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Should Obesity Interventions Focus on Weight Loss or Fitness?

Should Obesity Interventions Focus on Weight Loss or Fitness?

This is part of our “In Medical News” series where Dr. Sara Laudani shares a study or article in recent news and offers some analysis and tips about the news, to help patients stay informed.

A recent study review concluded that obesity interventions would be more effective at preventing deaths if they focused less on weight loss and more on increased physical activity and improved fitness. They argue that weight shouldn’t be the only goal or determinant of success.
“If you increase fitness, you improve outcomes even when people don’t lose weight,” noted Ross, one of the researchers from the School of Kinesiology and Health Studies at Queen’s University in Canada.
The results of their review, which directly compared the mortality risk reduction associated with weight loss compared with increasing fitness, physical activity, or both, were clear. As summarized by study author Glenn A. Gaesser, PhD, “Increasing fitness, physical activity, or both are associated with greater mortality reductions than intentional weight loss. We argue that a weight-neutral approach to treating obesity is the way to go.” He added that there are no downsides to exercise, but there can be with weight loss. This is particularly because weight gain often follows weight loss from such interventions, creating an unhealthy cycle that is also frustrating for the patients.
However, a few days after this study was published another review was done that strongly calls for weight loss of at least 15% of starting body weight as the primary goal for most patients with obesity and type 2 diabetes. Other experts argue it should not be one or the other, as both increased fitness and weight loss are necessary.
One of the biggest problems with making strong conclusions from these reviews is that they’re based on observational studies. Many are based on patient estimations, which are inherently flawed.
The authors of this study have previously released similar data and recommendations, but they feel clinicians and programs rarely act on it, continuing to focus on weight loss. “We propose that the proxy for health improvements should not be weight loss but instead improvements in cardiometabolic parameters, functional status, and fitness.”
As they shared, they do also recommend a balanced diet and this, together with the exercise interventions, should mean that patients do not gain weight and often lose weight. They are primarily suggesting that interventions have often neglected to measure fitness improvement when it may be the best predictor of reducing disease and death.


• One step at a time: we have a body, a powerful machine; it doesn’t matter its shape and weight. As a first step, let’s make sure this machine working, and let’s start moving. Slowly but consistently. Small steps towards changing from a sedentary life to a more active one, because we know that exercise, particularly cardiovascular exercise, offers significant health benefits and reduces your risk of death, regardless of body weight. Improving our fitness is one of the best ways to improve many health issues. We don’t need to wait to lose weight before enjoying the benefits of physical activity.
• Weight is not the only indicator of health.
• As species, we are not meant to spend our days on chairs and sofas. We have limbs to walk and run, to climb and lift and each single action counts! Choose to climb the stairs whenever possible instead of taking the elevator, choose to walk or bike instead driving, choose to challenge your machine every time you can. We will discover many opportunities a day for moving our bodies.

Dr. Sara Laudani offers consultations in internal medicine and functional and nutritional medicine in our Hongmei Road Clinic – Hongqiao. Click here to schedule an appointment with her and find out how her holistic approach and protocols can help you resolve your health issues.