To Lose Weight Or To Be Lean?
by Tanya Zilberter, PhD"Do not allow the body to attain extreme thinness, for that, too, is treacherous, but bring it only to a condition that will naturally continue unchanged, whatever that may be." -- Hippocrate
OK, We do know that being overweight is bad for your health. But does it automatically mean that losing weight can repair all the damage?
We are told that very year 300,000 deaths in the United States are caused by obesity. However, that figure is by no means well established. For example, this figure may be misleadingly high because overweight people are more likely to be sedentary and of low socio-economic status.
But how about weight loss as a heavily propagandised method to reach better health?
The New England Journal of Medicine (1998 -- Vol. 338, No. 1) stated that a few well established facts linking obesity to increased health risks could never really prove that the benefits of weight loss are equal to the benefits of being initially and permanently lean:
"It does not follow that losing weight will reduce the risk. We simply do not know whether a person who loses 20 lb. will thereby acquire the same reduced risk as a person who started out 20 lb. lighter."
Undoubtedly, the best approach is to prevent obesity. But what should those who are already overweight do? Well, said the authors of the editorial, it depends: the obese are not created equal:
"Many overweight persons are happy and in reasonably good health, some overeat because they are depressed, and still others are depressed because they are overweight.
In our view, doctors should recommend weight loss if a patient is suffering from health problems that can be ameliorated by weight loss, such as hypertension, diabetes, or osteoarthritis.
Finally, doctors should do their part to help end discrimination against overweight people in schools and workplaces.
We should also speak out against the public's excessive infatuation with being thin and the extreme, expensive, and potentially dangerous measures taken to attain that goal."
Dr. Glenn A. Gaesser, from the University of Virginia, Charlottesville, contributed the data on the prominent health benefits of positive life style changes with little weight loss if any at all (Am J Cardiol 1992;69:440-4.):
When 72 obese men and women consumed a low-fat diet high in complex carbohydrates and fiber and exercised daily for three weeks, significant reductions were observed in:serum cholesterol (22 %)The average weight loss in these subjects was less than 5 % of initial body weight!
triglycerides (26 %)
insulin (32 %)
glucose (13 %)
systolic (6 %) and
diastolic (8 %) blood pressure.
The results of the Dietary Approaches to Stop Hypertension trial, published in the Journal last year, (N Engl J Med1997;336:1117-24) demonstrated that subjects could reduce their blood pressure within two weeks by consuming a healthier diet, without losing weight.
In addition to remembering that "Above all else, do no harm," we would be wise to heed one of Hippocrates' more insightful, if less well known, aphorisms:
"Do not allow the body to attain extreme thinness, for that, too, is treacherous, but bring it only to a condition that will naturally continue unchanged, whatever that may be."
