What looks like an obvious conclusion at first sight will mean significant changes are needed to the way Public Health currently talk about people who are ‘obese’. This Guardian article reporting the studies also discusses what needs to be done to support those struggling to lose weight, given that they are already stigmatised by their ‘condition’, even though their view of themselves as too fat may be wholly inaccurate. The implications for working with teenagers, with a distorted view of what is a healthy look and weight, are particularly stark.
“Individuals who identified themselves as being ‘overweight’ were more likely to report overeating in response to stress and this predicted subsequent weight gain,” the authors write. “These findings are in line with recent suggestions that the stress associated with being part of a stigmatised group may be detrimental to health.”
This supports the research I have been doing in preparation for the Weight Reduction Clinic launching in the Autumn.
Here is the abstract from the International Journal of Obesity http://www.nature.com/ijo/journal/v39/n8/full/ijo2014184a.html
Background: Public health and clinical interventions for obesity in free-living adults may be diminished by individual compensation for the intervention. Approaches to predict weight outcomes do not account for all mechanisms of compensation, so they are not well suited to predict outcomes in free-living adults. Our objective was to quantify the range of compensation in energy intake or expenditure observed in human randomized controlled trials (RCTs).
Methods: We searched multiple databases (PubMed, CINAHL, SCOPUS, Cochrane, ProQuest, PsycInfo) up to 1 August 2012 for RCTs evaluating the effect of dietary and/or physical activity interventions on body weight/composition. Inclusion criteria: subjects per treatment arm greater than or equal to5; greater than or equal to1 week intervention; a reported outcome of body weight/body composition; the intervention was either a prescribed amount of over- or underfeeding and/or supervised or monitored physical activity was prescribed; greater than or equal to80% compliance; and an objective method was used to verify compliance with the intervention (for example, observation and electronic monitoring). Data were independently extracted and analyzed by multiple reviewers with consensus reached by discussion. We compared observed weight change with predicted weight change using two models that predict weight change accounting only for metabolic compensation.
Findings: Twenty-eight studies met inclusion criteria. Overfeeding studies indicate 96% less weight gain than expected if no compensation occurred. Dietary restriction and exercise studies may result in up to 12–44% and 55–64% less weight loss than expected, respectively, under an assumption of no behavioral compensation.
Interpretation: Compensation is substantial even in high-compliance conditions, resulting in far less weight change than would be expected. The simple algorithm we report allows for more realistic predictions of intervention effects in free-living populations by accounting for the significant compensation that occurs.