Health, Not Diets
Thank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping CartTraining and workshops in the Non-Diet Approach
Training and workshops in the Non-Diet Approach
Blog
Blog
Blog
But there are significant risks for mortality with increased BMI!!
| Posted on January 12, 2017 at 11:50 PM |
From a fellow dietitian:
"I do believe there are significant risks for mortality with increased BMI, irrespective of diet. I have seen studies supporting that, so I don’t think it’s a slam dunk for embracing any level of obesity. See the latest BMJ systematic review for example:
http://www.bmj.com/content/bmj/353/bmj.i2156.full.pdf"
My response:
My fingers get twitchy when I see this kind of research used to justify recommending weight loss, but I see it all the time and I think it's important to unpack the details.
The meta-analysis you've posted is a good one and can tell us many things. Mainly it shows that a group of larger people is, on average, likely to have a shorter lifespan than a group of smaller people. Interestingly, this one shows that smoking appears to be worse for you if you have a high BMI. The identification of the nadir of risk is great news for people who have a lower BMI relatively effortlessly despite living in an obesigenic environment that causes 2/3 of the population to creep up in weight over time (ie genetic jackpot). The recent influx of big BMI and mortality meta-analyses interestingly comes in response to Flegal's paper from 2013 which found that being overweight conferred the lowest risk of death in an NHANES dataset, thus suggesting that larger bodies might not be as bad as originally thought. Anyway, I digress. There are far more interesting things for dietitians in this study.
Firstly, where are our intentional weight losers (ie including our clients)? Well, we don't know. Unless they are running separate analysis for those who intentionally lost weight into a lower BMI category we cannot tell whether they have the same risks as so-called 'never-fat' people and so we cannot say that weight loss delivers on it's promise. This study found that using highest adult BMI when analysing mortality resulted in even lower risks for the lower BMI categories. So this might mean that all weight loss is bad, or it might mean that there are so few healthy people losing weight, keeping it off and not dying early that the disease-related weight loser stats drown them out. Think about that for a bit: there are more people actively dying from disease to the point that they are losing weight than there are people who have successfully, permanently lost weight. Probably a bit of both is true. Bottom line: population studies showing how bad obesity is do not justify recommending weight loss; they just show that being overweight/obese confers risk. They say nothing about the merits of no longer being obese or about the risks of becoming obese. Clearly there are also issues with the assumption that being, or not being, obese is completely within individual control. The answers to these questions are waiting to be discovered, hidden in datasets until such time that obesity researchers stop trying to be weight loss agents. https://www.cambridge.org/core/journals/nutrition-research-reviews/article/a-review-and-meta-analysis-of-the-effect-of-weight-loss-on-all-cause-mortality-risk/26226C6DF1BA32BEB00AAC87FC416667" target="_blank">Here is another paper looking at the mortality risks related to intentional weight loss (spoiler: overweight people who intentionally lost weight had an 11% increase in mortality).
Secondly, the BMJ paper says that they did make adjustments for dietary quality and fitness. This sounds fabulous at face value, but I know this literature well and I wondered where on earth they found 230 BMI and mortality cohort studies that controlled for diet and exercise. So I nerded out in the supplementary material. Of the 230 studies included in the analysis, 59 controlled for physical activity (but not dietary factors), 10 controlled for dietary factors and physical activity, and 2 controlled for dietary factors (but not physical activity). People in these studies represented 7.7%, 3.8% and 0.062% of the total people studied respectively. I would not really consider that adequately controlled for food and fitness factors.
Accepting the findings of this paper, and those like it that do not properly adjust for food and fitness, means essentially that we are accepting that nourishment and fitness make no difference to mortality. Sedentary people with poor diets are lumped in with fit people with great diets within each of the BMI categories. Most of the studies included did not adjust for SES either. Does that seem fair or accurate? It makes a mockery of the work that we do every day to move people towards a healthier lifestyle. BMI does not measure dietary quality or fitness; we need to insist that studies do not continue to conflate BMI with health behaviours and actually measure the behaviours as endpoints instead. Studies that look at health behaviours independently of BMI find consistently that behaviours do make a difference to morbidity and mortality regardless of weight. Even if dietitians can't quite accept the futility of intentional weight loss, it might be helpful to think of focussing on health behaviours instead of weight as a form of damage control.
I used to do weight loss counselling in the early days of having my private practice. They would lose weight and I would feel great, they would feel great; it was celebration time. On the less frequent occasion of a client actually reaching their goal weight I had a spring in my step for days. It confirmed to me at the time that I must be a good dietitian and that dietetics really did have the key to lasting weight loss. I believed that those who weren't losing weight weren't following my plan or trying hard enough, so it was easy to label it as an adherence/noncompliance problem, not an issue with the way we were doing things in dietetics.
Becoming a researcher and working in academia involved the humbling process of accepting that my experiences and beliefs were not representative. Only seeing the 'honeymoon' phase of weight loss and devaluing the importance of my clients' previous (failed) weight loss attempts had lead me to have a distorted view of the effectiveness of dietetic counselling for weight loss. Unless a dietitian is following all of their clients for 5+ years it is likely that they suffer this same confirmation bias. In the absence of good quality research showing the 5 year outcomes of dietitian-delivered, individualised weight loss counselling, we have to accept that we are probably the same or worse than the well-funded, multidisciplinary, beautifully designed weight loss studies described in the literature which were used by the NHMRC in their review to conclude that long-term weight loss for the majority of people is unattainable.
Categories: HAES, Dietitian, Research
Post a Comment
Oops!
The words you entered did not match the given text. Please try again.
13049 Comments





le-de-cialis/ - cialis et dialyse[/URL - [URL=http://eatingaftergastricbypass.net/erythromycin/ - erythromycin[/URL - [URL=http://bootstrapplusplus.com/prednisone/ - buy prednisone 5mg[/URL - [URL=http://homemenderinc.com/viagra-professional/ - professional viagra online[/URL - [URL=http://umichicago.com/doxycycline/ - buy doxycycline[/URL - [URL=http://iliannloeb.com/cheap-viagra/ - buy viagra[/URL - [URL=http://gccroboticschallenge.com/kamagra/ - kamagra[/URL - [URL=http://redlightcameraticket.net/diovan/ - diovan best price[/URL - pheasant's field, viagra online nizagara viagra uk revia generic purchase flutivate skin cream cialis claritin without dr prescription nombre del generico intercambiable de cialis erythromycin india prednisone dosage prednisone 10mg generic professional viagra cost of doxycycline tablets viagra kamagra diovan whistling explanation: slit-like http://stephacking.com/viagra-online/ viagra online http://carbexauto.com/product/generic-nizagara-from-canada/ generic nizagara from canada http://davincipictures.com/viagra-100mg/ buying viagra http://albfoundation.org/revia/ cheapest revia http://frankfortamerican.com/flutivate-skin-cream/ flutivate skin cream price flutivate skin cream online uk http://bootstrapplusplus.com/tadalafil-20-mg/ cialis http://frankfortamerican.com/claritin/ claritin for sale http://thenectarystpaul.com/nombre-del-generico-intercambiable-de
-cialis/ cialis stop working http://eatingaftergastricbypass.net/erythromycin/ where to buy erythromycin http://bootstrapplusplus.com/prednisone/ cheap prednisone http://homemenderinc.com/viagra-professional/ buy professional viagra online http://umichicago.com/doxycycline/ buy doxycycline http://iliannloeb.com/cheap-viagra/ cheap viagra http://gccroboticschallenge.com/kamagra/ kamagra for sale http://redlightcameraticket.net/diovan/ generic diovan cool, executioners.


da/ - buy pharmacy products online[/URL - [URL=http://davincipictures.com/lyrica-medication/ - the drug lyrica[/URL - early-onset modalities online generic finasteride ip canadian pharmacy prednisone prednisolone india levitra from uk levitra buy levitra cheap prednisolone buy in canada generic cialis canada health healthboards lyrica alternative prescription for nerve pain cialis.com propecia no prescription nizagara canada online pharmacy lyrica medication hallux monoamine http://umichicago.com/finasteride-ip/ finasteride ip http://recipiy.com/canadian-pharmacy/ pharmacy buy in canada http://thehealingheartcenter.org/prednisone-canadien/ prednisone http://iliannloeb.com/prednisolone/ prednisolone online http://center4family.com/levitra-generic/ levitra 20 mg http://carbexauto.com/levitra/ levitra 20 mg http://redlightcameraticket.net/levitra/ levitra online http://davincipictures.com/cheapest-prednisolone/ buy prednisolone uk prednisolone information http://bioagendaprograms.com/generic-cialis/ cialis http://davincipictures.com/lyrica/ can lyrica help with lewy body http://thegrizzlygrowler.com/cialis-com/ cialis 20 mg http://mannycartoon.com/buy-propecia/ generic propecia finasteride http://redlightcameraticket.net/nizagara-for-sale/ prices for nizagara http://gaiaenergysystems.com/product/northwest-pharmacy-canada/ canada online pharmacy http://davincipictures.com/lyrica-medication/ drug lyrica possibilities appearance.






moncler http://www.moncler--outlet.us.com

yeezy 350 http://www.yeezyboost350v2s.us



- el tadalafil cialis[/URL - [URL=http://lokcal.org/topamax/ - topamax online[/URL - [URL=http://lokcal.org/pharmacy/ - pharmacy[/URL - [URL=http://stephacking.com/generic-cialis-lowest-price/ - cialis 20mg for sale[/URL - [URL=http://iliannloeb.com/prednisolone/ - prednisolone nextday[/URL - [URL=http://eatingaftergastricbypass.net/ampicillin/ - ampicillin.com[/URL - [URL=http://aawaaart.com/ciprofloxacin-500-mg/ - cipro[/URL - midwife fly zithromax buy online does propecia cause genetic disorders plaquenil plaquenil strattera adults strattera online price of female cialis prednisone no prescription order lasix online cheap cialis pills cialis efectos adversos topamax buy pharmacy w not prescription generic cialis lowest price prednisolone prednisolone india ampicillin.com order ampicillin online buy cipro numerical predispose http://cgodirek.com/purchase-zithromax-online/ purchase zithromax online http://recipiy.com/propecia-online/ propecia ou minoxidil http://center4family.com/plaquenil-information/ plaquenil information plaquenil information http://enews-update.com/strattera/ strattera adhd http://jacksfarmradio.com/female-cialis-for-sale/ online female cialis http://stephacking.com/prednisone/ prednisone http://ormondbeachflorida.org/lasix/ furosemide 40 mg lasix no prescription http://davincipictures.com/buy-cialis/ cialis http://naturalgolfsolutions.com/generic-cialis-lowest-price/ generic cialis lowest price canadian pharmacy cialis http://lokcal.org/topamax/ topiramate topamax online http://lokcal.org/pharmacy/ pharmacy http://stephacking.com/generic-cialis-lowest-price/ lowest price for cialis 20 mg http://iliannloeb.com/prednisolone/ prednisolone online methylprednisolone http://eatingaftergastricbypass.net/ampicillin/ ampicillin http://aawaaart.com/ciprofloxacin-500-mg/ cipro myaesthenia nominates leakage: constant.

cia/ - propecia[/URL - propecia [URL=http://stephacking.com/propecia/ - propecia en ligne[/URL - reject ago insensitive canada pharmacy online no script lyrica amoxicillin 500mg capsules cialis atomoxetine amoxil lowest nizagara prices generic nizagara canada pharmacy prednisone viagra professional buy no prescription viagra professional order online buy prednisone online without a prescrip... cialis order retin a snorting lyrica effects overnight shipping on propecia generic propecia finasteride cap, bit, problem-orientated http://davincipictures.com/canadian-pharmacy-online/ canadian pharmacy cialis http://aawaaart.com/lyrica-medicine/ lyrica medicine http://recipiy.com/amoxil-500-mg/ amoxil 500mg no prescription amoxicillin http://umichicago.com/buy-cialis/ buy cialis on line http://iliannloeb.com/atomoxetine/ atomoxetine http://umichicago.com/amoxil/ amoxil http://iliannloeb.com/nizagara/ buying nizagara online http://carbexauto.com/prednisone/ prednisone http://stephacking.com/viagra-professional/ viagra professional http://vowsbridalandformals.com/prednisone/ buy prednisone http://talleysbooks.com/generic-cialis-10mg/ prezzo cialis 5 mg generic cialis mexican http://frankfortamerican.com/tretinoin-cream-0-05-/ where to buy retin a tretinoin cream 0.05% http://frankfortamerican.com/lyrica/ lyrica http://thecluelessmomph.com/pill/overnight-shipping-on-propecia/ propecia 1 mg without prescription http://stephacking.com/propecia/ buy propecia online reason dyslexic woe.


Oops!
Oops, you forgot something.