As a population we are gaining weight and the majority of people in the UK are now overweight or obese. Obesity is a complex medical condition requiring intervention from multiple sectors of society including the medical profession, pharmaceutical industry, food manufacturers, media, advertising companies, government and others. Enabling people with obesity to reduce their weight is a focus of significant research and resources, but another critical part of the management of the obesity epidemic is to prevent further weight gain in people who are in the healthy weight or overweight categories. We know that many people gain weight throughout life, but that this does not occur steadily; rather, it occurs mostly on a seasonal basis, and Christmas is a time when a significant number of people gain weight suddenly, and often this weight gain remains after the end of the festive season. Weight gain of even a small amount has consequences for our health as a population, and so preventing Christmas weight gain is one of the many ways we can continue to address obesity.
A recent, much publicised randomised controlled trial published in the BMJ this month considered whether a simple, lifestyle based intervention may help to prevent this weight gain, and their data suggest that it just might do so. It was discussed on national TV and made the headlines in a number of mainstream newspapers, the message being that weighing yourself regularly and following some sensible lifestyle advice can avoid the weight gain typically seen at this time of year. At first glance the numbers appear small; both groups were given written advice about healthy lifestyle including one version of a healthy diet, ways to increase physical activity and reduce sedentary behaviour, and information about sleep and stress management. All of these had previously been shown to be effective in reducing weight. One group was then advised to weigh themselves at least twice a week while the other was given no advice about monitoring their weight. At the end of the study the intervention group had lost a small amount of weight and the control group had gained a few hundred grams, the difference between the two being approximately 500g or 1lb in weight. There was no ‘usual care’ group so it is difficult to say whether the weight gain in the control group was less than in the general population, but previous studies suggest the advice given to the control group should have been effective.
We seem to live in a society where we like sensational results; whether discussing weight or any other issue, we like to see extremes. TV programmes about clutter several years ago showed people with a few possessions out of place getting some cool new storage system to things up a bit, whereas now we crave sagas about people who are hoarding not just years of junk, but also a few dead rats and other health hazards with the associated risk of eviction if they don’t up their game completely and immediately. Homes are transformed from the equivalent of the city tip to a minimalist dream in a few short minutes of televisual melodrama and we applaud it. Similarly, we are no longer satisfied with some overweight individuals being encouraged to make a few dietary tweaks and hit the gym a bit more often with a resultant loss of a few pounds. These days only stories of ‘extreme weight loss’ make the media cut the majority of the time with both very large starting weights and proportionally equally large weight losses, and as well as being gripping viewing for many, they can also make those of us with a modest weight problem feel better by comparison.
However, a simple intervention which results in a difference of one pound in weight between intervention and control groups is a very welcome part of the obesity management toolkit and has potentially far reaching public health benefits, so I believe we overlook this at our peril.
The reason that I want to cover this in a lifestyle medicine context is to highlight the advice that the participants in this trial were given, which has putative benefits far beyond just weight loss or prevention of weight gain. Some of us in the lifestyle medicine community may give different dietary advice from the high carbohydrate, low fat version they provide; nevertheless any evidence based healthy eating advice aimed at reducing energy intake, monitoring weight, increasing physical activity, reducing sedentary time, good sleep, managing stress and being mindful of – well – mindfulness, have putative health benefits beyond a very modest weight loss. All of the above are a great foundation for any person wanting to use lifestyle medicine to improve their health and we could expect to see reduced risk of developing or advancing multiple chronic diseases, and possibly a reversal of some, and improvements in mental health, wellbeing and overall function besides, and most of these independently of any change in weight.
Lifestyle medicine is for life, not just for Christmas!