Response: lifestyle not weight should be the primary target

Abstract

We are glad to see such a wide range of esteemed scholars engage complex questions surrounding the relationship between body mass and health. We are also pleased to see so many points of agreement between our respondents and ourselves. First, everyone is in agreement with the parameters of global weight change, as defined in detail by Flegal 1 —the average person has gained about one pound per year. Opinions vary sharply over the likely consequences of this creeping ‘epidemic’. Second, as many acknowledge, the debate surrounding weight and health is often contentious and confusing because of economic and cultural factors that affect it at every turn. For instance, Kim and Popkin 2 applaud our efforts in drawing attention to ‘some of the complexities in overweight/obesity and health relationships and [the] covert financial interests involved in obesity research and related promotion activities’. Similarly, Lobstein 3 recognizes the need to acknowledge the current diversity of opinion on this subject. The powerful cultural and ideological factors that drive the current world wide obsession with thinness and fatness are eloquently discussed by Orbach. 4 Her response illustrates the painful consequences— especially for women and girls—of modern tendencies to demonize certain foods and larger bodies. In regard to the relationship between weight and health, we note Flegal 1 agrees that ‘to date it is not clear what the major health effects of the trends in obesity and overweight have been’, given continually improving life expectancy and declining rates of many conditions such as heart disease. Similarly, Blair and LaMonte 5 caution against the ‘uncritical acceptance of many of any claim about the health hazards of obesity’, and point out that ‘much of the extant prospective data indicate that there is little difference in risk across a very wide range of BMI values, and these associations may be different for various subgroups’. Even Rigby 6 acknowledges this general point when he argues that optimal BMI may be lower for Asians, although he fails to note that much evidence suggests optimal BMI for people of West African descent is higher than for other groups or that it is difficult to find any difference in risk estimates for all-cause mortality among many subgroups across an extremely wide range of BMI values, i.e. 18.5–35. Given the disproportionate attention being focused on obesity among racial minorities, this represents an interesting selective citation of data. We also agree that, as Kim and Popkin 2 note, there are important risks associated with weight loss methods and products, and it troubles us that obesity researchers often ignore or understate these risks. We strongly support programmes that promote health, but such programmes should actually improve health, not merely attempt to make or keep people thin. This is the core of the debate about weight and health, and our view is captured by Blair and LaMonte’s 5 statement that ‘there has been an overemphasis on weight loss as a clinical target’.‘ Consider, for example, the interpretation Kim and Popkin, 2