If you haven’t been introduced to the Obesity Panacea blog, it’s time to fix that. Travis Saunders and Peter Janiszewski are both researchers who study the connections between food, exercise or sedentary behavior, weight, and health. Recent interesting posts include a review of a study that says that even a couple of hours of uninterrupted sitting has negative implications for your health and a caution that fruit juice is neither “natural” nor particularly good for you.

Yesterday, Travis posted the full text of a scientific review that he coauthored suggesting that it might be time to stop blaming the presence or amount of body fat for the increase in our modern metabolic and cardiovascular health problems. The language is slightly technical but still readable. The topic is one we should take seriously.

Although counter-intuitive, many prospective observational studies suggest that weight loss increases rather than decreases the risk of premature death [17–19]. Paradoxically, most short-term weight loss intervention studies do find improvements in many health indicators. However, given that intentional weight loss is generally accompanied by a change in dietary and physical activity behaviors, it is not known whether or to what extent the improvements can be attributed to the weight loss per se. The case of liposuction can certainly provide relevant information about the effects of subcutaneous fat loss in the absence of behavior change. In their study, Klein et al. [20] evaluated the effects of large-volume abdominal liposuction on metabolic risk factors in obese women before and 10 to 12 weeks after liposuction. Although the participants lost 10.5 kg of fat, liposuction did not improve obesityassociated metabolic abnormalities, suggesting that decreasing adipose tissue mass alone (and especially reducing subcutaneous fat stores) without behavior change will not achieve the metabolic benefits of weight loss. In contrast, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost or not.

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The fact that more than over 80% of individuals return to pre-weight loss levels of body fatness after otherwise successful weight loss certainly illustrates this “sad” reality [25], whereas studies of people successful at sustained weight loss indicate that the maintenance of a reduced degree of body fatness requires a lifetime of meticulous attention to energy intake and expenditure [26]. Among the adverse effects of weight loss, it is well-known that body fat loss complicates appetite control, reduces energy expenditure to a greater extent than predicted, increases the proneness to hypoglycemia and its related risk towards depressive symptoms, increases the plasma and tissue levels of persistent organic pollutants that promote hormone disruption and metabolic complications, and increases psychological stress, all of which are adaptations that significantly increase the risk of weight regain [27].

This is not a counterintuitive look at weight, because our views on weight are more cultural than instinctual, but it is a change from the mainstream views. It is certainly a change from the fat-shaming views that are prevalent outside those who have been researching the topic over the last several years. If you’re new to the scientific results on this, you may find yourself fighting the message of the paper as you read it. I recommend reading it anyway and giving yourself some time to let it sink in before you try to argue against it.