The health at any size paradigm for obesity treatment: the scientific evidence
W. C. Miller,
A. V. Jacob,
W. C. Miller
Exercise Science Programs, The George Washington University Medical Center, Washington, DC, USA;
Search for more papers by this authorA. V. Jacob
Department of Counseling/Human and Organizational Studies, The George Washington University Medical Center, Washington, DC, USA
Search for more papers by this authorW. C. Miller,
A. V. Jacob,
W. C. Miller
Exercise Science Programs, The George Washington University Medical Center, Washington, DC, USA;
Search for more papers by this authorA. V. Jacob
Department of Counseling/Human and Organizational Studies, The George Washington University Medical Center, Washington, DC, USA
Search for more papers by this author
Address reprint requests to:
Wayne C Miller
Exercise Science Programs, The George Washington University Medical Center, 817 23rd Street, NW, Washington, DC 20052, USA. E-mail: [email protected]
Summary
Traditional weight loss (TWL) treatments have been unsuccessful at reducing the prevalence of obesity in the population. Health-care professionals and consumers have criticized TWL treatments as being detrimental to the obese person's health. Consequently, an alternative approach to obesity treatment, the health at any size (H@AS) paradigm, has been proposed. The H@AS paradigm is based on the philosophy that once diet restrictions and barriers to activity have been removed, the individual will develop healthier eating and activity patterns that lead to a naturally healthy body weight. This paper reviews the philosophical foundation and the scientific data that support and oppose the H@AS paradigm and compares it with that of TWL treatments.
References
- 1 National Heart, Lung and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Heart, Lung and Blood Institute, Bethesda, MD, 1998, pp 1–228.
- 2 Berg FM. Women Afraid to Eat. Healthy Weight Network, Hettinger, ND, 1999, pp 1–376.
- 3 Lyons P & Burgard D. Great Shape: the First Fitness Guide for Large Women. Bull Publishing, Palo Alto, CA, 1990, pp 1–24.
- 4
Parham ES.
Is there a new weight paradigm?
Nutr Today
1996; 31: 155–161.
10.1097/00017285-199607000-00005 Google Scholar
- 5
Robison J.
Weight management: shifting the paradigm.
J Health Educ
1997; 28: 28–34.
10.1080/10556699.1997.10608585 Google Scholar
- 6 Gast J & Hawks SR. Weight loss education: the challenge of a new paradigm. Health Educ Behav 1998; 25: 464–473.
- 7 Miller WC. Fitness and fatness in relation to health: implications for a paradigm shift. J Social Issues 1999; 55: 207–219.
- 8 Lyons P & Miller WC. Effective health promotion and clinical care for large people. Med Sci Sports Exerc 1999; 31: 1141– 1146.
- 9 Miller WC, Koceja DM & Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes 1997; 21: 941–947.
- 10 Miller WC & Lindeman AK. The role of diet and exercise in weight management. In: Dalton S (ed). Overweight and Weight Management: the Health Professional's Guide to Understanding and Practice. Aspen Publishers, Gaithersburg, MD, 1997, pp 405–438.
- 11 Foreyt JP & Goodrick GK. Evidence for success of behavioral modification in weight loss and control. Ann Int Med 1993; 119: 698–701.
- 12 Gaesser GA. Big Fat Lies. Fawcett Columbine, New York, NY, 1996, pp 1–312.
- 13 Erdman CK. Nothing to Lose. Harper Collins, San Francisco, CA, 1995, pp 1–189.
- 14 Shape Up America American Obesity Association. Guidance for Treatment for Adult Obesity. Shape Up America, Bethesda, MD, 1996, pp 1–101.
- 15 Dalton S. Overweight and Weight Management: the Health Professional's Guide to Understanding and Practice. Aspen Publishers, Gaithersburg, MD, 1997, pp 1–615.
- 16 World Health Organization. Obesity: Preventing and managing the Global Epidemic. World Health Organization, Geneva, Switzerland, 1998, pp 1–276.
- 17 Brownell KD. Whether obesity should be treated. Health Psychol 1993; 12: 339–341.DOI: 10.1037//0278-6133.12.5.339
- 18 Ciliska D. Evaluation of two nondieting interventions for obese women. Western J Nurs Res 1998; 20: 119–135.
- 19 Hawks SR & Gast J. Weight loss management: a path lit darkly. Health Educ Behav 1998; 25: 371–382.
- 20 Omichinski L & Harrison KR. Reduction of dieting attitudes and practices after participation in a non-diet lifestyle program. J Can Dietet Assoc 1995; 56: 81–85.
- 21 Goodrick GK, Poston WSC III, Kimball KR & Foreyt JP. Nondieting versus dieting treatment for overweight binge-eating women. J Consul Clin Psychol 1998; 66: 363–368.
- 22 Popkess-Vawter S. Holistic self-care model for permanent weight control. J Holistic Nurs 1993; 11: 341–355.
- 23 Polivy J & Herman CP. Undieting: a paradigm to help people stop dieting. Int J Eat Disord 1992; 11: 261–268.
- 24 Carrier KM, Steinhardt MA & Bowman S. Rethinking traditional weight management programs: a 3-year follow-up evaluation of a new approach. J Psychol 1993; 128: 517–535.
- 25 Polivy J. Psychological consequences of food restriction. J Am Dietet Assoc 1996; 96: 589–592.
- 26 Gaesser GA & Miller WC. Symposium: has body weight become an unhealthy obsession? Med Sci Sports Exerc 1999; 31: 1118–1146.
- 27 Gaesser GA & Bouchard C. Is Obesity Detrimental to Health?. American College of Sports Medicine, 44th Annual Meeting, June 3–6, 1998, Orlando, FL.
- 28 Ikeda JP, Hayes D, Satter E, Parham ES, Kratina K, Woolsey M, Lowey M & Tribole E. A commentary on the new obesity guidelines from NIH. J Am Dietet Assoc 1999; 99: 918– 919.
- 29 Robinson JI, Hoer SL, Petersmark KA & Anderson JV. Success in obesity intervention: the new paradigm. J Am Dietet Assoc 1995; 95: 422–423.
- 30 Strain GW. Response to promoting size acceptance in weight management counseling. J Am Dietet Assoc 1999; 99: 926–928.
- 31 Parham ES. Promoting body size acceptance in weight management counseling. J Am Dietet Assoc 1999; 99: 920–925.
- 32 Kassirer JP & Angell M. Losing weight – an ill-fated new year's resolution. New Engl J Med 1998; 338: 52–53.
- 33 Allan JD. New directions for the study of overweight. Western J Nurs Res 1998; 20: 7–12.
- 34 National Film Board of Canada. Fat Chance. National Film Board of Canada, Winnipeg, Manitoba, Canada, 1994.
- 35 Kilbourne J. Slim Hopes. Median Education Foundation, Northampton, MA, 1995.
- 36 Berg FM. Health Risks Associated with Weight Loss. Healthy Weight Journal, Hettinger, ND, 1995, pp 1–156.
- 37 Rippe JM, Price JM, Hess SA, Kline G, DeMers KA, Damitz S, Kreidieh I & Freedson P. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. Obes Res 1998; 6: 208–218.
- 38 Mellin L, Chroughan-Minihane M & Dickey L. The solution method: 2-year trends in weight, blood pressure, exercise, depression, and functioning of adults trained in development skills. J Am Dietet Assoc 1997; 97: 1133–1138.
- 39
Tanco S,
Linden W &
Earle T.
Well-being and morbid obesity in women: a controlled therapy evaluation.
Int J Eat Disord
1998; 23: 325–339.DOI: 10.1002/(sici)1098-108x(199804)23:3<325::aid-eat10>3.3.co;2-6
10.1002/(SICI)1098-108X(199804)23:3<325::AID-EAT10>3.0.CO;2-X CAS PubMed Web of Science® Google Scholar
- 40 Roughan P, Seddon E & Vernon-Roberts J. Long-term effects of a psychologically based group programme for women preoccupied with body weight and eating behavior. Int J Obes 1990; 14: 135–147.
- 41 Sbrocco T, Nedegaard RC, Stone JM & Lewis E. Behavioral choice treatment promotes continuing weight loss: preliminary results of cognitive-behavioral decision-based treatment for obesity. J Consult Clin Psychol 1999; 67: 260–266.DOI: 10.1037//0022-006x.67.2.260
- 42 French SA & Jeffery RW. Consequences of dieting to lose weight: effects on physical and mental health. Health Psychol 1994; 13: 195–212.DOI: 10.1037//0278-6133.13.3.195
- 43 Wilson GT. Relation of dieting and voluntary weight loss to psychological functioning and binge eating. Ann Int Med 1993; 119: 727–730.
- 44 Klem ML, Wing RR, McGuire MT, Seagle HM & Hill JO. A descriptive study of individuals successful at long-term weight loss. Am J Clin Nutr 1997; 66: 239–246.
- 45 National Task Force on the Prevention and Treatment of Obesity. Very low-calorie diets. JAMA 1993; 270: 967–974.
- 46 Mole PA, Stern JS, Schultz CL, Bernauer EM & Holcomb BJ. Exercise reverses depressed metabolic rate produced by severe caloric restriction. Med Sci Sports Exerc 1989; 21: 29–33.
- 47 Bryner RW, Ullrich IH, Sauers J, Donley D, Hornsby G, Kolar M & Yeater R. Effects of resistance vs. aerobic training combined with an 800 calorie liquid diet on lean body mass and resting metabolic rate. J Am College Nutr 1999; 18: 115–121.
- 48 Svendsen OL, Hassager C & Christiansen C. Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight post menopausal women. Am J Med 1993; 95: 131–140.
- 49 Ryan AS, Nicklas BJ & Dennis KE. Aerobic exercise maintains regional bone mineral density during weight loss in post menopausal women. J Appl Physiol 1998; 84: 1305–1310.
- 50 Pi-Sunyer FX. Comorbidities of overweight and obesity: current evidence and research. Med Sci Sports Exerc 1999; 31: S602–S608.
- 51
Telch CF &
Agras WS.
Obesity, binge eating and psychopathology: are they related?
Int J Eat Disord
1994; 15: 53–61.
10.1002/1098-108X(199401)15:1<53::AID-EAT2260150107>3.0.CO;2-0 CAS PubMed Web of Science® Google Scholar
- 52 National Institutes of Health Technology Assessment Conference Panel. Methods for voluntary weight loss and control. Ann Int Med 1993; 119: 764–770.
- 53
Heatherton TF,
Polivy J &
Herman CP.
Dietary restraint: some current findings and speculations.
Psychol Addict Behav
1990; 4: 100–106.DOI: 10.1037//0893-164x.4.2.100
10.1037//0893-164x.4.2.100 Google Scholar
- 54 Schoeller DA, Shay K & Kushner RF. How much physical activity is needed to minimize weight gain in previously obese women. Am J Clin Nutr 1997; 66: 551–556.
- 55 US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. USDHHS, Centers for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 1996, pp 9–14.
- 56 Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J & Wilmore JH. Physical activity and public health: a recommendation from the Centers for Disease Control and the American College of Sports Medicine. JAMA 1995; 273: 402–407.
- 57 Tremblay A, Doucet E & Imbeault P. Physical activity and weight maintenance. Int J Obesity 1999; 23: S50–S54.
- 58 American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Dietet Assoc 1997; 97: 71–74.
- 59 Forster J & Jeffrey R. Gender differences related to weight history, eating patterns, efficacy expectations, self-esteem, and weight loss among participants in a weight reduction program. Addict Behav 1986; 11: 141–147.
- 60 Tiggemann M & Rothblum ED. Gender differences in internal beliefs about weight and negative attitudes towards self and others. Psychol Women Quart 1997; 21: 581–593.
- 61 Miller WC & Eggert KE. Weight loss perceptions, characteristics, and expectations of an overweight male and female population. Med Exerc Nutr Health 1992; 1: 42– 47.
- 62 Molley BL & Herzberger SD. Body image and self-esteem: a comparison of African-American and Caucasian women. Sex Roles 1998; 38: 631–643.
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