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Doctors should emphasize exercise, not weight loss

706 new weight guidelines

Do you dread going to the doctor because you know they will pin your health problems on your weight? Or maybe you quit going to the doctor all together to avoid feeling embarrassed and ashamed. Because the stigma attached to body size has been shown to cause weight gain, researchers are calling for doctors to emphasize exercise rather than weight loss.

Although it’s true obesity is linked to myriad inflammatory health conditions, it’s also true that diets fail the majority of people and often lead to weight gain. Also, some people are overweight due to genetic predisposition, numerous starvation diets, a history of an eating disorder in response to childhood trauma, and so on.

For those people who have spent a lifetime battling their weight and the stigma associated with it, a visit to the doctor simply opens a Pandora’s box of shame, despair, hopelessness, and self-loathing. Many decide it’s simply healthier not to go.

Policy may shift to taking the emphasis off weight

Fortunately, the Centers for Disease Control and Prevention is aware of the ineffectiveness of shaming patients.

A recent essay published by the CDC called for doctors to lay off patients who don’t meet the body mass index (BMI) guidelines and instead shift the focus to helping a patient exercise regularly.

The essay argues that avoiding “fat shaming” will go a long way to establishing better doctor-patient rapport and trust, thus facilitating a patient’s sense of positivity and willingness to adapt healthier habits.

Diets and thinking you are fat lead to obesity

Studies consistently show diets actually lead to long-term weight gain and obesity.

What’s even more shocking is that the perception you are overweight also leads to long term weight gain, even if your original BMI was in the normal range.

In other words, telling a patient they are too fat can actually make them gain weight, not lose it.

And telling yourself you are too fat will do the same.

Addressing obesity and health without stigma

Clearly, telling people they are too heavy and need to lose weight isn’t working.

The key, say researchers, is to promote the idea that a person can be healthy at any weight. This requires decreasing the stigma, establishing trust and rapport, and encouraging exercise and healthy behaviors. It also requires taking into consideration the patient’s social and financial situation.

According to recent studies, regular exercise improves health at any weight. It also reduces the risk of chronic diseases such as diabetes, heart disease, and Alzheimer’s.

Focusing on regular exercise also shifts the focus away from judging the person’s body and instead puts it on behaviors that can be influenced, barriers that can be addressed, and progress that can be measured at follow-up visits, regardless of weight.

Diets have a terrible track record for the majority of people. However, exercise is an area where most people can succeed, regardless of their body size or fitness level.

Ask my office how we can help you improve your health in a way that works for you.


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Fitness, not fatness, predicts how long you live

fitness not fatness predicts mortality

We’ve long been told if we want to be healthier and live longer we need to drop the pounds, but turns out being fit is the best predictor for longevity, even if you’re overweight.

A team of researchers examined a collection of studies that together looked at thousands of people for as long as 16 years.

They divided study subjects into three groups: normal weight, overweight, and obese. They then divided them into fit and unfit groups based on endurance tests, typically running on a treadmill.

Their analysis showed that the subjects’ performance in the endurance tests determined their mortality risk in the coming years, not their weight. In fact, the unfit people had twice the risk of dying as the fit people, regardless of their weight. Overweight and obese people who were fit had the same mortality risks as fit participants who were normal weight.

In a nutshell  A thin unfit person is twice as likely to die as an obese fit person. This is great news to those who have struggled much of their lives, unsuccessfully, to lose weight. As long as they keep exercising, they can expect to live a longer, healthier life.

A big downside to the study was that the majority of subjects were men, so we can’t say for sure how the results apply to women. Also, it would be interesting to look at a study like this in relation to diabetes, cancer, high blood pressure, and other chronic health risks. The researchers only looked at length of life and not occurrence of disease.

So what does being fit look like?

Fortunately, enjoying these benefits of being fit does not require you to be a warrior at the gym or at Crossfit. In fact, in functional medicine we know that over exercising (which varies from person to person) is a great way to tax your health.

Most of the “fit” study participants were evaluated for an average of eight to 12 minutes on a treadmill. This falls in line with federal guidelines that suggest as little as two and a half hours of exercise a week, which can be done in increments as short as 10 minutes at a time, qualify you as fit.

Ways to meet those weekly goals can include parking far enough away from your destination that you have to walk 10 minutes to reach it, using a standing or stationary bike desk at work, and taking regular brisk walks.

Exercise is about much more than living longer

The promise of a longer life does not actually provide much motivation for many people, especially those who are younger. Instead, it’s important to look at other benefits of regular exercise.

Regular walking and other exercise have been shown to improve brain function, ward off depression  and boost self-esteem  and even curb cravings and addiction.