Assessment and management of body weight is a major priority in health policy in the light of current obesity trends. The Body Mass Index (BMI) is a poor measurement and a controversially inaccurate indicator to assess health. However, a plethora of studies have suggested that a high body mass index (BMI) increases an individual’s risk of lifestyle related diseases.
The food and nutrition industry has embraced the drive towards weight management by controlling energy intake. The mainstream food industry is operating to a mandate to reduce sugar and saturated fat in products, while new functional foods and supplements are geared towards making dieting easier by boosting satiety or blocking fat absorption, for instance.
But Lucy Aphramor of Coventry University in the UK says epidemiological data does not indicate that that overweight people necessarily die younger than those of ‘normal’ weight.
She believes the current research emphasis is misguided. Moreover, she says weight loss research appears to “enjoy special immunity from accepted standards in clinical practice and publishing ethics”.
“Weight management research appears to occupy a hallowed place where deviations from regular scientific conduct are readily tolerated, for example, continued support of research programmes that do not adequately report adverse effect, or rely on acceptance of common assumptions that are inadequately supported by data, which in turn may point to a lack of stringency in research ethics decisions regarding weight management,” she wrote in Nutrition Journal.
The influence of ideology in selecting and reporting data could have unintentional implications on participant welfare, and eclipse other approaches to health policy.
Aphramor reached her conclusion after conducting a narrative review of all articles focused on weight loss published in The Journal of Human Nutrition and Dietetics between January 2004 and December 2008.
She found that papers “unfailingly frame fat as a pathological condition that is primarily under personal control through volitional modification of eating and exercise habits”.
Weight management advice tends to be justified by claims that weight loss will yield a range of benefits, from metabolic fitness to relief from musculoskeletal conditions to less discrimination.
“The belief in the value of weight loss is so firmly held that the rationale may not always be explicitly articulated,” wrote Aphramor in Nutrition Journal.
Aphramor proposes that the weight-centic approach is standing in the way of another approach to well-being, called ‘health at every size’ (HAES).
This approach advocates adopting a weight-neutral approach to lifestyle change, where modifying health behaviours is the aim, rather than weight change.
She cites research that indicates improving a person’s health behaviours could can bring benefits, even if their weight remains the same.
As well as being weight neutral and encouraging self esteem in people of all shapes and sizes, the HAES approach teaches people to eat intuitively and rely on internal signals rather than external regulation.
“Importantly, HAES challenges implicit and overt size discrimination in and beyond the clinic,” Aphramor wrote.
Nutrition Journal 2010 9:30 www.nutritionj.com/content/9/1/30