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Revised draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Children and Adolescents

ID: 
3
Personal Details
First Name: 
Oliver
Last Name: 
Frank
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In regard to your comments, do you have a Conflict of Interest to disclose?: 
No
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Comments: 
General comments
Comments: 

When health professionals are considering how to help people who are too fat and who want to become slimmer, we are doing them a disservice if we do any of the following:

  • weigh them;

  • advise them to weigh themselves;

  • use any indices that attempt or purport to measure fatness by including weight in the calculation, such as BMI;

  • talk about weight, overweight, weight loss or losing weight.

There are three main reasons why we are doing our patients a disservice if we do any of the things listed above. The first reason is that what we, and hopefully the patient, are really concerned about and interested in is fatness, shape and size. We know that weight, for the reasons listed in table 4.3 in the draft Guidelines, is often a relatively poor indicator of fatness.

The second main reason is that focussing on the number on the weighing machine often has a counter productive effect on people who are trying to become slimmer. It is well known that weight often fluctuates for a number of reasons. If the number on the weighing machine increases or does not become less, many fat people who are trying to become slimmer give up, and continue or revert to their behaviours that caused them to become fat in the first place. If the number becomes smaller, some people relax their efforts and revert to some of all of the behaviours that caused them to become fat in the first place.

The third reason why using the expressions "loosing weight" and "weight loss" is undesirable is that for many people, this has sinister connotations, as in: "My uncle Jim lost a lot of weight, and then he died".

Health professionals would help fat people who want to become slimmer better by:

  • using simple words that everybody understands such as "fat" and "slim", as in: "I agree that you are too fat, and I am very happy to help you to become slimmer";

  • explaining the limitations of weight as a measure of fatness and as a measure of progress towards slimness;

  • not weighing them;

  • advising them not to weigh themselves;

  • if we are going to use any measurements of progress towards slimness, use measures that better reflect fatness, such as waist circumference;

  • advising patients that their progress towards slimness will be quite evident to them by looking in the mirror, by their changing clothing size and by their feeling of well-being.

To avoid perpetuating the misplaced and misleading focus on and obsession with the numbers on weighing machines, I strongly recommend that in most places in the Guidelines in which the word "weight" appears, it should be removed and replaced by a more appropriate, meaningful and specific expression. For example:

"2.1 Energy balance and regulation of body weight"

2.2 Drivers of weight gain

PART B — WEIGHT MANAGEMENT IN ADULTS

7.2 Long-term weight management"

would be better as something like:

"2.1 Energy balance and regulation of body fat"

2.2 Drivers of fat gain

PART B — FATNESS MANAGEMENT IN ADULTS

7.2 Long-term body fatness management"

Page reviewed: 6 September, 2012