In other words , helping someone lose weight is time-consuming and complicated , may conflict with social factors beyond anyone ’ s control , and certainly can ’ t be accomplished in a short primary care visit .
“ The PCP [ primary care provider ] is given an impossible task ,” says Jason Lillis , PhD , a research scientist at The Miriam Hospital ’ s Weight Control and Diabetes Research Center . “ In a 10-minute primary care visit , you ’ re going to what , tell someone , eat different and be active ? OK , both of those things are really hard to do . I can say that because I do these intensive interventions and only have modest success rates with people .”
Lillis , an associate professor of psychiatry and human behavior ( research ), studies how acceptance and mindfulness can help promote healthy behavior change , and how weight stigma can impede that . While simply telling a patient to eat less and exercise more “ has an infinitesimal chance ” of actually producing long-term weight loss , he says , it could very much make them feel terrible . “ There needs to be more support there and more intervention if you actually want the outcome ,” Lillis says .
IN THE PAST FEW DECADES , THE BODY MASS INDEX , OR BMI , HAS become a stand-in for individual health status — inviting stigma for people at higher BMIs , with the potential to harm patients of all sizes . It doesn ’ t differentiate between fat , muscle , and bone mass , nor does it account for how people ’ s body compositions vary across gender and racial groups . Disregarding these factors , along with other measurements and medical history and lifestyle , may lead a clinician to over- or underestimate a patient ’ s disease risk based on weight and height alone .
“ We don ’ t know based on someone ’ s BMI whether they have high blood pressure or high cholesterol . You have to do the actual test to do that ,” says KayLoni Olson , PhD , an assistant professor of psychiatry and human behavior ( research ) and a clinical health psychologist at the Weight Control and Diabetes Research Center . “ And making assumptions about health status while neglecting to do those follow-up tests on someone who has a ‘ healthy ,’ quote-unquote ,
“ The way that society approaches weight is very disrespectful to people ’ s autonomy .”
or a higher BMI is dropping the ball , and jumping to conclusions .” Goldstein , who ’ s also a psychologist in the Weight Control and Diabetes Research Center , acknowledges that she has more time to spend with her cardiac rehab patients than does a PCP at a typical checkup , so she understands why some providers may use a patient ’ s BMI as a quick way to assess their health .
“ Given how fast-paced and demanding medicine has gotten , a lot of people are looking at BMI to be a proxy for all of these other important variables ,” like blood pressure , cholesterol , blood sugar , and triglycerides , Goldstein says . “ But we really might be missing the boat by quite a bit . There ’ s probably a lot of quote-unquote ‘ healthy BMI ’ -range folks who actually need various health interventions like cholesterol-lowering statins or improvements in dietary quality or improvements in cardiorespiratory fitness .”
Weight loss for the sake of weight loss doesn ’ t guarantee better health . A 2013 study of the long-term impacts of numerous diets did not find significant correlations between weight loss and improvements in indicators of metabolic health like blood pressure , glucose , cholesterol , or triglycerides ; nor were there clear differences in outcomes like diabetes and hypertension . Other studies suggest that up to a third of people falling in the “ normal ” BMI range are metabolically unhealthy , while a third of those classified as “ obese ” and almost half in the “ overweight ” category are metabolically healthy .
For more than 20 years , a large nationwide clinical trial has followed thousands of adults with prediabetes or at risk for type 2 diabetes as they made intensive changes to their diet and exercise habits . Panza says participants who increased their physical activity and changed their diets lowered their risk of developing diabetes significantly more than those who took metformin , which helps control blood sugar . Many participants also lost a modest amount of weight .
Interestingly , Olson notes , “ There was a legacy effect of that weight loss that , over a decade later , even if weight was regained , that group still had a lower risk of converting to diabetes .” That may be because the participants maintained lifestyle changes , she says :
14 HEALTH DISCOVERIES l WINTER 2023