We know that weight loss programs as public health initiatives are neither successful nor evidence based. #betterhealthuk

So what does helpful public health policy look like? a summary of recommendations from recent work by @drhunger, Joslyn Smith and Janet Tomiyama (A thread)

Their paper "An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy." Social Issues and Policy Review 14.1 (2020).

Presents evidence that approaches focussing on weight and weight surveillance are both ineffective at improving health but also harmful;

Broadly, helpful policy looks like:
1. Exclude weight from policy goals and language.
2. Avoid federal reimbursements for treatments targeting weight loss
3. Focus on modifiable behaviours
4. Remove stigmatising language
5. Eliminate BMI report cards and weight surveillance

Assumption 1/5: higher body weight equals poorer health.

“to ascribe a causal role of body weight ignores the likely possibility of third variables or reverse causation”. “

“to build policy based on something that we cannot definitively say is a primary causal factor seems both ineffective and scientifically unsound”

Recommendation 1: exclude weight from policy goals & language.

Assumption 2/5: Long-term weight loss is widely achievable

Those randomly assigned to [calorie deficit] did not lose signf more weight in the long term [2 yrs] cf randomly assigned to control groups. Prospective diet studies with no control group fare even worse - 33-66% of dieters gain back more weight than initially lost on the diet

Recommendation 2: Avoid federal reimbursement for treatments that target weight loss.

Assumption 3/5: Weight loss results in consistent improvements in physical health

“Given that weight loss attempts on average result in weight regain and thus weight fluctuation, the potential negative health consequences of weight loss attempts must be considered when shaping policy”

Recommendation 3: Focus on modifiable behaviours rather than weight

Assumption 4/5: weight stigma will motivate individuals to lose weight

“Current health promotion approaches often rely on weight stigma to carry their anti-ob*sity message

“Descriptions paint being higher weight as a dire threat & a drain on national resources, one that seemingly can be remedied through personal control & individual responsibility”

“We need to be concerned about weight stigma because evidence now exists that weight stigma promotes poor health”

Recommendation 4: Remove stigmatising language from policy language and public health campaigns

Assumption 5/5: Accurate perception of weight is needed to promote health

“perceiving oneself as “overweight” not only fails to produce weight reduction, it is also robustly associated with poorer health outcomes.”

Recommendation 5: Eliminate BMI report cards and other weight surveillance campaigns.