Commentary: Current perspectives on obesity and health: Black and white, or shades of grey?

Abstract

Much attention has been focused on the increasing prevalence of overweight and obesity in many countries around the world. The causes of these increases over recent decades are not well understood, although they must be due to changes in various lifestyle factors. We think that the risks of overweight and obesity have often been overstated, but nonetheless believe that the upward trends in average weight and BMI do not augur well for public health. In our opinion, there has too often been an uncritical acceptance by many of any claim about the health hazards of obesity, and there has been an overemphasis on weight loss as a clinical target. A focus on weight loss is often counterproductive and unsuccessful, and sometimes may even be unnecessary. Too many health professionals appear to not look past the BMI when performing clinical risk stratification or making health recommendations. We do not think that the individual with a BMI of 31 who has normal values for lipids, blood pressure, and glucose; is physically active every day; and follows other lifestyle and preventive medicine recommendations needs to attempt weight loss. We prefer to focus attention, both for clinical interventions and for public health programmes, on healthful lifestyle behaviours. Everyone should be encouraged to follow a healthful dietary pattern that emphasizes fruits, vegetables, and whole grains; limits intake of saturated and trans fat; and includes a wide variety of foods. Everyone also should be encouraged to engage in moderate intensity physical activity for at least 30 min on at least 5 days/week. These recommendations clearly lead to improved health and function and will provide benefits whether or not they result in weight loss. Let us keep the focus on lifestyle behaviours and their effect on biological risk factors and health outcomes rather than their effect on the scale. © The Author 2005; all rights reserved.