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Weight and cardiometabolic health: new perspectives

International Journal of Obesity volume 40, page 1331 (2016)Cite this article

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We read the letter by Caleyachetty et al.1 with interest, and are gratified that they agree with us regarding the misguided nature of the Equal Employment Opportunity Commission’s (EEOC) proposed ruling. However, we would like to address their assertion that the metabolic health of higher-body mass index (BMI) individuals will inevitably decline with time. Evidence in support of this position is still equivocal. For example, Guo and Garvey2 found that the metabolic status of higher-BMI individuals remained relatively stable over an average follow-up time of 18.7 years. Even when a decline in metabolic health is observed among higher-BMI individuals, it remains unclear if this is a function of adiposity per se. Instead, it is quite plausible that any longitudinal decline in health simply reflects the cumulative effects of weight stigma. Indeed, Meunnig3 was one of the first scholars to suggest that ‘obesity-associated stigma produces obesity-associated medical conditions,’ a notion supported by contemporary models of weight stigma and health.4, 5

We also question the contention that weight loss should remain the primary goal for risk reduction. This position is divorced from both the (a) efficacy and (b) ill effects of a weight-centric approach to public health. Weight loss remains an unsustainable goal for many higher-BMI individuals and is not reliably associated with improvements in health.6 Those who laud the benefits of weight loss often tout the Diabetes Prevention Program (DPP). However, when this literature is considered on the whole, DPP is the exception rather than the rule. In fact, our meta-analysis showed that the amount of weight lost on diets was unrelated to clinical markers of health such as blood pressure, cholesterol, triglycerides and fasting blood glucose.6

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References

  1. Caleyachetty R, Muennig P, Kengne A . Misclassification of cardiometabolic health when using body mass index categories. Int J Obes 2016 (this issue).

  2. Guo F, Garvey WT . Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: stability of metabolic health status in adults. Obesity (Silver Spring) 2016; 24: 516–525.

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Authors and Affiliations

  1. Department of Psychology, University of California, Los Angeles, CA, USA

    A J Tomiyama, J Nguyen-Cuu & C Wells

  2. Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA

    J M Hunger

Authors
  1. A J Tomiyama
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  2. J M Hunger
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  3. J Nguyen-Cuu
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  4. C Wells
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Correspondence to A J Tomiyama.

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Tomiyama, A., Hunger, J., Nguyen-Cuu, J. et al. Weight and cardiometabolic health: new perspectives. Int J Obes 40, 1331 (2016). https://doi.org/10.1038/ijo.2016.83

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