Overview: A recent article published in a recent edition of Preventing Chronic Disease: Public Health Research, Practice and Policy proposes a shift from discussing BMI and weight loss with patients in the provider’s office, to focusing on the topics of awareness and education surrounding healthy life habits, physical activity in particular. Authors Emily Dollar and team encourage an emphasis on cardiorespiratory fitness over body size to minimize the risk of stigma associated with overweight and obesity and increase collaboration between patient and provider.
Key Points: The Centers for Disease Control and Prevention (CDC) estimate 70.7% of adults aged 20 years and over are overweight or obese. With these numbers in the United States reaching epidemic levels, new solutions to the crisis are desperately needed. Historically, data show focusing on weight loss as a key end point has not been successful. Sustained weight loss of greater than 5% of body weight is rare while many forms of weight loss focused strategies and plans lead to long-term weight regain and higher risks of obesity.  Take for example the hit show “The Biggest Loser”. Fourteen competitors who had, on the average, lost a total of 58.3 kg of body weight during the competition were found to have gained back an average of 41 kg six years post competition. 
Dollar and her team noted that focusing on weight loss and BMI goals often leads to shame and frustration for the patient who very often has tried various forms of weight loss in the past unsuccessfully. A 2017 systematic review and meta-analysis found that the worldwide prevalence of weight control attempts in the past-year in adults aged 18 years and older was 42%.  Many patients are aware of the relationship between high BMIs and chronic disease risk including heart disease, cancer, cognitive decline and type 2 diabetes (T2D). Moreover, motivation for losing weight goes beyond reduction of chronic disease risk for many patients and moves into the realm of self-esteem and healthy body image. It’s not for lack of tries that weight continues to be a problem for so many.
Realizing the desire for many patients for sustainable weight loss and practitioner’s goals of improving the long term health for their patients, it’s obvious a different tactic is needed.
An approach focusing on health promotion, versus weight loss, includes being inclusive to the patient and their needs along with understanding their beliefs and current life resources. It should be conducted without stigma in a style that encourages healthful lifestyle habits for all weights and should include meaningful and sustainable health goals.
A key component to this approach is physical activity. Evidence indicates that regular physical activity, in particular cardiorespiratory fitness, is a vital element in reducing numerous chronic disease risks as well as overall mortality risk. Regular physical activity lowers risk of T2D, coronary heart disease and Alzheimer’s disease. Similar to the well-known saying “Food as Medicine”, the American College of Sports Medicine has spearheaded “Exercise is Medicine” to encourage practitioners and patients to advocate for increased physical activity to combat chronic disease.
By focusing the conversation around physical activity versus weight loss, practitioners have the ability to encourage sustainable lifestyle changes in their patients which will lead to improved BMIs, cardiovascular health and other vital cardiometabolic markers. Physical activity as a part of a long term lifestyle medicine plan that includes healthful nutritional changes such as an anti-inflammatory diet, healthier sleep patterns and enhanced stress modification behaviors is key to changing the current disease centered paradigm to a new model that emphasizes overall mind and body health and wellness.
Focusing on physical activity education versus weight loss may:
- Reduce stigma, frustration and shame from unsuccessful past attempts at weight loss
- Improve patient-practitioner relationships
- Encourage healthful behavior modifications
- Create opportunity for weight loss as a side effect of increased physical activity
- Reduce risk factors associated with T2D, cardiovascular disease and Alzheimer’s disease
- Increase opportunity for further lifestyle modification education by practitioner at future visits
Dollar E, Berman M, Adachi-Mejia AM. Do No Harm: Moving Beyond Weight Loss to Emphasize Physical Activity at Every Size. Prev Chronic Dis 2017;14:170006. DOI: https://doi.org/10.5888/pcd14.170006.
 Centers for Disease Control and Prevention. Obesity and Overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm Accessed 6/14/2017
 Sawamoto R, et al. Predictors of successful long-term weight loss maintenance: a two-year follow-up. Biopsychosoc Med. 2017 Jun 6;11:14. doi: 10.1186/s13030-017-0099-3.
 Fothergill E, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring) 2016;24(8):1612-9.
 Santos I, et al. Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis. Obesity Reviews 18, 32–50, January 2017.