It seems like there has been a swing in weight loss trends over the past 15 years. Excess body weight used to be considered the root of almost every disease and because of that, the weight loss industry was booming. While for some this did help in reducing body weight and perhaps managing diseases like diabetes and heart disease, for others who were overweight but metabolically healthy (i.e. do not have any other diseases), it led to feelings of ‘fat shaming’ and for some, even feelings of discrimination.
Fast forward to now, and while weight loss is still a huge industry, the norms of the conventional “diet” industry have been challenged from mental and physical health perspectives, and because of this the traditional restrictive “dieting” culture may become a thing of the past.
In questioning the traditional thoughts on weight loss, a legitimate question is: Can someone still be healthy and overweight? We now have research focused on the health benefits of healthy eating and exercise, without weight loss, and this research does show some potential health benefits. From this, the weight inclusive movement Health At Every Size (HAES*) was born, which is a proponent of the idea that size is not a marker of health.
So who is right? Does Weight Loss play a role in reducing the risk of or managing diseases? How about treatment? If it does, what diseases and how much does someone need to lose to improve their health?
*HAES is a science-based approach to healthy eating and what dietitians incorporate into their practice. This blog is NOT an argument against HAES, rather a discussion regarding the facts that weight can play a role in various conditions.
Read on to find out more!
What is the role of body weight in developing certain health conditions?
To date, there is a wealth of research linking weight loss to various positive health outcomes, including:
- Decreased joint pain and reduced symptoms in both osteo and rheumatoid arthritis
- Decreased risk of certain cancers
- Decreased risk of diabetes and improved blood sugar levels
- Decreased risk of heart disease, including improvements in cholesterol levels and reduced blood pressure
- Decreased risk or improvement in symptoms of sleep apnea
- Improved fertility
There are two main ways that excess body weight, and more specifically excess body fat, may play a role: mechanistically and metabolically.
From a mechanistic standpoint, excess body weight puts pressure on our joints, leading to excess wear and tear. Additionally, it can put pressure on our organs, such as in the case of our lungs and airways in sleep apnea or the digestive system in gastro-esophageal reflux and diverticulosis.
- Think of strapping 30 lbs onto your chest and trying to walk up a flight of stairs, or take deep breaths while laying down.
Metabolically, excess fat can lead to disease conditions in multiple ways. When we accumulate fat, it doesn’t just go to our fat stores (adipocytes), but other places in our bodies, including our livers and blood vessels. Fat accumulation interferes with metabolic machinery, which means our organs can’t do their jobs properly.
Another example of the metabolic effects of excess body fat is through the production of something called cytokines. Our fat cells produce the molecules which then in turn cause inflammation in the body. The more body fat we have, the more inflammation we will have. Cytokines and inflammation both play a role in the development of chronic conditions such as diabetes, heart disease and various cancers.
Lastly, “free fatty acids”, which are basically how fats travel through our bodies, increase with increased body fat and interfere with our body’s metabolic machinery, leading to insulin resistance, which leads to type two diabetes.
So, from a ‘science’ standpoint, yes, excess body weight and body fat play a role in how some diseases develop. But how much does weight actually play a part in developing diseases?
Okay, so science says yes, bodyweight, specifically body fatness, plays a role in the development of various diseases.
The Top 7 Chronic Diseases Affected by Body Weight
As the degree to which weight loss impacts the prevention and management of any given disease differs, let’s take a look at the most common chronic conditions and how weight loss may help.
Note: This research refers to weight loss in those who are overweight or obese. Weight loss in those who are a healthy body weight or underweight does not appear to have health benefits.
When looking at bodyweight, research often uses something called ‘body mass index’ or BMI to classify people as underweight, normal weight, overweight or obese. While there are other ways to assess someone’s weight and weight distribution, we refer to BMI in this article as it is currently the most common way of assessing body weight.
You can calculate your BMI using the equation weight (kg) / height (m)2
Type 2 Diabetes
The interaction between body weight and diabetes is one of the most in-depth studies in areas of health and nutrition and the American Diabetes Prevention Program, which now has hundreds of research papers and thousands of subjects, found that weight loss of 6.7% reduced the risk of diabetes by 58%. Wow. If you’re looking to reduce your risk of diabetes, perhaps weight loss should be a consideration.
Additionally, in individuals with impaired glucose tolerance** (a key marker of pre-diabetes), for every kilogram (or 2.2 pounds) of weight lost there was a 16% reduction in risk for progression to diabetes. This was seen for up to 10 kg of weight loss. Keep in mind, this study looked at people who were overweight or obese, not weight loss in those who were of a healthy weight.
A modest weight loss of 5% to 10% of initial body weight can improve insulin sensitivity, glycemic control and blood pressure in those with diabetes.
What about treating diabetes? Weight loss of about 15 kg can lead to complete remission of type two diabetes in about 80% of those with diabetes. Again, this is in those who are overweight or obese.
**Impaired glucose tolerance is measured by something called the oral glucose tolerance test (OGTT) and is a common test done to assess the risk of diabetes, as well as can be used to diagnose diabetes.
Excess body weight can contribute to various markers of heart disease, including high blood pressure, high cholesterol levels and plaque accumulation in arteries. While body weight is not the only factor, for example, smoking and an overall unhealthy diet impacts heart disease risk regardless of weight, it is the most common modifiable (meaning we have some degree of control) risk factor for heart disease.
For every 1 kg/m2 increase in BMI, the risk of heart failure increased 5% in men and 7% in women. What does this translate to? If you are 200 lbs at 5’8”, increasing your weight to 207 lbs would increase your risk of heart failure by 5% if you’re male, and 7% if you’re female. Increase your weight to 213 lbs, and you’ve increased your risk by 10% if you’re a male, and 14% if you’re a female, and so on.
So we know weight contributes to heart disease but does losing weight help to treat those already with heart disease? Modest weight loss (5 to 10%) is associated with improvement in systolic and diastolic blood pressure and cholesterol levels. Specifically, weight loss around one’s midsection significantly improves cardiovascular health in those with cardiovascular disease (Check out our FAQon how long it would take to lose inches off your waist).. For those who are of higher BMI, additional weight loss (above 10%) will have additional cardiovascular health benefits and some research shows that those on medication for high blood pressure may be able to reduce or eliminate their need for medication with weight loss greater than 10%.
Excess body weight is a known risk factor for gastrointestinal diseases ranging from gastroesophageal reflux disease (GERD, also known as heartburn) to diverticulosis, as well as gallstones and gastrointestinal cancers. Yes, what you eat also plays a very big role in these diseases and we do help clients reduce their risk and manage symptoms through nutrition.
Regarding GERD, even a modest weight loss of 2-3 kg has been shown to significantly reduce symptoms.
Weight loss has also been shown to be helpful in relieving both constipation and diarrhea when paired with overall healthy eating and physical activity. How? Excess body weight puts pressure on our digestive system and this excess pressure can lead to both constipation and diarrhea.
Research shows a very clear link between being overweight or obese and risk of at least 12 types of cancer, including breast, colon, stomach, esophageal, and pancreatic cancer. In fact, it is estimated that excess body weight is responsible for about 11% of cancers in women and about 5% of cancers in men in the United States. The impact of obesity on the risk of each cancer may differ, but one important example is the link between obesity and liver cancer; being obese increases one’s risk of liver cancer by 60%.
The good news is that the research is promising regarding weight loss and cancer risk. Again, the reduced risk varies for each type of cancer, but on average weight loss reduces one’s risk of all cancers by 16%.
Excess body fat accumulation and high blood sugar levels are two of the main contributors to developing non-alcoholic fatty liver disease, or NAFLD, which can eventually lead to scarring of the liver and liver failure, which is when one’s liver no longer functions and the only option is liver transplant.. The key to treating fatty liver is to help the body remove fat, or ‘triglycerides’ from the liver and overall body fat loss is an effective way of achieving this.
In one study:
- 5% weight loss reduced liver triglycerides (fat) by 13%,
- 11% weight loss reduced it by 52% and
- 16% by 65%!
Regarding the treatment of fatty liver, currently, weight loss and healthy eating are the most effective ways of reversing the disease.
Excess body weight, especially around one’s midsection, is one of the main causes of sleep apnea, a sleep disorder that not only affects sleep but also increases one’s risk of heart disease and diabetes.
In terms of improving sleep quality in those with sleep apnea, a 10 to 15% weight loss significantly improves sleep quality and a weight loss of 10 kg has been shown to reverse sleep apnea in some people.
Excess body weight puts mechanical stress on our joints, especially in our backs, hips and knees.
A weight loss of 5% significantly reduces osteoarthritis-related knee pain and a weight loss of 10% reduces pain and increases joint function. Similar results have been seen for back and hip pain and function.
Bodyweight and body fat play a pretty large role in developing, preventing and managing many health conditions (NOTE: we have an FAQ on the difference between body weight and body fat here). I hope that by reading this article you’ll both be inspired to take control of your health, as well as let go of any shame you may feel in reaching out for help in weight loss.
There is nothing wrong with losing weight for esthetic reasons, for example, to look great in a bikini or have a six-pack or really just to feel your best in your body, and as dietitians, we help people with weight loss for various reasons. We ask you at your Initial Assessment and again throughout your weight loss journey your ‘why’ or reasons for weight loss, and help to set goals accordingly, whether that be to ‘get lean’ or to lose 10% of your body weight for disease prevention or management.
So what is our approach at NutriProCan?
We agree fat-shaming has no role in health. It leads to decreased mental health, barriers to healthcare and often increased body weight. When clients come to us regarding health goals, such as correcting high blood sugar levels or reversing fatty liver, we talk to them about all of the potential components that can help, including specific foods to include more or less of, the role of physical activity, as well as, when applicable, the role of weight loss.