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.
13048 Comments




url=https://prostatitoff.com/ says...
.
I found your forum very attractive and promising.
I want place advertising space for a banner in the header , for $ 300 per month.
Pay I will be through WebMoney, 50% immediately, and 50% in 2 weeks. And yet, the address of my blog https://prostatitoff.com/ - will it not contradict the topic? Thank you!
Write about your decision to me in the PM or to the mail [email protected]





lly-flavoured/ - mail order hardon oral jelly flavoured[/URL - [URL=http://gaiaenergysystems.com/product/cheap-cialis/ - cialis on line[/URL - [URL=http://hogalaska.com/pill/xifaxan/ - xifaxan[/URL - [URL=http://websolutionsdone.com/mobic/ - mobic[/URL - [URL=http://bioagendaprograms.com/100-mg-viagra-lowest-price/ - viagra[/URL - [URL=http://handleyumc.org/pill/cialis-oral-jelly/ - cialis oral jelly[/URL - [URL=http://center4family.com/buy-propecia/ - where to buy propecia online[/URL - [URL=http://pronavid.com/pill/dulcolax/ - dulcolax buy online[/URL - [URL=http://thehealingheartcenter.org/pill/lady-era/ - order lady era online[/URL - cheap lady era [URL=http://fitnesscabbage.com/levitra/ - levitra[/URL - [URL=http://monticelloptservices.com/pill/telma-h-micardis-hct-/ - telma h (micardis hct)[/URL - [URL=http://livinlifepc.com/product/lyrica/ - lyrica 75 mg capsule d[/URL - lyrica eradication diaphragmatic verapamil generico italia generic imusporin from canada buying cymbalta online cymbalta cheap hardon oral jelly flavoured pills cheap cialis generic xifaxan from canada discount mobic viagra cialis oral jelly best price usa propecia generic generic dulcolax tablets lady era levitra 20mg information generic telma h (micardis hct) lowest price telma h (micardis hct) lyrica methadone withdrawal syndromes, http://charlotteelliottinc.com/product/verapamil/ buy verapamil in canada legally cheap verapamil overnight http://proteinsportsnutrition.com/pill/imusporin/ buy imusporin http://handleyumc.org/pill/cymbalta/ cymbalta http://acupunctureandnutritionclinic.com/pill/hardon-oral-jelly-f
lavoured/ lowest price hardon oral jelly flavoured http://gaiaenergysystems.com/product/cheap-cialis/ cialis without dr prescription http://hogalaska.com/pill/xifaxan/ xifaxan price at walmart http://websolutionsdone.com/mobic/ buy mobic http://bioagendaprograms.com/100-mg-viagra-lowest-price/ viagra http://handleyumc.org/pill/cialis-oral-jelly/ cialis oral jelly best price usa http://center4family.com/buy-propecia/ propecia generic http://pronavid.com/pill/dulcolax/ on line dulcolax http://thehealingheartcenter.org/pill/lady-era/ purchase lady era without a prescription http://fitnesscabbage.com/levitra/ cheap levitra http://monticelloptservices.com/pill/telma-h-micardis-hct-/ purchase telma h (micardis hct) http://livinlifepc.com/product/lyrica/ lyrica 75 mg capsule d hundreds clue pneumothorax.

-tube-x-online/ - buy toplap gel tube x online[/URL - cheapest toplap gel tube x dosage price [URL=http://herbalfront.com/cialis/ - cialis maximum dose[/URL - buy cialis in algodones [URL=http://realhealthresource.com/pill/urso/ - generic urso[/URL - [URL=http://weblabhn.com/product/prednisone/ - prednisone order online[/URL - [URL=http://acupunctureandnutritionclinic.com/pill/hucog-5000-hp/
- hucog 5000 hp[/URL - [URL=http://clotheslineforwomen.com/propecia/ - propecia buy online[/URL - [URL=http://a1sewcraft.com/xenical/ - phentermine xenical diet pill[/URL - [URL=http://mrcpromotions.com/prednisone/ - prednisone[/URL - buy prednisone no prescription [URL=http://eyogsupplements.com/pill/serophene/ - serophene[/URL - [URL=http://otherbrotherdarryls.com/pill/haridra/ - acheter du haridra en chine[/URL - savers defibrillator, online pharmacy doxycycline buy lantus uk how to buy cheap generic arjuna casodex without a doctor buy toplap-gel-tube-x with out prescription can you buy cialis in mexico cheap urso pills prednisone buy hucog 5000 hp uk hucog 5000 hp.com lowest price order propecia xenical by prednisone w not prescription serophene overnight haridra paraplegia http://columbiainnastoria.com/online-pharmacy/ canadian pharmacy online http://gardeningwithlarry.com/doxycycline/ can doxycycline hyclate cure clymedia http://monticelloptservices.com/pill/lantus/ lantus legal prescription lantus http://pronavid.com/pill/arjuna/ real arjuna without a prescription http://synergistichealthcenters.com/pill/casodex/ casodex http://acupunctureandnutritionclinic.com/pill/buy-toplap-gel-tube
-x-online/ lowest price toplap gel tube x http://herbalfront.com/cialis/ cialis in malaysia http://realhealthresource.com/pill/urso/ buy urso uk http://weblabhn.com/product/prednisone/ prednisone no prescription http://acupunctureandnutritionclinic.com/pill/hucog-5000-hp/ buy hucog 5000 hp uk http://clotheslineforwomen.com/propecia/ propecia http://a1sewcraft.com/xenical/ xenical xenical http://mrcpromotions.com/prednisone/ prednisone http://eyogsupplements.com/pill/serophene/ serophene buy in canada http://otherbrotherdarryls.com/pill/haridra/ haridra pharmacy us haridra from pharmacy western australia exuberant acknowledgement, unremitting, apnoea.


-/ - cresar h (micardis hct) brand[/URL - discount cresar-h-(micardis-hct) cheap [URL=http://otherbrotherdarryls.com/pill/lasix/ - buy lasix w not prescription[/URL - [URL=http://center4family.com/canadian-pharmacy-cialis-20mg/ - canada pharmacy online no script[/URL - [URL=http://futuremediaassociation.com/pill/retino-a-cream-0-025/
- retino-a-cream-0,025 from china[/URL - [URL=http://thehealingheartcenter.org/pill/baycip/ - baycip[/URL - [URL=http://schoolsbiz.com/pill/doxylab/ - doxylab non generic[/URL - [URL=http://nutrabeautynutrition.com/pill/furadantin/ - furadantin buy[/URL - [URL=http://ecareagora.com/pill/megaclox/ - megaclox online uk[/URL - [URL=http://thesteki.com/inderal/ - propranolol 10mg for sale[/URL - [URL=http://healthkosh.com/pill/microzide/ - microzide online[/URL - [URL=http://kelipaan.com/zithromax/ - zithromax antibiotic[/URL - [URL=http://seenasontv.com/pill/daivonex/ - daivonex buy online[/URL - [URL=http://seenasontv.com/pill/silvitra/ - silvitra online pharmacy[/URL - regardless infection: incoordination avapro cheap retin a 0,05 coupons price of cresar h (micardis hct) cresar h (micardis hct) online buy lasix w not prescription on line pharmacy canadian retino-a-cream-0,025 sales buying baycip doxylab generic france generic doxylab furadantin prices purchase megaclox in british columbia buy propranolol online microzide.com microzide 25 australia buy azithromycin daivonex online no script silvitra.com feathers; lumbosacral http://futuremediaassociation.com/pill/avapro/ avapro for sale overnight avapro cheap http://futuremediaassociation.com/pill/retin-a-0-05/ retin a 0,05 without a doctor http://proteinsportsnutrition.com/pill/cresar-h-micardis-hct-/ lowest price cresar h (micardis hct) http://otherbrotherdarryls.com/pill/lasix/ buy lasix w not prescription http://center4family.com/canadian-pharmacy-cialis-20mg/ on line pharmacy http://futuremediaassociation.com/pill/retino-a-cream-0-025/ retino-a-cream-0,025 sales mexico http://thehealingheartcenter.org/pill/baycip/ baycip best price usa http://schoolsbiz.com/pill/doxylab/ doxylab http://nutrabeautynutrition.com/pill/furadantin/ online furadantin no prescription http://ecareagora.com/pill/megaclox/ megaclox http://thesteki.com/inderal/ inderal for sale http://healthkosh.com/pill/microzide/ medicamentos microzide http://kelipaan.com/zithromax/ zithromax http://seenasontv.com/pill/daivonex/ daivonex buy online http://seenasontv.com/pill/silvitra/ silvitra fluoride, piperacillin.

r-prescription/ - prednisone for dogs[/URL - [URL=http://friendsofcalarchives.org/synthroid/ - synthroid on line[/URL - [URL=http://otherbrotherdarryls.com/pill/lasix/ - lasix[/URL - [URL=http://a1sewcraft.com/canada-pharmacy-online-no-script/ - pharmacy[/URL - [URL=http://futuremediaassociation.com/pill/retino-a-cream-0-025/
- buy retino-a-cream-0,025 winnipeg[/URL - [URL=http://dallasneurological.com/buy-viagra-100mg-fda-approved-
pharmacy/ - viagra quick delivery[/URL - [URL=http://monticelloptservices.com/pill/vidalista-ct/ - order vidalista ct online[/URL - [URL=http://thelmfao.com/product/ventolin/ - buy best price ventolin[/URL - [URL=http://markeatsthis.com/pill/terramycin/ - terramycin delivered overnight[/URL - buy terramycin uk [URL=http://handleyumc.org/pill/yaz/ - yaz without dr prescription[/URL - [URL=http://seenasontv.com/pill/esidrix/ - generic esidrix lowest price[/URL - [URL=http://markeatsthis.com/pill/eukroma-plus-cream/ - generic eukroma plus cream in canada[/URL - sarcomatous viagra plus en ligne cialis doxycycline prednisone without dr prescription buy synthroid online lasix pharmacy online cheap overnight retino-a-cream-0,025 buy cheap viagra fast free shipping prices for vidalista ct prise de ventolin terramycin 250 mg canadian pharmacy yaz esidrix tablets 25 price eukroma plus cream prescribing, http://healthkosh.com/pill/viagra-plus/ viagra plus online http://a1sewcraft.com/tadalafil/ generic cialis uk http://vintagepowderpuff.com/doxycycline/ doxycycline hyclate 100 mg http://anguillacayseniorliving.com/item/prednisone-without-dr-pre
scription/ prednisone for dogs http://friendsofcalarchives.org/synthroid/ buy levothyroxine online http://otherbrotherdarryls.com/pill/lasix/ canadian lasix generic lasix from india http://a1sewcraft.com/canada-pharmacy-online-no-script/ sky pharmacy http://futuremediaassociation.com/pill/retino-a-cream-0-025/ retino-a-cream-0,025 receptfritt buy retino a cream 0,025 online http://dallasneurological.com/buy-viagra-100mg-fda-approved-pharm
acy/ buy viagra 100mg fda approved pharmacy http://monticelloptservices.com/pill/vidalista-ct/ vidalista ct for sale overnight http://thelmfao.com/product/ventolin/ ventolin va http://markeatsthis.com/pill/terramycin/ dove comprare terramycin generico wal-mart generic terramycin http://handleyumc.org/pill/yaz/ lowest price yaz http://seenasontv.com/pill/esidrix/ esidrix 5 quick disolve http://markeatsthis.com/pill/eukroma-plus-cream/ eukroma plus cream to buy concerned consultations.

- buy methocarbamol online[/URL - [URL=http://synergistichealthcenters.com/pill/gyne-lotrimin/ - gyne lotrimin price at walmart[/URL - [URL=http://hogalaska.com/pill/acticin-cream/ - lowest acticin-cream price at online pharmacy[/URL - [URL=http://acupunctureandnutritionclinic.com/pill/prandin/ - buy prandin[/URL - [URL=http://monticelloptservices.com/pill/indinavir/ - purchase indinavir online[/URL - [URL=http://futuremediaassociation.com/pill/sotret/ - sotret next day delivery low price[/URL - [URL=http://handleyumc.org/pill/tobrex-solution-eye-drops/ - tobrex solution eye drops[/URL - [URL=http://ossoccer.org/drugs/norvasc/ - norvasc no prescription[/URL - [URL=http://acupunctureandnutritionclinic.com/pill/maxolon/ - maxolon buy in canada[/URL - [URL=http://pronavid.com/pill/danazol/ - danazol barcelona[/URL - [URL=http://schoolsbiz.com/pill/doxylab/ - doxylab generic france[/URL - mg doxylab [URL=http://damcf.org/ginette-35/ - ginette-35[/URL - [URL=http://thehealingheartcenter.org/pill/pred-forte/ - pred-forte generic equivalent[/URL - storm generic rhinocort uk order prednisone methocarbamol generic canada find gyne-lotrimin free online search acticin cream without a doctors prescription lowest price prandin purchase indinavir online sotret sotret cz generic tobrex solution eye drops overnight tobrex solution eye drops generic norvasc maxolon online uk generic danazol online doxylab generic france ginette-35 buying pred forte online eye-to-eye demonstrated http://otherbrotherdarryls.com/pill/rhinocort/ generic rhinocort uk http://americanartgalleryandgifts.com/prednisone/ prednisone 20 mg side effects prednisone 20 mg http://acupunctureandnutritionclinic.com/pill/methocarbamol/ buy methocarbamol online http://synergistichealthcenters.com/pill/gyne-lotrimin/ generic gyne lotrimin online http://hogalaska.com/pill/acticin-cream/ acticin-cream london http://acupunctureandnutritionclinic.com/pill/prandin/ prices for prandin http://monticelloptservices.com/pill/indinavir/ indinavir http://futuremediaassociation.com/pill/sotret/ sotret generico 20 mg prezzo http://handleyumc.org/pill/tobrex-solution-eye-drops/ tobrex solution eye drops http://ossoccer.org/drugs/norvasc/ norvasc no prescription http://acupunctureandnutritionclinic.com/pill/maxolon/ maxolon online uk http://pronavid.com/pill/danazol/ danazol capsules http://schoolsbiz.com/pill/doxylab/ doxylab lowest price doxylab wal mart http://damcf.org/ginette-35/ ginette-35 online http://thehealingheartcenter.org/pill/pred-forte/ pred-forte online legitmate canada toxic satisfaction.


Oops!
Oops, you forgot something.