Joanne P. Ikeda, MA, RD

People are often told that the only way they can be healthy is to lose weight. They are advised to achieve this by restricting calories and increasing physical activity (1). However, scientific studies document that 95 to 97 percent of persons who lose weight using this approach regain the weight within 5 years (2–4).

Michael Schwartz and Randy Seeley, biochemists at the University of Washington, explain that “most forms of obesity are likely to result not from an overwhelming lust for food or lack of willpower, but from powerful biochemical defects at one or more points in the system responsible for body weight” (5). They go on to say that “the use of energy restriction to normalize body weight of an obese person has little likelihood of long-term success.”

Although the National Institutes of Health experts insist on weight loss as the goal of weight management programs for obese individuals, they admit that there is little information regarding the health benefits or risks of long-term intentional weight loss (6,7). Thus, we have a situation where people are pressured to achieve the unachievable with little evidence that it will benefit them.

Some health professionals have concluded that research does not support the traditional advice to restrict calories and increase exercise as a way to achieve permanent weight loss and are recommending a new paradigm (8). It is based on the belief that although we may not be able to help fat people permanently lose weight, we can help them improve their health and reduce their risk of chronic disease.

Recent research supports this hypothesis. In a study of more than 21,000 men of varying body sizes, researchers at the Cooper Institute in Texas found that unfit lean men with a body mass index (BMI) of 25 or less had twice the risk of mortality from all causes than fit men with a BMI of 27.8 or greater (9). Results of the Dietary Approaches to Stop Hypertension (DASH) study demonstrated that individuals could lower their blood pressure in only 2 weeks by eating more fruits and vegetables and less saturated fat (10). This improvement in health was independent of weight loss.

The challenge now is to develop health promotion programs that celebrate the benefits of a healthy lifestyle, programs that promote body satisfaction, and the achievement of realistic and attainable health goals without concern for weight change. Programs should never promote body dissatisfaction, low self- esteem, restrained eating, eating disorders, or the achievement of an idealized body size and shape.

Some programs continue to have weight loss as their goal. They prescribe diets without calling them diets or they confuse size acceptance with a lack of size discrimination. Size acceptance is more than the avoidance of discrimination based on size. Size acceptance means accepting a person at their current size and that weight loss isn’t necessary to be healthy or to become healthier. The “Tenets of Size Acceptance” were developed to guide recognition of what constitutes a nondiet, size-acceptance approach to health.

Tenets of size acceptance
• Human beings come in a variety of sizes and shapes. We celebrate this diversity as a positive characteristic of the human race.
• There is no ideal body size, shape, or weight that every individual should strive to achieve.
• Every body is a good body, whatever its size or shape.
• Self-esteem and body image are strongly linked. Helping people feel good about their bodies and about who they are can help motivate and maintain healthy behaviors.
• Appearance stereotyping is inherently unfair to the individual because it is based on superficial factors over which the individual has little or no control.
• We respect the bodies of others, even though they might be quite different from our own.
• Each person is responsible for taking care of his or her body.
• Good health is not defined by body size; it is a state of physical, mental, and social well-being.
• People of all sizes and shapes will have a reduced risk of poor health with a healthy lifestyle.

Developed by dietitians and nutritionists who advocate size acceptance; coordinated by Joanne P. Ikeda, MA, RD, nutrition education specialist in the Department of Nutritional Sciences, University of California, Berkeley, CA 94720-3104. Comments may be sent to .(JavaScript must be enabled to view this email address).

References
1. National Institute of Health: National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 1998; 6 Suppl 2.
2. Kassirer JP, Angell M. Losing weight—an ill-fated New Year’s resolution [editorial]. N Engl J Med 1998; 52–54.
3. Garner DM, Wooley SC. Confronting the failure of behavioral and dietary treatments for obesity. Clin Psy¬chol Rev 1991; 729–780.
4. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med 1995; 621–628.
5. Schwartz MW, Seeley RJ. The new biology of body weight regulation. J Am Diet Assoc 1997: 54–58.
6. National Institute of Health RFA DK-98-020, Study of Health Outcomes of Weight-Loss (SHOW), November 18, 1998.
7. Lee IM, Paffenbarger RS Jr. Is weight loss hazardous? Nutr Rev 1996; S116–124.
8. Robison JI, Hoerr SL, Petersmarck KA, et al. Redefining success in obesity intervention: the new paradigm. J Am Diet Assoc 1995; 422–423.
9. Barlow CE, Kohl HW III, Gibbons LW, et al. Physical fit¬ness, mortality, and obesity. Int J Obes 1995; S41–S44.
10. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997; 1117–1124.

This article is from the Health at Every Size Journal and can be cited as Paul Ernsberger, PhD, and Richard J. Koletsky, MD, “Part 1: Rationale for a Wellness Approach to Obesity” from Health At Every Size 14:1 (January/February 2000).