2025-06-26T04:17:00Z

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In a thought-provoking article published in The BMJ, experts warn that concentrating exclusively on weight loss for individuals with a high body mass index (BMI) might cause more harm than good. Led by Dr. Juan Franco, the research team argues that the majority of individuals dealing with higher weight struggles to maintain a clinically significant weight loss through lifestyle changes. Additionally, the potential negative consequences of weight loss interventions, such as perpetuating weight stigma, remain inadequately understood.

Dr. Franco and his colleagues emphasize the importance of a healthy lifestyle, stating that it offers significant benefits to overall well-being. However, they caution against using weight alone as a definitive measure of health. Instead, they advocate for healthcare providers to deliver high-quality, evidence-based care tailored to the unique preferences and needs of each patient, irrespective of their weight.

For decades, lifestyle interventions have primarily targeted energy intake reduction and increased physical activity as the main strategies for weight reduction among those with obesity. Despite this long-standing approach, rigorous research has shown that these interventions frequently fall short when it comes to achieving sustained, long-term weight loss and reducing serious health risks such as cardiovascular events, which encompass heart attacks and strokes, or even mortality.

While it is acknowledged that embracing a healthy lifestyle can yield important health benefits, it is equally essential to recognize that relying solely on weight as an indicator of health is insufficient. The authors suggest that understanding the limitations of traditional lifestyle interventions could lead to more effective, patient-centered healthcare strategies.

Moreover, the authors argue that an intense focus on weight loss can foster societal weight bias—negative perceptions and judgments about individuals based solely on their weight. This stigma not only adversely affects mental health but can also be linked to unhealthy eating behaviors, the emergence of disordered eating patterns, and, paradoxically, weight gain.

Recent clinical guidelines reflect a growing awareness that weight is an inadequate health metric. Alternative approaches, such as Health at Every Size (HAES), propose that individuals can achieve good health without necessarily losing weight. Preliminary findings indicate that these methods can lead to improvements in eating behaviors and overall health.

While the authors stress the necessity of conducting large clinical trials to evaluate these alternative approaches, they also urge healthcare professionals to adapt their practices based on the insights gained from them. This information can help doctors provide more compassionate and effective care for patients with larger body types.

“Physicians should be equipped to inform patients seeking weight loss about both the potential benefits and risks associated with various interventions, with a goal to minimize the likelihood of developing eating disorders and managing long-term metabolic impacts,” the authors state. They propose that a patient-centered approach is likely to improve care, align with individual patient preferences, and alleviate weight bias.

In conclusion, Dr. Franco and his team assert that while doctors' advice regarding healthy eating and physical activity remains pertinent, the primary objective should be to deliver quality care independent of weight. This entails a shift from weight-centric discussions to conversations about health benefits, potential risks, and what matters most to each patient.

Source: BMJ Group Journal reference: Franco, J. V. A., et al. (2025) Beyond body mass index: rethinking doctors’ advice for weight loss. The BMJ. doi.org/10.1136/bmj-2025-084654.