The downside of weight loss: Realistic intervention in body-weight trajectory

Article Figures & Data

Table 1

Levels of evidence

LEVEL OF EVIDENCE	FEATURES	OUTCOME CONSIDERED	COMMENTS
Level I	At least 1 properly conducted RCT, systematic review, or meta-analysis	Mortality	2 good meta-analyses, 2 systematic reviews, 2 reviews of prospective cohort studies
		Morbidity (HRQOL)	Numerous RCTs and prospective clinical trials
		Interventions in weight trajectory	One meta-analysis, several RCTs, numerous traditional reviews
Level II	Other comparison trials; non-randomized, cohort, case-control, or epidemiologic studies; and preferably more than 1 study	Population weight metrics	Primarily population-based longitudinal, prospective cohort, and cross-sectional studies
Level III	Expert opinion or consensus statements	NA	NA

HRQOL—health-related quality of life, NA—not applicable, RCT—randomized controlled trial.

Table 2

Prevalence of overweight and obesity in adults

NA—not available.
Data from Orpana et al¹⁰ and the Public Health Agency of Canada and Canadian Institute for Health Information.¹¹

Table 4

Influence of body size and weight trajectory on mortality^{10,14,33–50}

WEIGHT TRAJECTORY	UNDERWEIGHT	NORMAL WEIGHT	OVERWEIGHT	OBESE			ELDERLY
WEIGHT TRAJECTORY	UNDERWEIGHT	NORMAL WEIGHT	OVERWEIGHT	CLASS 1	CLASS 2	CLASS 3	ELDERLY
Stable	Increased	Optimal	Optimal	Optimal	Increased	Increased	Optimal
Weight gain	Reduced	Optimal	Optimal	Increased	Increased	Increased	Optimal
Weight loss
• Intentional, healthy	Increased	Increased	Increased	Increased	Increased	Increased	Increased
• Intentional, morbidity	Increased	Increased	Increased	Reduced	Reduced	Reduced	Reduced
• Not intentional	Increased	Increased	Increased	Increased	Increased	Increased	Increased

Table 5

Measures for prevention of excess childhood weight gain

INTERVENTION	RECOMMENDATION
Fruits and vegetables	≥ 5 servings per day
Sugars and sugar-sweetened beverages	Minimize or eliminate (including soft drinks and juices)
Breakfast	Eaten every day
Family meals	5–6 per week minimum
Meals outside the home	Minimize; no “fast foods”
Food insecurity	Eliminate⁶⁷
Food portions	Self-regulated by child
Physical activity	≥ 1 hour per day
Sleep time	> 11.5 hours at 5–6 years of age⁶⁸
Screen time	No exposure younger than 2 years of age; 1–2 hours per day after 2 years of age; no television or video games in bedroom

Table 6

Possible indications for intentional weight loss

INDICATION	EXAMPLES
Personal choice	Esthetics Beliefs and values Quality of life
Weight-related comorbidity	Coronary artery disease Diabetes Metabolic syndrome Knee osteoarthritis Obstructive sleep apnea Nonalcoholic fatty liver disease
Improved quality of life	Relief of symptoms Improved cardiovascular risk Improved self-image