dairy industry has aggressively promoted the weight-loss benefits of milk and other dairy products, based largely on findings from short-term studies it has funded. One exception is the recent dietary and lifestyle change study from the Harvard School of Public Health, which found that people who increased their yogurt intake gained less weight; increases in milk and cheese intake, however, did not appear to promote weight loss or gain.

Read more about healthy drinks on The Nutrition Source. Like refined grains and potatoes, sugary beverages are high in rapidly-digested carbohydrate. See Carbohydrates and Weight , above. These findings on sugary drinks are alarming, given that children and adults are drinking ever-larger quantities of them: In the U.

The good news is that studies in children and adults have also shown that cutting back on sugary drinks can lead to weight loss.

Read more on The Nutrition Source about the amount of sugar in soda, fruit juice, sports drinks, and energy drinks, and download the How Sweet Is It? guide to healthier beverages.

Ounce for ounce, fruit juices-even those that are percent fruit juice, with no added sugar- are as high in sugar and calories as sugary sodas. Read more about alcohol on The Nutrition Source.

While the recent diet and lifestyle change study found that people who increased their alcohol intake gained more weight over time, the findings varied by type of alcohol.

They eat meals that fall into an overall eating pattern, and researchers have begun exploring whether particular diet or meal patterns help with weight control or contribute to weight gain. Portion sizes have also increased dramatically over the past three decades, as has consumption of fast food-U.

children, for example, consume a greater percentage of calories from fast food than they do from school food 48 -and these trends are also thought to be contributors to the obesity epidemic.

Following a Mediterranean-style diet, well-documented to protect against chronic disease, 53 appears to be promising for weight control, too. The traditional Mediterranean-style diet is higher in fat about 40 percent of calories than the typical American diet 34 percent of calories 54 , but most of the fat comes from olive oil and other plant sources.

The diet is also rich in fruits, vegetables, nuts, beans, and fish. A systematic review found that in most but not all studies, people who followed a Mediterranean-style diet had lower rates of obesity or more weight loss.

There is some evidence that skipping breakfast increases the risk of weight gain and obesity, though the evidence is stronger in children, especially teens, than it is in adults.

But there have been conflicting findings on the relationship between meal frequency, snacking, and weight control, and more research is needed. Since the s, portion sizes have increased both for food eaten at home and for food eaten away from home, in adults and children.

One study, for example, gave moviegoers containers of stale popcorn in either large or medium-sized buckets; people reported that they did not like the taste of the popcorn-and even so, those who received large containers ate about 30 percent more popcorn than those who received medium-sized containers.

People who had higher fast-food-intake levels at the start of the study weighed an average of about 13 pounds more than people who had the lowest fast-food-intake levels. They also had larger waist circumferences and greater increases in triglycercides, and double the odds of developing metabolic syndrome.

Weight gain in adulthood is often gradual, about a pound a year 9 -too slow of a gain for most people to notice, but one that can add up, over time, to a weighty personal and public health problem.

Though the contribution of any one diet change to weight control may be small, together, the changes could add up to a considerable effect, over time and across the whole society.

Willett WC, Leibel RL. Dietary fat is not a major determinant of body fat. Am J Med. Melanson EL, Astrup A, Donahoo WT. The relationship between dietary fat and fatty acid intake and body weight, diabetes, and the metabolic syndrome. Ann Nutr Metab.

Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. Shai I, Schwarzfuchs D, Henkin Y, et al.

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. Howard BV, Manson JE, Stefanick ML, et al. Field AE, Willett WC, Lissner L, Colditz GA. Obesity Silver Spring. Koh-Banerjee P, Chu NF, Spiegelman D, et al. Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 US men.

Am J Clin Nutr. Thompson AK, Minihane AM, Williams CM. Trans fatty acids and weight gain. Int J Obes Lond. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men.

Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR. Dietary protein, weight loss, and weight maintenance.

Annu Rev Nutr. Furtado JD, Campos H, Appel LJ, et al. Effect of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart Trial. Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.

Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major dietary protein sources and risk of coronary heart disease in women. Aune D, Ursin G, Veierod MB.

Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis.

Abete I, Astrup A, Martinez JA, Thorsdottir I, Zulet MA. Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutr Rev. Barclay AW, Petocz P, McMillan-Price J, et al. Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies.

Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. Koh-Banerjee P, Franz M, Sampson L, et al.

Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men. Liu S, Willett WC, Manson JE, Hu FB, Rosner B, Colditz G. Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women.

Ledoux TA, Hingle MD, Baranowski T. Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev. The Office of Disease Prevention and Health Promotion ODPHP cannot attest to the accuracy of a non-federal website. You will be subject to the destination website's privacy policy when you follow the link.

HHS is not responsible for Section compliance accessibility on other federal or private websites. Cancel Continue to your destination:. However, those who continue to participate in studies using meal replacements give these products high taste and satiety ratings.

More recently, McCrory et al. Wing et al. Subjects were randomly assigned to receive one of four treatment groups: a standard behavioral treatment program Group 1 ; a behavioral program supplemented with either specific meal plans and grocery lists Group 2 ; a behavioral program supplemented with food provision on a cost-sharing basis Group 3 ; or a behavioral program supplemented with free food provision Group 4.

After the 6-month program, all treatment contact and food provision was stopped. The groups who received the structured advice about what to eat whether through meal plans and grocery lists or with food provision all lost more weight than the group who received the standard behavioral treatment program both at 6-month and 1-year follow-ups.

No extra weight-loss benefit was seen by actually giving food to participants. These studies on food variety and provision suggest that providing patients with examples of what they should eat, either by providing the actual food or by providing specific meal plans, and limiting the food choices variety have advantages in producing weight-loss results.

For these reasons, we need to consider the use of meal replacements as an effective option in the repertoire of meal-planning approaches to help patients as they try to lose weight to prevent or treat type 2 diabetes.

Look Ahead Action for Health in Diabetes is a new multi-center research study designed to evaluate the long-term health effects of weight loss in 5, overweight people with type 2 diabetes. Based on an evidence-based review of the literature, the weight-loss intervention will include the use of meal replacements in the hopes that people in this part of the study will have greater success with weight loss and weight maintenance.

The experience of using meal replacement as a primary intervention strategy will further expand our knowledge and insights about the efficacy of this approach for patients who have type 2 diabetes and want to achieve long-term weight loss and its health benefits.

Delahanty, MS, RD, is a clinical nutrition specialist and research dietitian at Massachusetts General Hospital in Boston.

Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Spectrum.

Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 15, Issue 3. Previous Article Next Article. Weight-Loss Strategies in Type 2 Diabetes Before Evidence-Based Recommendations for Lifestyle Treatment of Overweight and Obesity.

Evidence-Based Research on Lifestyle Interventions for Diabetes Prevention. Medical Nutrition Therapy Guidelines for Type 2 Diabetes. Evidence-Based Research on Meal Replacements. Article Navigation.

Evidence-Based Trends for Achieving Weight Loss and Increased Physical Activity: Applications for Diabetes Prevention and Treatment Linda M. Delahanty, MS, RD Linda M.

Delahanty, MS, RD. This Site. Google Scholar. Diabetes Spectr ;15 3 — Connected Content. A reference has been published: Research Beyond Diabetes: What Is Translatable? Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. In Brief The prevalence of overweight and obesity is increasing dramatically and so is the incidence of type 2 diabetes.

Table 1. Expanded Meal-Planning Approaches for Weight Loss in Type 2 Diabetes. View large. View Large. Table 2. Effectiveness of Meal Replacement as a Meal-Planning Approach for Weight Loss. Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report.

Bethesda, Md. Colditz GA, Willet WC, Rotnitzky A, Manson JE: Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. Ford ES, Williamson DF, Liu S: Weight change and diabetes incidence: finding from a national cohort of US adults. Am J Epidemiol. Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS: Racial and ethnic differences in glycemic control of adults with type 2 diabetes.

Diabetes Care. Maggio CA, Pi-Sunyer FX: The prevention and treatment of obesity: application to type 2 diabetes. Wei M, Gibbons LW, Mitchell TL, Kampert JB, Lee CD, Blair SN: The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men. Wing RR, Jeffrey RW: Effect of modest weight loss on changes in cardiovascular risk factors: are there differences between men and women or between weight loss and maintenance?

Int J Obes Relat Metab Disord. Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS: American College of Sports Medicine position stand: exercise and type 2 diabetes. Med Sci Sports Exerc.

Department of Health and Human Services: Physical Activity and Health: a Report of the Surgeon General. Atlanta, Ga. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Wing RR, Marcus MD, Epstein LH, Salata R: Type II diabetic subjects lose less weight than their overweight non-diabetic spouses.

Wing RR, Koeske R, Epstein LH, Nowalk MP, Gooding W, Becker D: Long-term effects of modest weight in type 2 diabetic patients. Arch Intern Med. Brown SA, Upchurch S, Anding R, Winter M, Ramirez G: Promoting weight loss in type 2 diabetics. Upchurch S, Anding R, Brown SA: Promoting weight loss in persons with type 2 diabetes: what do we know about the most effective approaches?

Pract Diabetol. Eriksson KF, Lindgarde F: Prevention of type 2 non-insulin-dependent diabetes mellitus by diet and physical activity. Pan XR, Li GW, Lu YH, Wang JX, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV: Da Qing IGT and Diabetes Study.

Tuomilehto J, Lindstrom J, Eriksson JG, Walle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniema S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Finnish Diabetes Study: prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.

N Engl J Med. DPP Research Group: The Diabetes Prevention Program: baseline characteristics of the randomized cohort. The DPP Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Weight loss peaks about one year postoperative, after which gradual weight regain is the norm. Evidence: As discussed earlier, weight cycling is the most common result of engaging in conventional dieting practices and is known to increase morbidity and mortality risk.

Research identifies many other contraindications to the pursuit of weight loss. For example, dieting is known to reduce bone mass, increasing risk for osteoporosis [ — ]; this is true even in an obese population, though obesity is typically associated with reduced risk for osteoporosis[ ].

Research also suggests that dieting is associated with increased chronic psychological stress and cortisol production, two factors known to increase disease risk [ ]. Also, there is emerging evidence that persistent organic pollutants POPs , which bioaccumulate in adipose tissue and are released during its breakdown, can increase risk of various chronic diseases including type 2 diabetes [ , ], cardiovascular disease [ ] and rheumatoid arthritis [ ]; two studies document that people who have lost weight have higher concentration of POPs in their blood [ , ].

One review of the diabetes literature indicates "that obese persons that sic do not have elevated POPs are not at elevated risk of diabetes, suggesting that the POPs rather than the obesity per se is responsible for the association" [ ]. Positing the value of weight loss also supports widespread anxiety about weight [ , ].

Evidence from the eating disorder literature indicates an emphasis on weight control can promote eating disordered behaviors [ 7 ]. Prospective studies show that body dissatisfaction is associated with binge eating and other eating disordered behaviors, lower levels of physical activity and increased weight gain over time [ , ].

Many studies also show that dieting is a strong predictor of future weight gain [ 66 , — ]. Another unintended consequence of the weight loss imperative is an increase in stigmatization and discrimination against fat individuals. Discrimination based on weight now equals or exceeds that based on race or gender [ ].

Extensive research indicates that stigmatizing fat demotivates, rather than encourages, health behavior change [ ]. Adults who face weight stigmatization and discrimination report consuming increased quantities of food [ — ], avoiding exercise [ , — ], and postponing or avoiding medical care for fear of experiencing stigmatization [ ].

Stigmatization and bias on the part of health care practitioners is well-documented, resulting in lower quality care [ , ]. Evidence: That weight loss will improve health over the long-term for obese people is, in fact, an untested hypothesis.

One reason the hypothesis is untested is because no methods have proven to reduce weight long-term for a significant number of people. Also, while normal weight people have lower disease incidence than obese individuals, it is unknown if weight loss in individuals already obese reduces disease risk to the same level as that observed in those who were never obese [ 91 , 93 ].

As indicated by research conducted by one of the authors and many other investigators, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost [ 11 ]. For example, lifestyle changes can reduce blood pressure, largely or completely independent of changes in body weight [ 11 , — ].

The same can be said for blood lipids [ 11 , — ]. Improvements in insulin sensitivity and blood lipids as a result of aerobic exercise training have been documented even in individuals who gained body fat during the intervention [ , ]. Although this estimate has been granted credence by health experts, the word "estimate" is important to note: as the authors state, most of the cost changes are not "statistically different from zero.

All are independently correlated with both weight and health and could play a role in explaining the costs associated with having a BMI over Nor does it account for costs associated with unintended consequences of positing the value of a weight focus, which may include eating disorders, diet attempts, weight cycling, reduced self-esteem, depression, and discrimination.

Because BMI is considered a risk factor for many diseases, obese persons are automatically relegated to greater testing and treatment, which means that positing BMI as a risk factor results in increased costs, regardless of whether BMI itself is problematic.

Yet using BMI as a proxy for health may be more costly than addressing health directly. Consider, for example, the findings of a study which examined the "healthy obese" and the "unhealthy normal weight" populations [ ].

The study identified six different risk factors for cardiometabolic health and included subjects in the "unhealthy" group if they had two or more risk factors, making it a more stringent threshold of health than that used in categorizing metabolic syndrome or diabetes.

The study found a substantial proportion of the overweight and obese population, at every age, who were healthy and a substantial proportion of the "normal weight" group who were unhealthy.

Psychologist Deb Burgard examined the costs of overlooking the normal weight people who need treatment and over-treating the obese people who do not personal communication, March She found that BMI profiling overlooks When the total population is considered, this means that 31 percent of the population is mis-identified when BMI is used as a proxy for health.

The weight bias inherent in BMI profiling may actually result in higher costs and sicker people. As an example, consider a study published in the American Journal of Public Health The authors compared people of similar age, gender, education level, and rates of diabetes and hypertension, and examined how often they reported feeling sick over a day period.

Results indicated that body image had a much bigger impact on health than body size. In other words, two equally fat women would have very different health outcomes, depending on how they felt about their bodies.

Likewise, two women with similar body insecurities would have similar health outcomes, even if one were fat and the other thin. These results suggest that the stigma associated with being fat is a major contributor to obesity-associated disease. BMI and health are only weakly related in cultures where obesity is not stigmatized, such as in the South Pacific [ 48 , ].

This section explains the rationale supporting some of the significant ways in which the HAES paradigm differs from the conventional weight-focused paradigm.

The following topics are addressed:. HAES supports reliance on internal regulatory processes, such as hunger and satiety, as opposed to encouraging cognitively-imposed dietary restriction; and.

Conventional thought suggests that body discontent helps motivate beneficial lifestyle change [ , ]. However, as discussed previously in the section on the pursuit of weight loss, evidence suggests the opposite: promoting body discontent instead induces harm [ , , , ], resulting in less favorable lifestyle choices.

A common aphorism expressed in the HAES community is that "if shame were effective motivation, there wouldn't be many fat people. Promoting one body size as more favorable than another also has ethical consequences [ ], contributing to shaming and discrimination.

Compassion-focused behavior change theory emerging from the eating disorders field suggests that self-acceptance is a cornerstone of self-care, meaning that people with strong self-esteem are more likely to adopt positive health behaviors [ , ].

The theory is borne out in practice: HAES research shows that by learning to value their bodies as they are right now, even when this differs from a desired weight or shape or generates ambivalent feelings, people strengthen their ability to take care of themselves and sustain improvements in health behaviors [ 8 , 11 ].

Critics of HAES express concern that encouraging body acceptance will lead individuals to eat with abandon and disregard dietary considerations, resulting in weight gain. This has been disproven by the evidence; no randomized controlled HAES study has resulted in weight gain, and all studies that report on dietary quality or eating behavior indicate improvement or at least maintenance [ 11 , 14 — 23 ].

This is in direct contrast to dieting behavior, which is associated with weight gain over time [ 66 , — ]. Conventional recommendations view conscious efforts to monitor and restrict food choices as a necessary aspect of eating for health or weight control [ ].

The underlying belief is that cognitive monitoring is essential for keeping appetite under control and that without these injunctions people would make nutritionally inadvisable choices, including eating to excess.

The evidence, however, disputes the value of encouraging external regulation and restraint as a means for weight control: several large scale studies demonstrate that eating restraint is actually associated with weight gain over time [ 66 , — ].

In contrast, HAES teaches people to rely on internal regulation, a process dubbed intuitive eating [ ], which encourages them to increase awareness of their body's response to food and learn how to make food choices that reflect this "body knowledge.

HAES teaches people to make connections between what they eat and how they feel in the short- and medium-term, paying attention to food and mood, concentration, energy levels, fullness, ease of bowel movements, comfort eating, appetite, satiety, hunger and pleasure as guiding principles.

The journey towards adopting intuitive eating is typically a process one engages in over time. Particularly for people with a long history of dieting, other self-imposed dietary restriction, or body image concerns, it can feel very precarious to let go of old habits and attitudes and risk trying new ways of relating to food and self.

Coming to eat intuitively happens gradually as old beliefs about food, nutrition and eating are challenged, unlearned and replaced with new ones. A large popular literature has accumulated that supports individuals in developing intuitive eating skills [ 8 , — ].

Intuitive eating is also known in the literature as "attuned eating" or "mindful eating. There is considerable evidence that intuitive eating skills can be learned [ 11 , 18 , ], and that intuitive eating is associated with improved nutrient intake [ ], reduced eating disorder symptomatology [ 17 , 18 , — ] - and not with weight gain [ 11 , 13 , 16 — 18 ].

Several studies have found intuitive eating to be associated with lower body mass [ , , , ]. HAES encourages people to build activity into their day-to-day routines and focuses on helping people find enjoyable ways of being active. The goal is to promote well-being and self-care rather than advising individuals to meet set guidelines for frequency and intensity of exercise.

Active living is promoted for a range of physical, psychological and other synergistic benefits which are independent of weight loss. Myths around weight control and exercise are explicitly challenged.

Physical activity is also used in HAES as a way of healing a sense of body distrust and alienation from physicality that may be experienced when people are taught to over-ride embodied internal signals in pursuit of externally derived goals, such as commonly occurs in dieting.

In addition, some HAES programs have used physical activity sessions, along with other activities such as art and relaxation, to further a community development agenda, creating volunteer, training and employment opportunities and addressing issues of isolation, poor self-esteem and depression among course participants.

There are serious ethical concerns regarding the continued use of a weight-centered paradigm in current practice in relation to beneficence and nonmaleficence. Beneficence concerns the requirement to effect treatment benefit. There is a paucity of literature to substantiate that the pursuit of weight control is beneficial, and a similar lack of evidence to support that weight loss is maintained over the long term or that programs aimed at prevention of weight gain are successful.

Nonmaleficence refers to the requirement to do no harm. Much research suggests damage results from a weight-centered focus, such as weight cycling and stigmatization. Consideration of several dimensions of ethical practice - veracity, fidelity, justice and a compassionate response - suggests that the HAES paradigm shift may be required for professional ethical accountability [ ].

The new public health ethics advocates scrutiny of the values and structure of medical care, recognizing that the remedy to poor health and health inequalities does not lie solely in individual choices. This ethicality has been adopted by HAES in several ways. HAES academics have highlighted the inherent limitations of an individualistic approach to conceptualizing health.

Individual self-care is taken as a starting point for HAES programs, but, unlike more conventional interventions, the HAES ethos recognizes the structural basis of health inequities and understands empowerment as a process that effects collective change in advancing social justice [ ].

HAES advocates have also stressed the need for action to challenge the thinness privilege and to better enable fat people's voices to be heard in and beyond health care [ 8 , ]. The hallmark theme of the new public health agenda is that it emphasizes the complexity of health determinants and the need to address systemic health inequities in order to improve population-wide health outcomes and reduce health disparities, making use of the evidence on the strong relationship between a person's social positioning and their health.

For example, research since the s has documented huge differences in cardiac health between and across socioeconomic gradients which has come to be recognized as arising from disparities in social standing and is articulated as the status syndrome [ ].

Since weight tracks closely with socioeconomic class, obesity is a particularly potent marker of social disparity [ ]. There is extensive research documenting the role of chronic stress in conditions conventionally described as obesity-associated, such as hypertension, diabetes and coronary heart disease [ ].

These conditions are mediated through increased metabolic risk seen as raised cholesterol, raised blood pressure, raised triglycerides and insulin resistance. The increase in metabolic risk can in part be explained by a change in eating, exercise and drinking patterns attendant on coping with stress.

However, changes in health behaviors do not fully account for the metabolic disturbances. Instead, stress itself alters metabolism independent of a person's lifestyle habits [ ]. Thus, it has been suggested that psychological distress is the antecedent of high metabolic risk [ ], which indicates the need to ensure health promotion policies utilize strategies known to reduce, rather than increase, psychological stress.

In addition to the impact of chronic stress on health, an increasing body of international research, discussed earlier, recognizes particular pathways through which weight stigmatization and discrimination impact on health, health-seeking behaviors, and quality of health care [ — ].

Policies which promote weight loss as feasible and beneficial not only perpetuate misinformation and damaging stereotypes [ ], but also contribute to a healthist, moralizing discourse which mitigates against socially-integrated approaches to health [ , , , ].

While access to size acceptance practitioners can ameliorate the harmful effects of discrimination in health care for individuals, systemic change is required to address the iatrogenic consequences of institutional size discrimination in and beyond health care, discrimination that impacts on people's opportunities and health.

Quite aside from the ethical arguments underscoring inclusive, non-discriminatory health care and civil rights, there are plausible metabolic pathways through which reducing weight stigma, by reducing inequitable social processes, can help alleviate the burden of poor health.

From the perspective of efficacy as well as ethics, body weight is a poor target for public health intervention. There is sufficient evidence to recommend a paradigm shift from conventional weight management to Health at Every Size.

More research that considers the unintended consequences of a weight focus can help to clarify the associated costs and will better allow practitioners to challenge the current paradigm. Continued research that includes larger sample sizes and more diverse populations and examines how best to deliver a Health at Every Size intervention, customized to specific populations, is called for.

We propose the following guidelines, which are supported by the Association for Size Diversity and Health ASDAH , to assist professionals in implementing HAES.

Our proposed guidelines are modified, with permission, from guidelines developed by the Academy for Eating Disorders for working with children [ 7 ]. Interventions should meet ethical standards. They should focus on health, not weight, and should be referred to as "health promotion" and not marketed as "obesity prevention.

Interventions should seek to change major determinants of health that reside in inequitable social, economic and environmental factors, including all forms of stigma and oppression. Interventions should be constructed from a holistic perspective, where consideration is given to physical, emotional, social, occupational, intellectual, spiritual, and ecological aspects of health.

Interventions should promote self-esteem, body satisfaction, and respect for body size diversity. Interventions should accurately convey the limited impact that lifestyle behaviors have on overall health outcomes.

Lifestyle-oriented elements of interventions that focus on physical activity and eating should be delivered from a compassion-centered approach that encourages self-care rather than as prescriptive injunctions to meet expert guidelines.

Interventions should focus only on modifiable behaviors where there is evidence that such modification will improve health. Weight is not a behavior and therefore not an appropriate target for behavior modification.

Lay experience should inform practice, and the political dimensions of health research and policy should be articulated. These guidelines outline ways in which health practitioners can shift their practice towards a HAES approach and, in so doing, uphold the tenets of their profession in providing inclusive, effective, and ethical care consistent with the evidence base.

We accept this argument; we have used "overweight" and "obese" throughout this paper when necessary to report research where these categories were used.

We recognize, however, that "normal" does not reflect a normative or optimal value; that "overweight" falsely implies a weight over which one is unhealthy; and that the etymology of the word "obese" mistakenly implies that a large appetite is the cause.

Linda Bacon and Lucy Aphramor are HAES practitioners. Both also speak and write on the topic of Health at Every Size and sometimes receive financial remuneration for this work.

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Edited by: Striegel-Moore R, Smolak L. Sugar can be called at least 30 different names on the package, including sucrose, fructose, corn syrup, dextrose, honey, molasses and many more. The highest sugar content is found in sodas, candies, snacks, and condiments.

According to another study, skipping on sleep may lead to overeating the next day. The scientists found that those who slept only 3. By disrupting the body's internal clock, sleep deprivation may affect appetite hormones leptin and ghrelin , as well as insulin, leading to increased hunger and food intake, decreased calorie-burning, and increased fat storage.

Intermittent fasting is one of the world's most popular health and fitness trends. It is a pattern in which people cycle between periods of fasting and eating. Short-term studies suggest intermittent fasting is as effective for weight loss as continuous calorie restriction.

Refined carbohydrates include sugar and grains that have been stripped of their nutritious parts. These include white bread and pasta. Studies show that refined carbs can spike blood sugar rapidly, leading to hunger, cravings and increased food intake a few hours after eating them.

Eating refined carbs is strongly linked to obesity. One of the worst side effects of dieting is that it tends to cause muscle loss and metabolic slowdown, often referred to as starvation mode. The best way to prevent this is to do some sort of resistance exercise, such as lifting weights.

Studies show that weight lifting can help keep your metabolism high and prevent you from losing precious muscle mass. In order to see the results you're aiming for, take initiative and implement these tips into your daily routine to help start your weight loss journey.

This could be as simple as getting a good night's rest to drinking a bit more water before a meal. Slowly add in these tips and work toward your goal of feeling healthier and happier. Drink water, especially before meals. Make your lunch your main meal. Watch out for added sugar.

Getting more sleep.