Advertisements, news articles, celebrity interviews, blogs, books, social media. We’re inundated with information on weight and weight loss. Along with it is the notion weight is closely connected to health. And, with that, losing weight will improve one’s health. It may not come as a surprise then that the weight loss industry is worth approximately $225 billion globally and will surpass $400 billion by 2030. But will losing weight actually make you healthier?
It’s true being overweight or having obesity can increases one’s risk for a number of diseases and early death. This is concerning given nearly two billion (39%) adults are considered overweight and one-third of those have obesity (13%). In regions such as the United States and Europe, the prevalence of obesity is much higher at 42% and 23%, respectively. And at any given time, 1 in 6 people is on a diet to lose weight.
These are staggering numbers resulting in great cost to individuals who have obesity, and society at large. Societal costs are expected to reach $4.3 trillion annually globally. An amount comparable to the COVID-19 pandemic. Much of these costs are related to the health consequences of obesity. As a result, there is great potential for improvements in quality of life and cost reductions with preventing and treating obesity.
What is an ideal weight?
The body mass index (BMI) is the most common measure used to classify a person as overweight or having obesity. The BMI is a measure of weight over height (squared) and is used by health professionals as a patient’s vital sign, just as blood pressure is. Overweight is defined as a BMI ≥25 kg/m2 and obesity ≥30 kg/m2. An ideal BMI is 18.5-25 kg/m2. However, the BMI was created as a tool for population health research, not for use as an individual indicator of health.
The problem is the use of weight in calculating the BMI. When it comes to health, it’s the amount of fat a person has that’s of concern. Weight is a measure of fat, bone and muscle. Classifying one’s health risk based on their weight, of which fat is only a minor component, doesn’t provide an accurate picture. There are many people who have obesity as defined by the BMI, but it’s not due to excess fat (such as Dwayne Johnson). Likewise, it’s possible to be in the ideal BMI range and have a high among of body fat.
But excess fat isn’t the only concern. Where one carries their fat is also important. Fat around the waist is more problematic than in the thighs, legs and arms. That’s because this fat around the waste acts differently than fat elsewhere. As a result, current guidelines for assessing and managing obesity have started moving away from the use of the BMI. Instead, obesity is defined as a disease characterized by abnormal or excessive body fat (adiposity), that impairs health.
Losing Weight isn’t Always Healthy
The top reason people have for wanting to lose weight is health. Appearance falls a distant second. With that, and the fact 1 in 6 adults at any given time trying to lose weight, one would think losing weight is a healthy choice. But not all weight loss is healthy.
Unintentional weight loss is often the most concerning. As the name suggests, this is weight loss occurring without any conscious effort to lose weight. Often it’s a sign of a pre-existing, or progressing, disease. It may be accompanied by a loss of appetite, but not always. Diseases that can cause unexplained weight loss include depression, cancer, respiratory disease and inflammatory bowel disease. In addition, muscle loss occurs as one ages, which can be indicative of sarcopenia. While the loss of muscle will show up on the scale as weight loss, it’s not ideal, but this can be prevented and treated through strength training.
For many people who have excess body fat, their weight gain happened over decades. Yet weight loss plans often look to lose much of that weight in months or weeks, instead of years. This often isn’t realistic and can lead to disappointment, a sense of failure and even more weight gain later. In addition, rapid weight loss may be accompanied by loss of water and muscle, not always fat. This often occurs by following strict dietary habits that may not be sustainable in the long-term, and can lead to weight gain later on. Even greater than before, which may increase your chances for later disease.
Healthy Weight Loss
Randomized controlled trials in people with excess body fat indicate weight loss as little as 5% can lower blood glucose and blood pressure, as well as improve cholesterol. It can alleviate symptoms from diseases which are hampered by excess weight. For example, pain from arthritis in weight-bearing joints can be reduced. In addition, shortness of breath from heart failure and respiratory disease my decrease as it’s easier moving around with less weight.
Despite the associations of obesity with disease and early death, little evidence exists linking weight loss to disease prevention. Weight loss studies are challenging. And to prevent disease and early death, these studies need to be conducted for years. We can get some insight by studying people who had bariatric surgery. Compared to people of the same age, BMI and other characteristics, bariatric surgery resulted in nearly 50% less chances of getting heart disease or early death. However, these studies weren’t randomized and bariatric surgery is done in only the most severe cases of obesity.
A pivotal randomized study, called the Look AHEAD trial set out to see if long term weight loss could prevent heart disease in people with type 2 diabetes. After 9.6 years, people in the weight loss group lost 6% of their body weight and had improved risk factors, less depression, kidney disease and sleep apnea, and higher quality of life. Despite this, the weight loss had no effect on heart disease rates. A subsequent study in people with type 2 diabetes found weight loss over two years resulted in a reduction in medication use and remission of diabetes in 36% of the participants.
Is weight loss right for you?
Weight loss, or rather fat loss, can lead to improved health. Even at small amounts, such as 5% of body weight. But as anyone who has tried to lose weight will know, weight loss is tough. And even harder to maintain. As a result, focus is now being placed on positive health behaviours, such as healthy nutrition, regular exercise, improved sleep quality and managing stress. These behaviours can lead to weight loss, but even if they don’t, they can make anyone healthier regardless of their weight.
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