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Weight Science: Evaluating the Evidence for a Paradigm Shift | Nutrition Journal | Full Text
Nutrition Journal body image dissatisfaction dissertation 10Article number: 9 Cite this article. Metrics details. Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality.
Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight body image dissatisfaction dissertation and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging.
A growing trans-disciplinary movement called Health at Every Size HAES challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures e. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
Peer Review reports. Concern regarding "overweight" and "obesity" is reflected in a diverse range of policy measures aimed at helping individuals reduce their body mass index BMI 1. Concern has arisen that this weight focused paradigm is not only ineffective at producing thinner, healthier bodies, but also damaging, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, body image dissatisfaction dissertation, eating disorders, other health decrement, and weight stigmatization and discrimination [ 6 — 8 ].
As evidence-based competencies are more firmly embedded in health practitioner standards, attention has been given to the ethical implications of recommending treatment that may be ineffective or damaging [ 59 ]. A growing trans-disciplinary movement called Health at Every Size SM HAES 2 shifts the focus from weight management to health promotion.
The primary intent of HAES is to support improved health behaviors for people of body image dissatisfaction dissertation sizes without using weight as a mediator; weight loss may or may not be a side effect. HAES is emerging as standard practice in the eating disorders field: The Academy for Eating Disorders, body image dissatisfaction dissertation, Binge Eating Disorder Association, Eating Disorder Coalition, International Association for Eating Disorder Professionals, and National Eating Disorder Association explicitly support this approach [ 10 ].
Civil rights groups including the National Association to Advance Fat Acceptance and the Council on Size and Weight Discrimination also encourage HAES. An international professional organization, the Association for Size Diversity and Health, has developed, composed of individual members across a wide span of professions who are committed to HAES principles.
Several clinical trials comparing HAES to conventional obesity treatment have been conducted. Some investigations were conducted before the name "Health at Every Size" came into common usage; these earlier studies typically used the terms "non-diet" or "intuitive eating" and included an explicit focus on size acceptance as opposed to weight loss or weight maintenance.
A Pub Med search for "Health at Every Size" or "intuitive eating" or "non-diet" or "nondiet" revealed 57 publications. Randomized controlled trials RCTs were vetted from these publications, and additional RCTs were vetted from their references. Only studies with an explicit focus on size acceptance were included. Evidence from these six RCTs indicates that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures e.
blood pressure, blood lipidsbody image dissatisfaction dissertation, health behaviors e. physical activity, eating disorder pathology and psychosocial outcomes e. g, mood, self-esteem, body image [ 11 — 20 ]. See Table 1. All studies indicate significant improvements in psychological and behavioral outcomes; improvements in self-esteem and eating behaviors were body image dissatisfaction dissertation noteworthy [ 11 — 141617body image dissatisfaction dissertation, 1920 ].
Four studies additionally measured metabolic risk factors and body image dissatisfaction dissertation of these studies indicated significant improvement in at least some of these parameters, including blood pressure and blood lipids [ 1112body image dissatisfaction dissertation, 16171920 ].
No studies found adverse changes in any variables. A seventh RCT reported at a conference also found significantly positive results [ 18 ], as did a non-randomized controlled study [ 21 ] and five studies conducted without a control [ 22 — 26 ]. All of the controlled studies showed retention rates substantially higher than, or, in one instance, as high, as the control group, and all of the uncontrolled studies also showed high retention rates.
Given the well-documented recidivism typical of weight loss programs [ 52728 ] and the potential harm that may arise[ 2930 ], this aspect is particularly noteworthy. Dieting and other weight loss behaviors are popular in the general population and widely encouraged in public health policy and health care practice as a solution for the "problem" of obesity.
There is increasing concern about the endemic misrepresentation of evidence in these weight management policies [ 58 ]. Researchers have demonstrated ways in which bias and convention interfere with robust scientific reasoning such that obesity research seems to "enjoy special immunity from accepted standards in clinical practice and publishing ethics" [ 5831 ].
This section discusses the assumptions that underlie the current weight-focused paradigm, presenting evidence that contests their scientific merit and challenges the value of promoting weight management as a public health measure. Evidence: Except at statistical extremes, body mass index BMI - or amount of body fat - only weakly predicts longevity [ 32 ].
Most epidemiological studies find that people who are overweight or moderately obese live at least as long as normal weight people, body image dissatisfaction dissertation, and often longer [ 32 — 35 ]. Analysis of the National Health and Nutrition Examination Surveys I, II, and III, which followed the largest nationally representative cohort of United States adults, determined that greatest longevity was in the overweight category [ 32 ]. As per the report, published in the Journal of the American Medical Association and reviewed and approved by the Centers for Disease Control and Prevention and the National Cancer Institute, body image dissatisfaction dissertation, "[this] finding is consistent with other results reported in the literature.
More recently, Janssen analyzed data in the elderly among whom more than 70 percent of all deaths occur - also from 26 published studies - and similarly found no evidence of excess mortality associated with overweight [ 37 ].
The Americans' Changing Lives study came to a similar conclusion, indicating that "when socioeconomic and other risk factors are controlled for, obesity is not a significant risk factor for mortality; and for those 55 or older, both overweight and obesity confer a significant decreased risk of mortality.
They also used a reference category much narrower than the entire "normal weight" category used by most other studies, body image dissatisfaction dissertation, which also contributed to making the relative risk for overweight higher. There is a robust pattern in the epidemiological literature that has been named the "obesity paradox" [ 4041 ]: obesity is associated with longer survival in many diseases.
For example, obese persons with type 2 diabetes [ 42 ], hypertension [ 4344 ], cardiovascular disease[ 4145 ], and chronic kidney disease [ 46 ] all have greater longevity than thinner people with these conditions [ 47 — 49 ]. Also, obese people who have had heart attacks, coronary bypass[ 50 ], angioplasty[ 51 ] or hemodialysis [ 52 ] live longer than thinner people with these histories [ 49 ]. In addition, obese senior citizens live longer than thinner senior citizens [ 53 ]. The idea that "this is the first generation of children that may have a shorter life expectancy than their parents" is commonly expressed in scientific journals [ 54 ] and popular press articles [ 55 ], even appearing in Congressional testimony by former Surgeon General Richard Carmona [ 56 ] and a report from the White House Task Force on Childhood Obesity[ 57 ].
When citation is provided, it refers to an opinion paper published in the New England Journal of Medicine [ 54 ], which offered no statistical evidence to support the claim. Life expectancy increased dramatically during the same time period in which weight rose from Both the World Health Organization and the Social Security Administration project life expectancy will continue to rise in coming decades [ 5960 ].
Evidence: While it is well established that obesity is associated with increased risk for many diseases, causation is less well-established.
Epidemiological studies rarely acknowledge factors like fitness, activity, nutrient intake, weight cycling or socioeconomic status when considering connections between weight and disease. Yet all play a role in determining health risk. When studies do control for these factors, increased risk of disease disappears or is significantly reduced [ 61 ].
This is less true at statistical extremes. It is likely that these other factors increase disease risk at the same time they increase the risk of weight gain.
Consider weight cycling as an example. Attempts to lose weight typically result in weight cycling, body image dissatisfaction dissertation, and such attempts are more common among obese individuals [ 62 ].
Weight cycling results in increased inflammation, which in turn is known to increase risk for many obesity-associated diseases [ 63 ]. Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia [ 64 ].
Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk [ 64 — 68 ]. Weight cycling can account for all of the excess mortality associated with obesity in both the Framingham Heart Study [ 69 ] and the National Health and Nutrition Examination Survey NHANES [ 70 ].
It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself [ 63 ]. As another example, consider type body image dissatisfaction dissertation diabetes, the disease most highly associated with weight and fat distribution. There is increasing evidence that poverty and marginalization body image dissatisfaction dissertation more strongly associated with type 2 diabetes than conventionally-accepted risk factors such as weight, diet or activity habits [ 3071 — 73 ].
A large Canadian report produced infor example, found that low income was strongly associated with diabetes even when BMI and physical activity was accounted for [ 73 ].
Also, much evidence suggests that insulin resistance is a product of an underlying metabolic disturbance that predisposes the individual to increased fat storage due to compensatory insulin secretion [ 6174 — 78 ]. In other words, obesity may be an early symptom of diabetes body image dissatisfaction dissertation opposed to its primary underlying cause. Hypertension provides another example of a condition highly associated with body image dissatisfaction dissertation research suggests that it is two to three times more common among obese people than lean people [ 79 ].
To what extent hypertension is caused by adiposity, however, is unclear, body image dissatisfaction dissertation. That BMI correlates more strongly with blood pressure than percent body fat [ 80 ] indicates that the association between BMI and blood pressure results from higher lean mass as opposed to fat mass.
Also, the association may have more to do with the weight cycling that results from trying to control weight than the actual weight itself [ 488182 ]. One study conducted with obese individuals determined that weight cycling was strongly positively associated with incident hypertension [ 82 ]. Another study showed that obese women who had dieted had high blood pressure, while those who had never been on a diet had normal blood pressure [ 67 ].
Rat studies also show that obese rats that have weight cycled have very high blood pressures compared to obese rats that have not weight cycled [ 8384 ].
This finding could also explain the weak association between obesity and hypertension in cultures where dieting is uncommon[ 4885 ]. Additionally, it is well documented that obese people with hypertension live significantly longer than thinner people with hypertension [ 4386 — 88 ] and have a lower risk of heart attack, stroke, or early death [ 45 ]. Rather body image dissatisfaction dissertation identifying health risk, as it does in thinner people, hypertension in heavier people may simply be a requirement for pumping blood through their larger bodies [ 89 ].
It is also notable that the prevalence of hypertension dropped by half between anda time when average weight sharply increased, declining much more steeply among those deemed overweight and obese than among thinner individuals [ 90 ]. Incidence of cardiovascular disease also plummeted body image dissatisfaction dissertation this time period and many common diseases now emerge at older ages and are less severe [ 90 ].
The notable exception is diabetes, body image dissatisfaction dissertation, which showed a small, non-significant increase during this time period [ 90 ]. While the decreased morbidity can at least in part be attributed to improvements in medical care, the body image dissatisfaction dissertation remains that we are simply not seeing the catastrophic disease consequences predicted to result from the "obesity epidemic. Evidence: Most prospective observational studies suggest that weight loss increases the risk of premature death among obese individuals, even when the weight loss is intentional and the studies are well controlled with regard to known confounding factors, including hazardous behavior and underlying diseases [ 91 — 96 ].
Recent review of NHANES, body image dissatisfaction dissertation, for example, a nationally representative sample of ethnically diverse people over the age of fifty, shows that mortality increased among those who lost weight [ 97 ]. While many short-term weight loss intervention studies do indicate improvements in health measures, because the weight loss is always accompanied by a change in behavior, it is not known whether or to what extent the improvements can be attributed to the weight loss itself.
Liposuction studies that control for behavior change provide additional information about the effects of weight fat loss itself. One study which explicitly monitored that there were no changes in diet and activity for weeks post abdominal liposuction is a case in point.
Participants lost an average of Note that liposuction removes subcutaneous fat, not the visceral fat that is more highly body image dissatisfaction dissertation with disease, and these results should be interpreted carefully. In most studies on type 2 diabetes, the improvement in glycemic control is seen within days, before significant weight or fat is lost. Evidence also challenges the assumption body image dissatisfaction dissertation weight loss is associated with improvement in long-term glycemic control, as reflected in HbA1c values [ 99body image dissatisfaction dissertation, ].
One review of controlled weight-loss studies for people with type 2 diabetes showed that initial improvements were followed by a deterioration back to starting values six to eighteen months after treatment, body image dissatisfaction dissertation, even when the body image dissatisfaction dissertation loss was maintained [ ]. Furthermore, health benefits associated with weight loss rarely show a dose response in other words, people who lose small amounts of weight generally get as much health benefit from the intervention as those who lose larger amounts.
These data suggest that the behavior change as opposed to the weight loss itself may play a greater role in health improvement. Evidence: Long-term follow-up studies document that the majority of individuals regain virtually all of the weight that was lost during treatment, regardless of whether they maintain their diet or exercise program [ 527 ].
The Science of Body Image
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Whenever students face academic hardships, they tend to run to online essay help companies. If this is also happening to you, you can message us at course help online. We will ensure we give you a high quality content that will give you a good grade. We can handle your term paper, dissertation, a research proposal, or an essay on any topic Sep 17, · The risk of developing an unhealthy body image is often highlighted, but McDade emphasises that this is just one aspect. during which he wrote a Purpose: Body image has a significant impact on the outcome of obesity surgery. This study aims to perform a semantic evaluation of body shapes in obesity surgery patients and a group of controls. Materials and Methods: Thirty-four obesity surgery (OS) subjects, stable after weight loss (average ± kg), and 35 overweight/obese
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