Our current model of healthcare is weight-centric, which equates weight with health. Research has shown that this approach can have negative implications when it comes to patient wellbeing [1]. Is weight truly the best indicator of health? Here’s what general practitioners need to know.
Research shows that the weight-normative approach is not effective for most people [2]. A weight-normative approach emphasises weight and weight loss when it comes to defining a patient’s picture of health. However, studies show that weight-loss interventions are more likely to lead to weight regain and weight cycling, which leads to inflammation and a number of negative health consequences. Additionally, the weight stigma associated with this model can negatively affect patient’s wellbeing [2].
A weight-inclusive approach, on the other hand, places an emphasis on viewing health and well-being as multifaceted. Current data supports a weight-inclusive approach, and interventions have showed an improvement in psychological and physical activity outcomes, and positive changes in eating habits [3].
A large prospective cohort study published in the British Medical Journal followed 11,761 people of various BMIs: underweight, average weight, overweight, and obese, over an average span of 170 months [4].
The health measures examined were the following: eating more than 5 fruits and vegetables daily, exercising regularly (>30 min/day at moderate to vigorous intensity), not smoking, and consuming alcohol in moderation (5-15g alcohol/day for women and 5-30g alcohol/day for men).
The researchers found that among people with a higher BMI, exposure to one or more low risk lifestyle factors significantly reduced their risk of mortality. Healthy lifestyle habits significantly reduced the risk of mortality, regardless of weight, highlighting that adopting healthy habits without losing weight can improve health outcomes [4].
Additionally, research has shown that even a small increase in health behaviours can positively affect health. For example, short bursts of exercise through incidental activity have been shown to improve cardiovascular health.
A large-scale UK-based study examined the cardiovascular health benefits of incidental non-exercise physical activity among over 25,000 adults [5]. The study found that short bursts of incidental physical activity, even as little as 1-3 minutes a day, were associated with a decreased risk of death and improved cardiovascular health.
GPs may wish to consider a weight-inclusive approach as an alternative to a weight-centric approach. GPs can encourage patients to adopt healthy habits such as increasing vegetable and fruit consumption, increasing exercise, abstaining from smoking, and engaging in regular exercise to improve markers of health, rather than focusing on their patient’s weight.
– Sarah Marko, Accredited Practising Dietitian
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References
[1] Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022 Dec;37(6):1291-1306. doi: 10.1002/ncp.10885. Epub 2022 Jul 12. PMID: 35819360.
[2] Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, Calogero RM. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes. 2014;2014:983495. doi: 10.1155/2014/983495. Epub 2014 Jul 23. PMID: 25147734; PMCID: PMC4132299.
[3] Ulian MD, Aburad L, da Silva Oliveira MS, Poppe ACM, Sabatini F, Perez I, Gualano B, Benatti FB, Pinto AJ, Roble OJ, Vessoni A, de Morais Sato P, Unsain RF, Baeza Scagliusi F. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018 Dec;19(12):1659-1666. doi: 10.1111/obr.12749. Epub 2018 Sep 27. PMID: 30261553.
[4] Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med. 2012 Jan-Feb;25(1):9-15. doi: 10.3122/jabfm.2012.01.110164. PMID: 22218619.
[5] Ahmadi MN, Hamer M, Gill JMR, Murphy M, Sanders JP, Doherty A, et al. Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study. Lancet Public Heal 2023. https://doi.org/10.1016/S2468-2667(23)00183-4.