The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward

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Abstract

A Health at Every Size (HAES) approach has been proposed to address weight bias and stigma in individuals living with obesity, and more recently articulated as a promising public health approach beyond the prevailing focus on weight status as a health outcome. The purpose of this article is to examine our understanding of HAES within the context of public health approaches to obesity, and to present strengths and limitations of the available evidence. Advancing our understanding of HAES from a public health perspective requires us to move beyond an ideological debate and give greater attention to the need for empirical studies across a range of populations. Only then can the value of HAES, as a weight-neutral, public health approach for the prevention of obesity and other chronic diseases, be fully understood.

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The stigma of obesity: a review and update.

Rebecca Puhl, Chelsea Heuer (2009)

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Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes

Rena R Wing, Wei Lang, Thomas A. Wadden … (2011)

OBJECTIVE Overweight and obese individuals are encouraged to lose 5–10% of their body weight to improve cardiovascular disease (CVD) risk, but data supporting this recommendation are limited, particularly for individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted an observational analysis of participants in the Look AHEAD (Action For Health in Diabetes) study (n = 5,145, 40.5% male, 37% from ethnic/racial minorities) and examined the association between the magnitude of weight loss and changes in CVD risk factors at 1 year and the odds of meeting predefined criteria for clinically significant improvements in risk factors in individuals with type 2 diabetes. RESULTS The magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight. CONCLUSIONS Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.