Yahoo News Does Weight Loss Matter as Much as We Think?
Adolphe Quetelet wasn’t trying to come up with the world’s most influential physical health-measuring tool when he devised what became the Body Mass Index (BMI) in 1831. All he wanted to do was observe as much as he could about human physiology in his quest to find out what made ‘the average man’.
Then, as now, scientists were obsessed with data and trying to find patterns to better explain the world around them; this Belgian statistician and astronomer hoped to numerically define the typical man so that fellows who did not fit Mr Average’s profile had something to measure up to. Accordingly, he found a relationship between height and weight that has remained central to our idea of healthy body size for almost two centuries.
It has endured despite opposition. In 1972, a study in the Journal Of Chronic Diseases looked into indicators of obesity – in which the Quetelet Index was renamed the Body Mass Index – and concluded that BMI is only a reliable indicator of a population’s health, not an individual’s. Guidance from the UK’s National Institute for Health and Care Excellence also says that lower BMI thresholds should be used for adults in black, Asian and other minority ethnic groups to trigger actions to prevent disease, especially type 2 diabetes.
Nonetheless, 50 years on, with BMI now accepted as a general indicator only, we’re even further away from a consensus as to what degree weight and body fat are persuasive indicators of health.
Weighing the nation
All evidence from the past half century tells us that, in the West and in particular the UK, we’re in the middle of an obesity crisis. The UK’s Obesity Profile, published by the Office for Health Improvement & Disparities, says that obesity is associated with reduced life expectancy and chronic illnesses such as type 2 diabetes, cardiovascular disease, liver and respiratory problems, and 12 kinds of cancer.
With that, inevitably, comes an increase in people attempting to lose weight. And for a person to lose weight successfully – in other words, to do so without affecting their general health, and to then keep it off – the shedding of stones and the kicking of kilos has to be done steadily and sustainably over time. Surely we can all agree on that, can’t we?
Well, it seems we can’t. There is a growing movement around the idea that weight and body fat percentage are unreliable markers of health, and that health advice should not focus so heavily on weight loss. There’s also the suggestion that the stigma around being overweight is misunderstood and a central factor in the poor health of larger people. In other words, the psychological burden of being overweight might be as bad for someone, or even worse, than the physiological effects of the numbers on the scales.
Analysis of 25 studies of weight stigma, by a team of scientists at University College London, found ‘extensive evidence’ that doctors and medical professionals were essentially fat-shaming their patients due to unconscious bias. The feeling of being judged when failing to adhere to nutrition or fitness plans increased a patient’s likelihood of not following those plans. This study-of-studies, published in August 2022, also found that during the pandemic, patients preferred online consultations to in-person appointments. ‘They felt they were not judged from the moment they leave their house to go see their doctor,’ said Anastasia Kalea, the lead author and principal teaching fellow at UCL’s Faculty of Medical Sciences.
Meanwhile, the body-positive movement is changing the way society views and thinks about body size in general. Larger people are increasingly ‘owning’ their bodies and embracing their size (though admittedly it seems to be a mostly female-led phenomenon so far). This one is particularly hard for some to take on board – can it be a good thing for people to celebrate being overweight? While advertising campaigns and influencers espouse the cause, the body-positive movement has been criticised by the medical community for overlooking the physical issues being overweight can cause.
Crunching numbers
In November 2022, the global population reached eight billion. Earlier last year, in March, the World Health Organization said one billion people worldwide are classified as obese (650 million adults, 340 million adolescents and 39 million children). Data from Sport England’s Active Lives Adult Survey also estimates that 25.3% of adults were ‘living with obesity’ in the year to November 2021, up from 24.4% in the year before that, and from 22.7% in the year to November 2016.
Crucially, these numbers do not tell us how healthy those obese people are. However, in 2016, using data from a US government health survey, researchers from the University of California, Santa Barbara, found that half of US adults classified as overweight were ‘metabolically healthy’, along with 29% of Americans in the obese category. Conversely, the results showed that 30% of normal-weight adults were ‘cardiometabolically unhealthy’.
Yet the idea of being ‘healthily obese’ is simply a myth, claims Rishi Caleyachetty, assistant professor at Warwick Medical School. In 2017, he led a study at the University of Birmingham, which looked at the medical records of 3.5 million UK adults over two decades from 1995 to 2015. The study concluded that obese people considered to be healthy were 96% more likely to have heart failure and 49% more likely to develop coronary heart disease. (The study looked only at the records of adults with no history of heart problems and defined ‘healthy’ as having normal blood pressure and cholesterol levels, with no signs of diabetes or metabolic disease.)
‘Our work shows that so-called “metabolically healthy” obese individuals are still at higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight, metabolically healthy individuals,’ Dr Caleyachetty said. ‘The priority of health professionals regarding these patients should be to promote and facilitate weight loss, as it is with any other obese patient.’
If only it were so simple. Other research has shown that not everyone is able to lose weight even if they try. ‘We’ve known that obesity has been a disease for about 70 years,’ says Fatima Cody Stanford, associate professor of medicine and paediatrics at Harvard Medical School, ‘but what most people don’t realise is that the brain is the most important part of the body for regulating weight.’ The hypothalamus, the part of the brain that controls your nervous system, has two signal pathways concerning fat storage and burning. Research has shown that obese people use one of those pathways more than the other one. Pure willpower alone, then, may not be enough.
The social factor
There’s a lot to take in here. Traditional ideas of obesity are being challenged, especially through the prism of mental health and the way in which psychological factors contribute. However, for the majority of doctors, scientists and dietitians, obesity remains a good indicator of wellbeing; and if you’re overweight, you can take measures to lose that weight. The question is how.
Responsible advice generally goes along the lines of the following. Someone who wants to reduce mass should first gather the relevant data about themselves, ideally in conjunction with medical professionals or trusted health services. They should also ensure that any future weight loss does not come too quickly as to be harmful to them, especially where nutrition is concerned. Losing weight rapidly by eating too little sets up the conditions of some eating disorders. Studies have also shown that rapid weight loss is more likely to result in later weight gain, which is why measures to lose weight should be ones that can be continued long-term, even permanently, to maintain good health and to keep the weight off.
Adam Ratcliffe, a 31-year-old from Herne Bay on the north Kent coast, decided he would go on his weight-loss journey with other people. In December 2021, he saw an advert on Facebook for Man v Fat, an organisation that encourages weight loss via nutritional changes and five-a-side football, which was profiled in Men’s Health last summer. Adam started the programme at his local league in Margate a year ago. Back then, he weighed just under 20st. At 6ft 2in, he had always been ‘on the larger side, but because I was tall, I always thought I carried the weight pretty well.’ He was the big man in his friendship group, the brunt of an occasional fat joke, but there was never so much of that sort
of thing that he felt pressured by it.
‘I joined Man v Fat because my eating had spiralled out of control. I don’t really drink, not least because I often have to drive to see my friends. But I was aware that I needed help. And Man V Fat had the structure that I knew would make me pull my socksup and get into a better way of things.’
Adam played football once a week for about an hour, depending on the number of players who turned up. ‘The first time, after two or three minutes of playing, I was dying, thinking, “Please can this be over.” And the recovery, up to two days after, was hard to deal with. It was quite a difference in lifestyle. But I also felt I was doing something good. After a couple of months, I was one of a few who felt a bit fitter, so we started playing twice a week. This was the real benefit of the programme for me – finding guys in the exact same boat as me who wanted to lose weight. There was no stigma to it. With your regular friends, you wouldn’t necessarily do this sort of thing at the same time.’
Finding your five-a-side pals, running buddy or sparring partner is scientifically proven to be beneficial. A team at the University of Pittsburgh School of Medicine monitored people on a weight-loss programme: 76% of those trying it alone were successful, but 95% of those teamed with chums achieved their goals. Dreading the idea of sweating buckets in front of
the gym crowd? A 2016 paper published in Obesity showed that weight loss improved in those who spent more time with their fitter, thinner peers, while a study at Santa Clara University learned that people tend to match the workouts of those around them. Of course, you won’t immediately be able to lift or pedal like the guy hitting it hard on the machine next to you, but he will, psychologically, rub off on you…
A long supermarket shop looking at the sugar content of what he usually ate helped Adam to make food swaps that were easy to stick with, and his new diet, coupled with enjoyment-first exercise and sipping water from a sports bottle rather than trying to swig pints to improve his hydration, helped him to lose almost 2st in the first six weeks. ‘It’s tricky
when you lose weight because you’re very mindful of yourself. You can end up checking in a lot, maybe too much, to see how much you’ve lost. Putting yourself under pressure. But I was enjoying what was happening to me, and not worrying about it.’ By November 2022, eight months after he started the programme, Adam had lost nearly 7st, weighing in at just under 13st. He now preaches what he practises, as a coach for Man v Fat, and his example is an inspiration to those who follow in his wake.
‘I did lose a lot of weight, and I have made decisions and changes I thought might be hard, but ultimately I just wanted to be fitter,’ he says. ‘Having specific weight-loss goals can be helpful, but perhaps not if you’re concentrating on those and not on making the lifestyle changes that will keep you consistently healthy and prevent you putting the weight back on. In my experience, if you focus on making sustainable changes that feel like natural self improvements, there’s a positive feeling that comes with that. It spurs you on.’
Doing it right
The end result of losing weight may be salutary – reduced chances of disease associated with obesity; increased self-esteem having achieved a long-term attritional goal that transforms you into a version of yourself that makes you happier – but the act of losing weight requires time, patience and effort. Doing it right, on paper at least, is easy: gradually take in fewer calories than you expend over an extended period of time via the method of sustainable lifestyle changes, and if your hypothalamus isn’t working against you, you’ll lose weight. Right?
In January 2012, I joined a gym in order to slim down before my wedding day in April that year. Looking at the wedding pictures a few weeks after the Big Day, having managed not a single workout before it – who knew that in the months leading up to a marriage I’d be busy or distracted? – I felt properly fat. Having been considered either ‘big-boned’, ‘solidly built’, ‘quite fat’ or just ‘a bit out of shape’ since childhood, depending on the benevolence of the observer, I was determined not to be any of these ever again and my gym membership card was finally put to use.
I paid for a personal trainer who saw me for two 30-minute weights-and-body-weight sessions a week for 10 weeks. I would also do one cardio session a week: either a 30-minute swim or what I called my ‘duathlon’ – 5K on the treadmill followed by whatever I could manage on the stationary bike. My first 5K was practically walked and took 39 minutes; I managed about half that time on the bike. ‘This is Paul,’ my trainer said to another of his clients as I trudged past them, sodden and panting after a run-and-cycle session a few weeks in. ‘My God, he is sweaty.’ His frankness was also reflected in his training with me: he eased me into the world of regular exercise and set goals that kept me keen to train without undermining any of my confidence.
I paid for another 20 training sessions and then continued going to the gym regularly – three times a week, cardio only: a swim and two duathlons – until June 2013, the one-year anniversary of my first personal training session. At my best, I’d swim for an hour, run 5K
in 25 minutes, then do 20K on the bike in about 35 minutes. Throughout that time, I cut back on drinking, and during the working week, I ate my lunch every day at a serve-yourself salad bar in the Tesco around the corner from my office, first turning my nose up but then quickly coming to love small hard-boiled eggs and shiny cubes of beetroot. At dinner, I eschewed potatoes and pasta. I gave up the two big lattes I once drank every day, switching to black coffee, and snacked on dried fruit and nuts.
At that first session, my trainer weighed me at 15st 10lb. A year after my first gym visit, my weight had dropped to 12st 11lb. At 6ft tall, my BMI had gone from 29.8, just 0.2 shy of obese, to 24.3, the higher end of the healthy weight range. Almost a decade on, after nine and a half years of sensible drinking and eating, including the last five as a vegetarian, I weigh 13st 6lb – just in the yellow overweight section on the right of the BMI chart, at the 25.5 mark.
I haven’t been to the gym since 2014, but I became a parent in 2015 and again in 2017. For some people parenthood means a loss of activity and weight gain, but that has not been the case for me. In addition, I’ve thought more about eating healthily as a family, so my children understand about eating well and that normal food is healthy food. Not wanting to become a fat, wheezy dad who can’t play football his kids has also been a motivating factor. Since getting a dog in 2020, I’ve walked for at least an hour every day, often for longer than that, but my BMI still marks me as just overweight, and I know I will be thinking about what I eat and drink for the rest of my life. Those thoughts don’t own me, they’re just part of the daily routine.
For many people, though, keeping the weight off is harder. The yo-yoing of numbers on the scales is problematic, especially since weight loss invariably means losing some muscle mass, even in the most obese people. And subsequent weight gain rarely involves an increase in muscle mass, unless it’s a specific goal with nutrition and exercise plans to achieve it. This is ‘The Problem With Weight Loss’. There are no shortcuts, there are few certainties, and it morphs into the longer-term task of keeping weight off. But once you learn what works best for you, it’s easier to make small, smart, informed choices to achieve it. There’s a real sense of control in remaining committed to something that makes you feel good physically and mentally. They say you shouldn’t sweat the small things. I’d say it’s the small things that, ultimately, stop you sweating, which end up being far more rewarding and powerful.
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