weight science evaluating the evidence for a paradigm shift

Weight management (i.e., weight loss and weight cycling) is a central component of health improvement and health care regimens in the United States and similarly westernized countries. Johnson cannot help but think, “Could there be a better way?” Promises are made, referrals are given, and patients drop out of sight until the next medical crisis that absolutely cannot be ignored. There is a predictably tense discussion about what needs to happen. There is a palpable sense of frustration about yet another problem related to high weight. Usually patients are coming in reluctantly, with medical issues that cannot wait any longer. Johnson thinks about all the moments like this one. Johnson and Jasmine look at each other, there is a beat of silence, and they both sigh. However, I need help for my migraines, so here I am.” Dr. Johnson, “I almost did not come in today knowing my weight is up from the last time I was here and you suggested a diet. Johnson greets her today, Jasmine seems anxious and tells Dr. Although Jasmine’s labs were normal in past visits, they are out of date. Her blood pressure was borderline high in contrast to the normal readings in previous visits. Jasmine is waiting in the exam room and her chart shows that her weight today is up five pounds from her last visit two years ago, putting her BMI at 32. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not.

In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma).

Weight science evaluating the evidence for a paradigm shift