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Also just did a little digging. At the bottom of the guidelines it says: These guideline recommendations were developed based on the evidence from the Adult Weight Management Systematic Review. To view the review, visit www.andeal.org/awm. So I went to the review.
There are several disclosures about conflicts of interest by the review team, as well as these key findings:
1. In adults with overw*ight or ob*sity, weight management interventions provided by a dietitian result in significantly decreased BMI and waist circumference, and increased percent weight loss and a likelihood of achieving a 5% weight loss.
2. In adults with overw*ight or ob*sity and T2DM, weight management interventions may reduce fasting blood glucose levels.
3. In adults with overw*ight or ob*sity, limited evidence suggested Health at Every Size/Non-Diet interventions provided by a dietitian did not affect cardiometabolic outcomes.
Notice how the first key finding has nothing to do with health markers other than weight. The second finding says "may reduce" not "will reduce". The third finding is pulling on "limited evidence".
Thank you for going into the details here! I was wanting to spread the word about these harmful guidelines but didn't have the capacity to break it down. Now I can share your newsletter and ask people to comment on the guidance!
Here is what I just left on their feedback page for their proposal (luckily, I just finished teaching a Fat Studies course so had the info at my finger tips):
Much of the justification for the negative treatment of fatness and fat people rests on arguments related to health and medicine. If we follow the normal procedures of science, we need to show that there is evidence for our hypothesis before assuming its true. But in real life, scientific consensus also occurs because "a priori" assumptions are so seamless that they are not questioned.
One of the a priori assumptions that does not seem to require evidence is the idea that being fat is unhealthy. Variations on this idea include the assumption that:
1. Fat itself causes the disorders with which it is often associated
2. One can tell by looking at a person’s weight what they must be eating or how much they exercise
3. Losing weight will improve health
4. Successful and lasting weight loss is possible
The GOOD research out there (i.e. the research that controls for confounding variables, has good sample sizes, and has high validity and reliability) does not support these a priori assumptions.
There's so much research out there that supports the notion that 90+ percent of people who diet to lose weight gain it back (and then some) within 1-5 years (Stunkard & McLaren-Hume, 1959; Fletcher et al, 1992; Miller, 1999; Mann et al, 2007; Aphramor, 2010; the Australian National Medical Health and Research Counsil on Obesity, 2013; Fildes et al, 2015; Panel of Canadian Obesity Experts, 2020).
Weight cycling is more highly correlated with the negative health outcomes traditionally associated with weight than weight alone is (Paffenbarger, 1986; Lissner et al, 1991; Rzehak et al, 2007). So if you're recommending diets to lose weight, you're actually doing harm (Tylka et al, 2014).
You're also using the BMI as a measurement which is absolutely inappropriate. It was developed to measure populations, not individuals (you KNOW that; this is your field of expertise). It doesn't account for fitness level, gender differences, aging, or racial differences. It doesn't even account for height accurately: short people are misled into thinking that they are thinner than they are, and tall people are misled into thinking they are fatter.
The problem with thinking of fat as the cause of disease (even if it's just the "disease of obesity") is that you then think that losing weight (fat) is the solution when, in fact, dieting compounds the problem. There are often OTHER FACTORS (ex: weight cycling; stigma of all kinds; fitness/activity level; socioeconomic status, zip code, access to respectful and affordable healthcare) that contribute to disease. If these other factors aren’t controlled for in studies looking at the associations between weight and health, then those studies are worse than useless in helping us understand what is really happening. I say “worse than useless” because of the harm they cause via weight stigma and weight cycling, both of which are more highly correlated with the poor health outcomes associated with weight than weight itself is (Muennig et. al, 2008; Puhl, Andreyeva, & Brownell, 2008; Puhl & Heuer, 2010; Schafer & Ferraro, 2012; Brewis et al, 2016; Tomiyama, et al, 2018).
In 2013, the AMA asked its own Committee on Science and Public Health to explore the issue of classifying obesity as a disease. The committee came up with a 5-page opinion suggesting that obesity should NOT be officially labeled as a disease, for several reasons (Brown, 2015):
1. “Obesity doesn’t fit the definition of a medical disease. It has no symptoms, and it’s not always harmful—in fact, for some people in some circumstances, it’s been known to be protective rather than destructive.”
2. “Disease, by definition, involves the body’s normal functioning gone wrong. But many experts think obesity—the body efficiently storing calories as fat—is a normal adaptation to a set of circumstances (periods of famine) that’s held true for much of human history. In that case, the bodies that tend toward obesity aren’t diseased; they’re actually more efficient than naturally lean bodies.” Famine is still going on today in the world (and will continue on into the future). Human bodies are brilliantly designed to help them survive that.
3. “Medicalizing obesity could potentially hurt patients, creating even more stigma around weight and pushing people into unnecessary — and ultimately useless — 'treatments.’”
“Dieting, or yo-yo dieting as it’s more accurately referred to, is but a temporary food plan with only temporary solutions to something that IS NOT INHERENTLY A PROBLEM” (Harrison, 2021, p. 40, emphasis mine).
You know that saying amongst certain religious folks: “Hate the sin, not the sinner”? It’s commonly used to justify negative thoughts and behaviors they have towards people who are gay (“I don’t hate this gay person in my life, I just think they should stop loving who they love and be straight”). That might be a way for you to think of how the message that fat bodies are a problem to be fixed via weight loss affects your clients. You are giving them the message that, “I don’t hate you [fat person], I just think you should stop eating what you eat and be thin." Just like conversion therapy doesn’t change a person’s sexual orientation, weight loss diets don’t change a body’s genetic blueprint for doing what it does with food and fat. So, when we set up the expectation that fat people should not be fat, we are in effect saying that fat people should not exist. That we should launch every weapon at our disposal to eradicate them in our "War on Obesity."
THAT does more harm than good. In the small number (less than 10%) of clients who do keep the weight off after dieting, there is no GOOD research (i.e. research that accounts for the above mentioned confounding variables) that that reduced weight actually improves their morbidity or mortality rates.
Our first task as healthcare professionals is to do no harm. Advocating diets to lose weight is demonstratively harmful and does MORE harm than letting their body decide where it's going to settle weight-wise. By all means, support healthy behaviors such as eating healthy and exercising. Stop advocating weight loss, though. Stop. Doing. Harm. It's unethical.
If you don't trust all of the research I just cited, then DO GOOD RESEARCH to confirm or deny it. Do not ignore it, though. Your biases are literally killing people.
I find these guidelines triggering for people who have struggled with disordered eating behavior and eating disorders, which in my experience represents most of my clients. These guidelines re-enforce the concept that body size and weight are the keys to optimal health and that anything outside of the 'right' weight is uhealthy. They reinforce the belief that weight-loss is entirely within a person's control and that those who struggle to lose weight are weak/unmotivated/broken. I do not encourage my clients to count calories or weigh themselves. I focus on shifting the balance from excessive fun foods to more nourishing foods in amounts that feel satisfying and energizing. I encourage my clients to move their bodies in ways that they enjoy, which may not be a structured and regimented exercise program. In my experience regular weighing, calorie counting, and strict exercise regimens are temporary, fleeting, solutions which only worsen physical and mental health. I encourage you to re-consider these guidelines, and especially 4.6. I find 4.6 insulting and misguided. Please complete a comprehensive review of the literature regarding HAES and Non-Diet Approaches and their positive impact on physical and mental health outcomes.
Are they actively trying to become inconsequential in the world of research-based health and weight management? To ignore the evidence for HAES approaches is so willfully ignorant.
I sent them these resources, along with other comments about my professional disappointment with the glaring omissions of the benefits of humane HAES approaches in this document:
This study shows that you can lower blood pressure significantly with the DASH eating style, without weight loss.
Hypertension, Volume 38, Issue 2, 1 August 2001; Pages 155-158
DASH (Dietary Approaches to Stop Hypertension) Diet Is Effective Treatment for Stage 1 Isolated Systolic Hypertension
Abstract
Use of the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low-fat dairy foods, significantly lowers blood pressure. Among the 459 participants in the DASH Trial, 72 had stage 1 isolated systolic hypertension (ISH) (systolic blood pressure, 140 to 159 mm Hg; diastolic blood pressure, <90 mm Hg). We examined the blood pressure response in these 72 participants to determine whether the DASH diet is an effective treatment for stage 1 ISH. After a 3-week run-in period on a typical American (control) diet, participants were randomly assigned for 8 weeks to 1 of 3 diets: a continuation of the control diet (n=25), a diet rich in fruits and vegetables (n=24), or the DASH diet (n=23). Sodium content was the same in the 3 diets, and caloric intake was adjusted during the trial to prevent weight change. Blood pressure was measured at baseline and at the end of the 8-week intervention period with standard sphygmomanometry. Use of the DASH diet significantly lowered systolic blood pressure compared with the control diet (−11.2 mm Hg; 95% confidence interval, −6.1 to −16.2 mm Hg; P<0.001) and the fruits/vegetables diet (−8.0 mm Hg; 95% confidence interval, −2.5 to −13.4 mm Hg; P<0.01). Overall, blood pressure in the DASH group fell from 146/85 to 134/82 mm Hg. Similar results were observed with 24-hour ambulatory blood pressure measurements. In the DASH diet group, 18 of 23 participants (78%) reduced their systolic blood pressure to <140 mm Hg, compared with 24% and 50% in the control and fruits/vegetables groups, respectively. Our results indicate that the DASH diet, which is rich in fruits, vegetables, and low-fat dairy foods, is effective as first-line therapy in stage 1 ISH.
This is the Weight Neutral for Diabetes Care (WN4DC) homepage which has lots of resources to encourage healthy blood sugar levels by eating and moving but not by unsustainable and restrictive diets. https://wn4dc.com/
Why A Weight-Neutral Approach is Essential in Diabetes Care
Also just did a little digging. At the bottom of the guidelines it says: These guideline recommendations were developed based on the evidence from the Adult Weight Management Systematic Review. To view the review, visit www.andeal.org/awm. So I went to the review.
There are several disclosures about conflicts of interest by the review team, as well as these key findings:
1. In adults with overw*ight or ob*sity, weight management interventions provided by a dietitian result in significantly decreased BMI and waist circumference, and increased percent weight loss and a likelihood of achieving a 5% weight loss.
2. In adults with overw*ight or ob*sity and T2DM, weight management interventions may reduce fasting blood glucose levels.
3. In adults with overw*ight or ob*sity, limited evidence suggested Health at Every Size/Non-Diet interventions provided by a dietitian did not affect cardiometabolic outcomes.
Notice how the first key finding has nothing to do with health markers other than weight. The second finding says "may reduce" not "will reduce". The third finding is pulling on "limited evidence".
Thank you for going into the details here! I was wanting to spread the word about these harmful guidelines but didn't have the capacity to break it down. Now I can share your newsletter and ask people to comment on the guidance!
Here is what I just left on their feedback page for their proposal (luckily, I just finished teaching a Fat Studies course so had the info at my finger tips):
Much of the justification for the negative treatment of fatness and fat people rests on arguments related to health and medicine. If we follow the normal procedures of science, we need to show that there is evidence for our hypothesis before assuming its true. But in real life, scientific consensus also occurs because "a priori" assumptions are so seamless that they are not questioned.
One of the a priori assumptions that does not seem to require evidence is the idea that being fat is unhealthy. Variations on this idea include the assumption that:
1. Fat itself causes the disorders with which it is often associated
2. One can tell by looking at a person’s weight what they must be eating or how much they exercise
3. Losing weight will improve health
4. Successful and lasting weight loss is possible
The GOOD research out there (i.e. the research that controls for confounding variables, has good sample sizes, and has high validity and reliability) does not support these a priori assumptions.
There's so much research out there that supports the notion that 90+ percent of people who diet to lose weight gain it back (and then some) within 1-5 years (Stunkard & McLaren-Hume, 1959; Fletcher et al, 1992; Miller, 1999; Mann et al, 2007; Aphramor, 2010; the Australian National Medical Health and Research Counsil on Obesity, 2013; Fildes et al, 2015; Panel of Canadian Obesity Experts, 2020).
Weight cycling is more highly correlated with the negative health outcomes traditionally associated with weight than weight alone is (Paffenbarger, 1986; Lissner et al, 1991; Rzehak et al, 2007). So if you're recommending diets to lose weight, you're actually doing harm (Tylka et al, 2014).
You're also using the BMI as a measurement which is absolutely inappropriate. It was developed to measure populations, not individuals (you KNOW that; this is your field of expertise). It doesn't account for fitness level, gender differences, aging, or racial differences. It doesn't even account for height accurately: short people are misled into thinking that they are thinner than they are, and tall people are misled into thinking they are fatter.
The problem with thinking of fat as the cause of disease (even if it's just the "disease of obesity") is that you then think that losing weight (fat) is the solution when, in fact, dieting compounds the problem. There are often OTHER FACTORS (ex: weight cycling; stigma of all kinds; fitness/activity level; socioeconomic status, zip code, access to respectful and affordable healthcare) that contribute to disease. If these other factors aren’t controlled for in studies looking at the associations between weight and health, then those studies are worse than useless in helping us understand what is really happening. I say “worse than useless” because of the harm they cause via weight stigma and weight cycling, both of which are more highly correlated with the poor health outcomes associated with weight than weight itself is (Muennig et. al, 2008; Puhl, Andreyeva, & Brownell, 2008; Puhl & Heuer, 2010; Schafer & Ferraro, 2012; Brewis et al, 2016; Tomiyama, et al, 2018).
In 2013, the AMA asked its own Committee on Science and Public Health to explore the issue of classifying obesity as a disease. The committee came up with a 5-page opinion suggesting that obesity should NOT be officially labeled as a disease, for several reasons (Brown, 2015):
1. “Obesity doesn’t fit the definition of a medical disease. It has no symptoms, and it’s not always harmful—in fact, for some people in some circumstances, it’s been known to be protective rather than destructive.”
2. “Disease, by definition, involves the body’s normal functioning gone wrong. But many experts think obesity—the body efficiently storing calories as fat—is a normal adaptation to a set of circumstances (periods of famine) that’s held true for much of human history. In that case, the bodies that tend toward obesity aren’t diseased; they’re actually more efficient than naturally lean bodies.” Famine is still going on today in the world (and will continue on into the future). Human bodies are brilliantly designed to help them survive that.
3. “Medicalizing obesity could potentially hurt patients, creating even more stigma around weight and pushing people into unnecessary — and ultimately useless — 'treatments.’”
“Dieting, or yo-yo dieting as it’s more accurately referred to, is but a temporary food plan with only temporary solutions to something that IS NOT INHERENTLY A PROBLEM” (Harrison, 2021, p. 40, emphasis mine).
You know that saying amongst certain religious folks: “Hate the sin, not the sinner”? It’s commonly used to justify negative thoughts and behaviors they have towards people who are gay (“I don’t hate this gay person in my life, I just think they should stop loving who they love and be straight”). That might be a way for you to think of how the message that fat bodies are a problem to be fixed via weight loss affects your clients. You are giving them the message that, “I don’t hate you [fat person], I just think you should stop eating what you eat and be thin." Just like conversion therapy doesn’t change a person’s sexual orientation, weight loss diets don’t change a body’s genetic blueprint for doing what it does with food and fat. So, when we set up the expectation that fat people should not be fat, we are in effect saying that fat people should not exist. That we should launch every weapon at our disposal to eradicate them in our "War on Obesity."
THAT does more harm than good. In the small number (less than 10%) of clients who do keep the weight off after dieting, there is no GOOD research (i.e. research that accounts for the above mentioned confounding variables) that that reduced weight actually improves their morbidity or mortality rates.
Our first task as healthcare professionals is to do no harm. Advocating diets to lose weight is demonstratively harmful and does MORE harm than letting their body decide where it's going to settle weight-wise. By all means, support healthy behaviors such as eating healthy and exercising. Stop advocating weight loss, though. Stop. Doing. Harm. It's unethical.
If you don't trust all of the research I just cited, then DO GOOD RESEARCH to confirm or deny it. Do not ignore it, though. Your biases are literally killing people.
Here is my comment!
I find these guidelines triggering for people who have struggled with disordered eating behavior and eating disorders, which in my experience represents most of my clients. These guidelines re-enforce the concept that body size and weight are the keys to optimal health and that anything outside of the 'right' weight is uhealthy. They reinforce the belief that weight-loss is entirely within a person's control and that those who struggle to lose weight are weak/unmotivated/broken. I do not encourage my clients to count calories or weigh themselves. I focus on shifting the balance from excessive fun foods to more nourishing foods in amounts that feel satisfying and energizing. I encourage my clients to move their bodies in ways that they enjoy, which may not be a structured and regimented exercise program. In my experience regular weighing, calorie counting, and strict exercise regimens are temporary, fleeting, solutions which only worsen physical and mental health. I encourage you to re-consider these guidelines, and especially 4.6. I find 4.6 insulting and misguided. Please complete a comprehensive review of the literature regarding HAES and Non-Diet Approaches and their positive impact on physical and mental health outcomes.
Thank-you.
Are they actively trying to become inconsequential in the world of research-based health and weight management? To ignore the evidence for HAES approaches is so willfully ignorant.
I sent them these resources, along with other comments about my professional disappointment with the glaring omissions of the benefits of humane HAES approaches in this document:
This study shows that you can lower blood pressure significantly with the DASH eating style, without weight loss.
https://www.ahajournals.org/doi/epub/10.1161/01.HYP.38.2.155
Hypertension, Volume 38, Issue 2, 1 August 2001; Pages 155-158
DASH (Dietary Approaches to Stop Hypertension) Diet Is Effective Treatment for Stage 1 Isolated Systolic Hypertension
Abstract
Use of the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low-fat dairy foods, significantly lowers blood pressure. Among the 459 participants in the DASH Trial, 72 had stage 1 isolated systolic hypertension (ISH) (systolic blood pressure, 140 to 159 mm Hg; diastolic blood pressure, <90 mm Hg). We examined the blood pressure response in these 72 participants to determine whether the DASH diet is an effective treatment for stage 1 ISH. After a 3-week run-in period on a typical American (control) diet, participants were randomly assigned for 8 weeks to 1 of 3 diets: a continuation of the control diet (n=25), a diet rich in fruits and vegetables (n=24), or the DASH diet (n=23). Sodium content was the same in the 3 diets, and caloric intake was adjusted during the trial to prevent weight change. Blood pressure was measured at baseline and at the end of the 8-week intervention period with standard sphygmomanometry. Use of the DASH diet significantly lowered systolic blood pressure compared with the control diet (−11.2 mm Hg; 95% confidence interval, −6.1 to −16.2 mm Hg; P<0.001) and the fruits/vegetables diet (−8.0 mm Hg; 95% confidence interval, −2.5 to −13.4 mm Hg; P<0.01). Overall, blood pressure in the DASH group fell from 146/85 to 134/82 mm Hg. Similar results were observed with 24-hour ambulatory blood pressure measurements. In the DASH diet group, 18 of 23 participants (78%) reduced their systolic blood pressure to <140 mm Hg, compared with 24% and 50% in the control and fruits/vegetables groups, respectively. Our results indicate that the DASH diet, which is rich in fruits, vegetables, and low-fat dairy foods, is effective as first-line therapy in stage 1 ISH.
This is the Weight Neutral for Diabetes Care (WN4DC) homepage which has lots of resources to encourage healthy blood sugar levels by eating and moving but not by unsustainable and restrictive diets. https://wn4dc.com/
Why A Weight-Neutral Approach is Essential in Diabetes Care
https://cme.dmu.edu/sites/default/files/Why%20A%20Weight-Neutral%20Approach%20is%20Essential%20in%20Diabetes%20Care.pdf
Health at Every Size (HAES) for People with Diabetes
https://ade.adea.com.au/health-at-every-size-haes-for-people-with-diabetes/
Great perspective, I also immediately wondered if there was a financial motive
Every person listed as a contributor is a women, and from what I can tell they're pretty much all thin white or Asian women.