine;369:145-54.
Look AHEAD Research Group. (2014). Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study. Obesity. 22, 5–13. doi:10.1002/oby.20662