Validity of claims made in weight management research: a narrative review of dietetic articles.

Lucy Aphramor

doi:10.1186/1475-2891-9-30

Abstract

BackgroundThe best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored.MethodsA narrative literature review of journal articles in The Journal of Human Nutrition and Dietetics from 2004 to 2008.ResultsAlthough the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence.ConclusionsDietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.

Highlights

The best available evidence demonstrates that conventional weight management has a high longterm failure rate
Clinical interventions focus on achieving energy balance deficit and are premised on claims that excess weight/ fatness (body mass index (BMI) > 25) is a significant direct cause of morbidity and mortality and, correspondingly, that weight loss in fat (’overweight’ or ‘obese’) people will reduce risk and/or improve health outcomes
The purpose of this review is to evaluate the validity of claims made by weight loss researchers

Summary

Introduction

The best available evidence demonstrates that conventional weight management has a high longterm failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored. The assessment and management of body weight is a major preoccupation of contemporary UK health policy. Clinical interventions focus on achieving energy balance deficit and are premised on claims that excess weight/ fatness (body mass index (BMI) > 25) is a significant direct cause of morbidity and mortality and, correspondingly, that weight loss in fat (’overweight’ or ‘obese’) people will reduce risk and/or improve health outcomes. There is a growing inter-disciplinary literature [2] that contests the effectiveness of a weight-centred approach to health and draws attention to the ethical implications of unintentional outcomes. It could be said that weight loss enjoys special immunity from accepted standards in clinical practice and publishing ethics. This paper analyses a selection of dietetic research articles to assess practice in the area

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