Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.
In the article by Wang et al. (1), are we to conclude that brain scans are better regarded as projective tests, eliciting all of the gender and weight stereotypes of the researchers? 1. The authors state, ''Because there are significant gender differences in the prevalence of obesity and eating disorders (8) . . .'' The reference supplied is a study of Harvard alumni, not an epidemiological study on either obesity or eating disorders. In fact, there are no data that women are significantly more likely to be obese. 2. ''Our findings of a lack of a response to inhibition in women are consistent with behavioral studies showing significantly higher scores in disinhibition in women than men (53).'' The reference study only includes women. ''The decreased inhibitory control in women could underlie their lower success in losing weight when compared with men (8).'' Again, the Harvard study, not a study comparing dieting success; and the male subjects were actually heavier. 3. The authors do not write about an obvious competing hypothesis that would explain the data, that women are more likely than men to diet, and to have a history of dieting. We know from rat studies that binging behavior can be induced in rats who have been exposed to dieting, stress, and palatable foods.I am alarmed at the way the data here have been interpreted and referenced with irrelevant or contradictory research. The seeming authority of a brain scan should not give us the illusion that these findings are ''facts'' made dispassionately without gender and weight bias.
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