Analysis

Challenging assumptions in obesity research

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5303 (Published 22 November 2017) Cite this as: BMJ 2017;359:j5303
  1. Elizabeth Sturgiss, lecturer1,
  2. Melanie Jay, associate professor of medicine and of population health2,
  3. Denise Campbell-Scherer, associate professor3,
  4. Chris van Weel, emeritus professor of family medicine4 5
  1. 1Academic Unit of General Practice, Australian National University Medical School, Canberra Hospital Campus, Garran, ACT, 2604, Australia
  2. 2New York University School of Medicine, New York, USA
  3. 3Department of Family Medicine, University of Alberta, Edmonton, Canada
  4. 4Radboud University, Nijmegen, Netherlands
  5. 5Australian National University, Acton, Australia
  1. Correspondence to: E Sturgiss elizabeth.sturgiss{at}anu.edu.au

Focusing exclusively on weight loss ignores the other benefits of lifestyle interventions for obesity and may contribute to society’s obsession with body image and weight, argue Elizabeth Sturgiss and colleagues

We have a problem in obesity research—clinical trials continue to prioritise weight loss as a primary outcome and rarely consider patients’ experience, quality of life, or adverse events.123 Weight loss in people with obesity can be positive,4 but interventions that strive for weight reduction at any cost and without regard to the patient’s personal, social, and environmental context,5 are not in anyone’s best interest.

In clinical practice and research, patients are our best teachers. During a recent feasibility trial of an Australian obesity intervention in primary care,6 a patient made us question our understanding of weight management: “I’ve got a friend with stomach cancer; she’s had all her stomach removed—you know, she’s thin as thin. People with cancer, thin as thin; they’re sick. Or their husbands have left—fantastic, you get really thin. You have a bit of trauma and illness and you’ll lose weight like it’s going out of style.”

It is inaccurate to assume that weight loss always means an improvement in health, even for someone with obesity.

Choice of research outcomes has a ripple effect on how obesity is viewed in the general population. Trial results trickle down into guidelines and on into clinical practice, thereby influencing what clinicians suggest to their patients and the way patients regard obesity. Social scientists work with the principle of double hermeneutics whereby, unlike in natural sciences, the act of research involving humans and human behaviour can itself influence the group that is studied. If we apply the principle of double hermeneutics to obesity research, when weight loss is given central importance it contributes to how …

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