The consequences of a weight‐centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight

Abstract

Current healthcare is weight-centric, equating weight and health. This approach to healthcare has negative consequences on patient well-being. The aim of this article is to make a case for a paradigm shift in how clinicians view and address body weight. In this review, we (1) address common flawed assumptions in the weight-centric approach to healthcare, (2) review the weight science literature and provide evidence for the negative consequences of promoting dieting and weight loss, and (3) provide practice recommendations for weight-inclusive care.

“Is it time to throw out the weighing scales?” Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches

“…In the literature, weight-inclusive programmes that focus on the social experience of living with obesity and psychological aspects of eating have been shown to provide physical and psychological benefit to patients. 39 , 40 , 41 …”

Sex-specific impact of body weight on atherosclerotic cardiovascular disease incidence in individuals with and without ideal cardiovascular health

“…8,9,27 Increasing evidence also suggest that weight-centric approaches are not sustainable for most people and may even be harmful, for instance by contributing to weight stigma. 28 Weight stigma often results in emotional distress (body dissatisfaction, low self-esteem and well-being, depression, etc.) and psychological stress, all of which are risk factors for ASCVD.…”

Dismantling weight stigma in eating disorder treatment: Next steps for the field

“…Weight stigma is associated with a host of adverse physical and psychological outcomes, yet remains overshadowed by the volume of literature equating weight and health ( 3 ). In a 2018 systematic review, researchers found that after controlling for weight status, weight stigma predicted elevation in biomarkers associated with hypothalamic–pituitary–adrenal axis reactivity, systemic inflammation, and type 2 diabetes mellitus ( 9 ).…”

“…Healthcare providers are a primary source of weight stigma ( 3 , 8 , 32 , 33 ), which can lead to spending less time with and being more critical of higher-weight patients ( 34 ), along with greater reluctance to provide routine medical care and education ( 35 ). It’s also associated with poorer patient-provider communication, loss of trust and rapport, and decreased patient engagement in care, as indicated by reduced adherence to treatment recommendations and greater avoidance of healthcare ( 7 ).…”

“…However, this approach vastly oversimplifies the complexity of body weight and fails to consider empirical evidence contradicting its underlying assumptions. Critiques of the weight-centric health paradigm have been discussed in detail (1)(2)(3)(4), yet the evidence supporting alternative models of care have not informed ED treatment. Central to these alternative models are three tenets: (1) there is no causal evidence supporting the link between higher body weight and disease or premature death (see the critiques cited above), (2) BMI is not empirically supported as a measure of an individual's health (5), and (3) interventions targeting health behaviors have shown to improve health independent of weight outcomes.…”