Let’s start with screenshot in the image taken from today’s Irish Times Health article. Headlines matter: studies show that many people share and discuss based on just the headline. Very few make it to the end of an article.
What was right about the headline: Weight isn’t a sole determinant of health. Exercise is really important for health.
What’s misleading about the title? The headline almost implies that if you exercise, your weight doesn’t matter.
Unfortunately, excess weight does pose health risks that have been highlighted during the pandemic. For example, it is an independent risk factor for worse outcome for both covid and influenza.
If you’ve gotten this far, let’s discuss the paper that the article is summarising. [Original is linked in comments if you want to have a read.]
This paper talked about in the IT is meta-analysis. This means the authors read a lot of other papers and wrote this one. This is not a new study. Meta-analysis can be good because it means lots of data from lots of studies. The can also be bad because the studies included aren’t related to each other so have to be careful comparing apples to oranges.
Here’s 10 take-aways from the actual paper:
1. “Adherence to PA [physical activity] may improve if health care professionals consider PA and CRF [cardiorespiratory fitness] as essential vital signs and consistently emphasize to their patients the …benefits of PA and CRF in the absence of weight loss. “ True. This is a fundamental concept in preventative and #lifestylemedicine!
2. “Repeated weight loss efforts may contribute to weight gain, and is undoubtedly associated with the high prevalence of weight cycling…” Weight loss for sake of weight loss without a lifestyle change, psychological support, and proper nutrition input is more likely to fail and be unhealthy. What is not mentioned is that patients who do have access to comprehensive intervention to make sustained lifestyle changes do better.
3. “An important question is whether weight loss should be the primary focus of obesity treatment.” I’m not sure that is a question. Weight and health are not the same as body image. Weight loss is NEVER the primary focus of obesity treatment for doctors: primary focus is to improve metabolic health, quality of life, and prevent complications from diabetes to arthritis to heart disease.
4. “Overall, data from observational studies and RCTs do not consistently show that intentional weight loss is associated with reduced mortality risk. Even in those studies that demonstrated a benefit of weight loss, it is not clear whether the weight loss itself was the primary factor that reduced the mortality risk.” My thoughts here is that death is a pretty blunt way to measure health or quality of life. That said, it underlines what we already know: weight loss for sake of weight loss is not enough to be healthy.
5. “It is fair to ask whether weight loss could have contributed to the reduced mortality risk associated with increases in either PA or CRF. Unfortunately, most of the studies did not report data on weight change associated with changes in either PA or CRF”
6. “Whether weight cycling poses a significant health risk has been debated over the years.” We really don’t know because this meta-analysis can’t give us enough information on this. Whether weight loss is sustained depends on a few things, but this study didn’t go into those factors. It’s always important to note what’s outside the scope of a paper.
7. “Thus, the improvements … reported in exercise training studies are comparable to those observed with weight-loss interventions. The meta-analyses of exercise training studies did not consider the potential contribution of weight loss or fat loss to the improvements in FMD. However, weight loss in exercise training studies is usually minimal.” Not enough information in this analysis. It is important to note docs do not recommend weight loss versus exercise – it’s both!
8. “The MHO [metabolically healthy obesity] phenotype has typically been defined as having no more than one […or] up to two components of the metabolic syndrome. The lack of standardized criteria used to define MHO has undoubtedly contributed to confusion as to whether the MHO phenotype is truly healthy and absent of risk…. Regardless, defining MHO as allowing even one component of the metabolic syndrome is problematic because it could be argued that such a phenotype is not truly metabolically healthy.” There is an argument that there are people who are obese but perfectly healthy. Many definitions however allows a patient to be categorised as healthy with one or two complications. There is added problem of a patient with no current complications of obesity but at risk to develop them later.
9. “It is unlikely that continued focus on weight loss as the primary metric for success will reverse the trends in obesity prevalence or result in sustainable weight loss.” When we are talking about health – not appearance – weight loss is never the primary metric for ‘success’. Sustainable lifestyle changes that support metabolic health, prevent complications, support mental health.
10. “Thus, a weight-centric approach to obesity treatment and prevention has been largely ineffective… it is essential to encourage PA as more than just a tool to produce an energy deficit.” Yes. This is not news. #LifestyleMedicine #JustMove
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