Weight Loss vs. Weight Maintenance: The Science May Surprise You

Obesity affects people worldwide. Overweight people have a higher risk of developing health conditions such as high blood pressure, diabetes, and high cholesterol. For decades, doctors have implored their patients to lose weight.

However, a growing number of experts are beginning to question this decades-old wisdom that weight loss is the only desirable outcome. Many professionals now emphasize embracing size acceptance and focus on healthy behaviors — instead of the number on the scale.

Understanding obesity

It is no secret that obesity has increased significantly in the past fifty years. According to the Centers for Disease Control, as of 2021, 42.1% of adults in America over 20 years old are obese. It’s impossible to avoid the topic as it seems to be mentioned or discussed on every talk show, local news broadcast, and health publication. The obesity ‘crisis’ and the ‘war on obesity have been raging for years.

It seems healthcare professionals worldwide have encouraged their patients to lose weight. Yet, this advice has yielded few results and spawned unintended harmful consequences.

While the health risks are real for some people with obesity, the high costs of weight stigma and weight bias when seeking medical care are real for all obese people.

This significant bias manifests in multiple ways; one is a decrease of trust in their medical teams, often leading them to avoid necessary care due to negative experiences. Other effects include harm to their mental health and delayed diagnosis of other diseases due to many health providers wrongly attributing medical concerns to obesity without appropriately exploring other causes.

Dr. Joseph Skelton, an obesity expert and a Professor of Pediatrics, Epidemiology, and Prevention at the Wake Forest University School of Medicine acknowledges the difficulty in treating overweight patients. Still, he firmly believes in the harm weight bias causes patients with obesity and seeks to address it in his practice and classroom.

Dr. Skelton states, “Recent research theorizes that a lot of the morbidity and mortality that we see from obesity comes not from having that excess body fat, but from the poor health care delivery they get due to all this weight bias and the stress that this weight bias causes on their body.”

Weight shaming and bias may be just as harmful to one’s health as obesity. So how do we address health and weight when desired, if that is true?

Size acceptance, a necessary thought shift

While healthcare professionals and society at large have shamed, criticized, and demanded overweight people lose weight, few who have attempted the endeavor have succeeded. Furthermore, those that do succeed, typically end up regaining the weight within five years.

As we start to understand the failures of traditional dieting and the severe mental and emotional health consequences of shaming overweight people, a new way of approaching the weight topic is needed. One that promotes healthy behaviors while acknowledging that a person’s size or weight does not necessarily predict their health.

The Association for Size Diversity and Health (ASDAH) uses the Health at Every Size (HAES) ® framework, and the broader size acceptance movement, to do just that. Growing numbers of healthcare providers aim to apply this philosophy in their practice as they recognize the need for a compassionate, non-judgmental approach to helping patients lead healthier lives.

The principles of HAES ® are:

• Weight inclusivity.
• Health enhancement.
• Eating for the well-being.
• Respectful care.
• Life-enhancing movement.

Proponents believe that by shifting to this healthcare philosophy, patients can focus on healthful behaviors rather than feelings of shame or guilt that often lead to years of yo-yo dieting, which we know has negative health consequences, and often poor weight loss results too.

Dr. Skelton utilizes aspects of the size acceptance movement in his work, helping families with obesity. He states, “We need to focus less on weight and more on the healthy behaviors we want to encourage.”

Obesity may be a health issue for some, but it is not a moral one.

Healthy habits, regardless of weight

Is it better to lose the extra pounds or maintain a steady weight?

The reality is, as with so many questions about our health, that the answer differs for each of us. If you are concerned about your weight, consult your doctor. However, you deserve a healthcare team that will check their weight bias and provides care that acknowledges you as a whole person.

Dr. Skelton says, “With the idea that obesity is a disease — which it is — there is no denying that for some people, extra weight on their body causes health problems. However, I also fully believe in the size acceptance movement; you need to look at my health for me, not just my body size.”

Size acceptance benefits everyone and creates a more just world where overweight people are not vilified for merely existing or wrongfully diagnosed simply because of the size of their bodies. Each individual should have a healthcare team who can address their health needs respectfully and effectively.

What you can do

The evidence is clear: we do not improve our health and wellness through self-loathing or shame.

Regardless of your current weight, there are many things you can do to embrace your body and become a healthier version of yourself.

Try one of these strategies to improve your health today:

Get your steps in — as few as 4,000 steps a day can have significant health benefits.

Increase your sleep — try going to bed 30 minutes earlier — with no screen time or ambient light, at least 30 minutes before bed.

Eat protein with each meal — increasing protein keeps us fuller longer and helps us build lean muscle tissue, which benefits everyone.

Be kind to yourself — no matter your goals, weight, or health, self-compassion correlates with improved mood and mental health.