Evidence from scientific studies strongly suggests what most dieters have known all along, that the current public health emphasis on weight management is in fact unproductive and damaging and supports a radical shift in focus from the conventional weight management approach to one that helps people of all shapes and sizes adopt healthy behaviours.
Co-authors of this review paper (which is featured in the January 2011 issue of Nutrition Journal) are Linda Bacon, an associate nutritionist at the University of California, Davis Department of Nutrition, and Lucy Aphramor, an NHS specialist dietitian and honorary research fellow at the Applied Research Centre in Health and Lifestyle Interventions at Coventry University.
They present compelling evidence that calls into question many of the long-held assumptions underpinning weight-focused public health policy.
They conclude that fatness is highly exaggerated as a risk for disease or decreased longevity, and that money would be better spent on campaigns that help people develop a healthy relationship with food and that advocate respect for every body - fat and thin.
They demonstrate that the research data does not support many other 'common sense' beliefs such as that:
• weight loss will prolong life;
• anyone can lose weight and keep it off through diet, exercise and willpower;
• weight loss is the only way overweight and obese people can improve their health; and
• obesity places an undue economic burden on society.
“The weight-focused approach does not, in the long run, produce thinner, healthier bodies,” said Bacon, who wrote the 2010 book, Health at Every Size: The Surprising Truth About Your Weight, based on research she published in top scientific journals.
“For decades, the United States’ public health establishment and $58.6 billion-a-year private weight-loss industry have focused on health improvement through weight loss,” Bacon said. “The result is unprecedented levels of body dissatisfaction and failure in achieving desired health outcomes.”
“The unintended negative consequences are very debilitating"
Concluding that the weight-focused approach to health is unsupported by the scientific evidence and has in fact been detrimental and costly, Bacon and Aphramor suggest the government and the health care community adopt a more ethical, evidence-based approach toward public health nutrition; one that instead encourages individuals to concentrate on developing healthy habits rather than concentrating on weight management.
Evidence shows that changing health behaviours can improve blood pressure, blood lipids, self-esteem, body image, and other indicators of health and well-being, independent of any weight change and without the contraindications associated with a weight focus. While weight loss may result, the goal is self-care as opposed to weight loss. This weight-neutral practice has become known as Health at Every Size (HAES).
“It is clear from our review of the data that body weight is a poor target for public health interventions,”
“Instead, the health care community should shift its emphasis from weight-management to health-improvement strategies, for the well-being of people of all shapes and sizes.”
Aphramor points out that: " it also pays attention to understanding the impact of structural factors, and size discrimination, on health outcomes, so a HAES philosophy sits well with the Knowledge and Skills Framework mandate to develop complex interventions and tackle some of the underlying causes of health inequalities."
Lucy Aphramor runs a HAES course, called Well Now, in Coventry innovatively funded as part of Coventry's Health Improvement Programme, an £18million partnership programme between Coventry City Council and NHS Coventry, to improve health levels of people in the city.
"It is striking what a difference this shift in emphasis makes in people's lives", she said.
" Removing guilt and stigma around body weight and food enables people to learn to value themselves as they are right now which then motivates self-care. This includes many people who felt sure they couldn't accept themselves until they had lost weight.
“HAES teaches people how to tune in to their body signals so they begin to feel more relaxed and in control around food. Not surprisingly, it's had a huge impact on people's mental wellbeing as well as influencing their eating and activity patterns.
“One woman described the course as ‘life-changing.’”
For further information contact:
Lucy Aphramor, Coventry University and University Hospitals Coventry and Warwickshire NHS Trust on 024 7625 2506 or email email@example.com or Ali Bushnell, External Press and Media Relations Officer on 024 7688 8245 or ali.bushnell@
The article will be freely accessible to the public at this site and at Nutrition Journal (no password protection) on 24 January.
For more details on Well Now visit www.atrium-health.co.uk
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