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It’s about not being denied your civil rights and not dying because a doctor misdiagnoses you.</div> </td></tr> <tr> <td style="padding:4px 10px 8px;font-size:smaller;line-height:1.6em;text-align:right;"><cite style="font-style:normal;position:relative;z-index:2">—Cat Pausé<sup id="cite_ref-highline_1-0" class="reference"><a href="#cite_note-highline-1">[1]</a></sup></cite> </td></tr></tbody></table> <div class="thumb tright"><div class="thumbinner" style="width:167px;"><a href="/wiki/File:Weight_vs_Habits_1.png" class="image"><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/7/78/Weight_vs_Habits_1.png/165px-Weight_vs_Habits_1.png" decoding="async" width="165" height="110" class="thumbimage" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/7/78/Weight_vs_Habits_1.png/248px-Weight_vs_Habits_1.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/7/78/Weight_vs_Habits_1.png/330px-Weight_vs_Habits_1.png 2x" data-file-width="2400" data-file-height="1600" /></a> <div class="thumbcaption"><div class="magnify"><a href="/wiki/File:Weight_vs_Habits_1.png" class="internal" title="Enlarge"></a></div>HAES advocates to focus less (or at least not only) on weight but also on other healthy habits.</div></div></div> <table class="infobox" cellpadding="1" cellspacing="0" style="float: right; margin: 0 0 0.5em 0.5em; text-align:left; border: 1px solid #ff1d8e; width:175px;"> <tbody><tr> <td style="font-size: 95%; text-align:center; color:White; background-color:#ff1d8e"><b>Checking our privilege</b><br /><a href="/wiki/Social_justice" title="Social justice"><font size="4" color="White"><b>Social justice</b></font></a> </td></tr> <tr> <td style="background-color:#FFD6EB;" align="center"><a href="/wiki/Category:Social_justice" title="Category:Social justice"><img alt="Icon SJ.svg" src="/w/images/thumb/a/a5/Icon_SJ.svg/100px-Icon_SJ.svg.png" decoding="async" width="100" height="100" srcset="/w/images/thumb/a/a5/Icon_SJ.svg/150px-Icon_SJ.svg.png 1.5x, /w/images/thumb/a/a5/Icon_SJ.svg/200px-Icon_SJ.svg.png 2x" data-file-width="200" data-file-height="200" /></a> </td></tr> <tr> <td style="font-size: 95%; color:White; background-color:#ff1d8e; text-align:center;"><b>Not <a href="/wiki/Category:Social_justice" title="Category:Social justice"><font color="#fff">ALL of our articles</font></a></b> </td></tr> <tr> <td style="font-size: 95%; background-color:#FFD6EB;"> <ul><li><a href="/wiki/Stereotype" title="Stereotype">Stereotype</a></li> <li><a href="/wiki/Political_correctness" title="Political correctness">Political correctness</a></li> <li><a href="/wiki/Basic_income" title="Basic income">Basic income</a></li> <li><a href="/wiki/Gamergate" title="Gamergate">Gamergate</a></li> <li><a href="/wiki/Transmisogyny" title="Transmisogyny">Transmisogyny</a></li> <li><a href="/wiki/Ilhan_Omar" title="Ilhan Omar">Ilhan Omar</a></li> <li><a href="/wiki/Christian_democracy" title="Christian democracy">Christian democracy</a></li> <li><a href="/wiki/Corporate_Equality_Index" title="Corporate Equality Index">Corporate Equality Index</a></li> <li><a href="/wiki/Misogyny" title="Misogyny">Misogyny</a></li> <li><a href="/wiki/Linda_Sarsour" title="Linda Sarsour">Linda Sarsour</a></li> <li><a href="/wiki/Julie_Bindel" title="Julie Bindel">Julie Bindel</a></li> <li><a href="/wiki/Vaush" title="Vaush">Vaush</a></li></ul> <div class="vte plainlinks" style="font-size:smaller; text-align:center;"><a href="/wiki/Template:SJ" title="Template:SJ">v</a> - <a href="/wiki/Template_talk:SJ" title="Template talk:SJ">t</a> - <a rel="nofollow" class="external text" href="https://rationalwiki.org/w/index.php?title=Template:SJ&action=edit">e</a></div> </td></tr></tbody></table> <p><b>"Health at every size"</b> (or HAES) is a multi-faceted movement with scientific, social, and a few anti-scientific components. Scientists with a HAES approach look for more effective ways to encourage weight loss and healthy habits. Activists with a HAES approach fight weight <a href="/wiki/Discrimination" title="Discrimination">discrimination</a>, stigma, and toxic diet culture. Denialists with a HAES approach cherry-pick data to 'prove' that obesity isn't unhealthy. </p><p>There's a variety of views in HAES. Good: promoting healthy eating and exercise no matter the weight, encouraging positive thinking, debunking <a href="/wiki/Fad_diet" title="Fad diet">fad diets</a>, not being a jerk to people because of their weight. Bad: denying obesity's health risks, forgetting to try at the "health" part of "health at every size," and denying that obesity is a disease.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2">[2]</a></sup> </p><p>HAES can have a positive focus: encouraging heavier people to love and take good care of their bodies, and to not be afraid to do things like swimming or working out. Research shows that exposure to the HAES movement leads to better health outcomes and even weight loss.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3">[3]</a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4">[4]</a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5">[5]</a></sup> People who don't hate their bodies may put more effort into taking care of them. </p><p>But some proponents of the HAES may ignore their own doctors' advice to lose weight because <i>there can't possibly be any link between obesity and disease.</i><sup id="cite_ref-6" class="reference"><a href="#cite_note-6">[6]</a></sup> However, doctors can miss other diseases if they only focus on the patient's weight.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7">[7]</a></sup> If you are concerned, ask your doctor to consider other possible reasons, make sure any refusals to conduct certain diagnostic checks are well-documented, and don't be afraid to get a second opinion if your doctor won't take treatment seriously. </p> <div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><span class="toctogglespan"><label class="toctogglelabel" for="toctogglecheckbox"></label></span></div> <ul> <li class="toclevel-1 tocsection-1"><a href="#Causes_of_obesity"><span class="tocnumber">1</span> <span class="toctext">Causes of obesity</span></a> <ul> <li class="toclevel-2 tocsection-2"><a href="#Genes_and_environment_play_a_notable_role"><span class="tocnumber">1.1</span> <span class="toctext">Genes and environment play a notable role</span></a></li> <li class="toclevel-2 tocsection-3"><a href="#Healthy_eating_isn.27t_simple_for_everyone"><span class="tocnumber">1.2</span> <span class="toctext">Healthy eating isn't simple for everyone</span></a></li> </ul> </li> <li class="toclevel-1 tocsection-4"><a href="#Diet_and_weight_loss"><span class="tocnumber">2</span> <span class="toctext">Diet and weight loss</span></a> <ul> <li class="toclevel-2 tocsection-5"><a href="#Diets_often_don.27t_work_and_can_be_harmful"><span class="tocnumber">2.1</span> <span class="toctext">Diets often don't work and can be harmful</span></a></li> <li class="toclevel-2 tocsection-6"><a href="#New_approaches_to_healthy_living"><span class="tocnumber">2.2</span> <span class="toctext">New approaches to healthy living</span></a> <ul> <li class="toclevel-3 tocsection-7"><a href="#Intuitive_eating"><span class="tocnumber">2.2.1</span> <span class="toctext">Intuitive eating</span></a></li> </ul> </li> <li class="toclevel-2 tocsection-8"><a href="#Weight_loss_programs"><span class="tocnumber">2.3</span> <span class="toctext">Weight loss programs</span></a></li> </ul> </li> <li class="toclevel-1 tocsection-9"><a href="#Social_issues"><span class="tocnumber">3</span> <span class="toctext">Social issues</span></a> <ul> <li class="toclevel-2 tocsection-10"><a href="#Negativity_won.27t_cause_positive_outcomes"><span class="tocnumber">3.1</span> <span class="toctext">Negativity won't cause positive outcomes</span></a></li> <li class="toclevel-2 tocsection-11"><a href="#Weight_stigma_leads_to_worse_healthcare"><span class="tocnumber">3.2</span> <span class="toctext">Weight stigma leads to worse healthcare</span></a></li> </ul> </li> <li class="toclevel-1 tocsection-12"><a href="#Issues"><span class="tocnumber">4</span> <span class="toctext">Issues</span></a> <ul> <li class="toclevel-2 tocsection-13"><a href="#HAES_doesn.27t_address_all_health_concerns"><span class="tocnumber">4.1</span> <span class="toctext">HAES doesn't address all health concerns</span></a> <ul> <li class="toclevel-3 tocsection-14"><a href="#Obesity_paradox"><span class="tocnumber">4.1.1</span> <span class="toctext">Obesity paradox</span></a></li> </ul> </li> </ul> </li> <li class="toclevel-1 tocsection-15"><a href="#References"><span class="tocnumber">5</span> <span class="toctext">References</span></a></li> </ul> </div> <h2><span class="mw-headline" id="Causes_of_obesity">Causes of obesity</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=1" title="Edit section: Causes of obesity">edit</a><span class="mw-editsection-bracket">]</span></span></h2> <p>The traditional understanding of obesity has centered diet and exercise as key determinants of weight. This has led to the common perception of obesity as being solely a product of poor self-control. However, recent scientific research, especially in the last decade, has pointed to a range of genetic, environmental, and socioeconomic factors that influence weight. These collectively suggest that obesity may be more complex than previously thought. </p><p>HAES seeks to advance the scientific understanding of obesity and in doing so improve the lives of fat people. The movement has several good points, but not all its claims are backed by scientific evidence. Some of this is due to lack of research.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8">[8]</a></sup> Researchers have found that a HAES (or "weight-inclusive") approach is linked with better physical health, better mental health, and healthier habits overall.<sup id="cite_ref-tylka_9-0" class="reference"><a href="#cite_note-tylka-9">[9]</a></sup> </p> <h3><span class="mw-headline" id="Genes_and_environment_play_a_notable_role">Genes and environment play a notable role</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=2" title="Edit section: Genes and environment play a notable role">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <p>Research has shown there are many genetic, epigenetic, and environmental factors that shape our bodies. It has been estimated that obesity is 40-70% heritable.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10">[10]</a></sup> One study found that 80% of the children of two obese parents were obese, while only 14% of the children of average-weight parents were obese.<sup id="cite_ref-nytimes1_11-0" class="reference"><a href="#cite_note-nytimes1-11">[11]</a></sup> </p><p>The <a href="https://en.wikipedia.org/wiki/thrifty_gene_hypothesis" class="extiw" title="wp:thrifty gene hypothesis" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: thrifty gene hypothesis">thrifty gene hypothesis</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup> posits that the human propensity for obesity may be a byproduct of our <a href="/wiki/Evolution" title="Evolution">evolution</a>. For early humans, the ability to store energy as fat during periods of plenty would have been advantageous, allowing them to better endure times of reduced food availability, and increasing their chances of surviving famine. However, in the modern societies with more stable food supplies, this fat-storing tendency has seemingly become detrimental.<sup id="cite_ref-thrifty1_12-0" class="reference"><a href="#cite_note-thrifty1-12">[12]</a></sup> This could explain why obesity rates rose alongside the wider availability of refined grains and sugars that followed the <a href="/wiki/Industrial_Revolution" title="Industrial Revolution">Industrial Revolution</a>.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13">[13]</a></sup> It might also explain why certain traditionally non-agrarian human populations, such as the <a href="https://en.wikipedia.org/wiki/Pima_people" class="extiw" title="wp:Pima people" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: Pima people">Pima people</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup> of <a href="/wiki/Arizona" class="mw-redirect" title="Arizona">Arizona</a> and the <a href="https://en.wikipedia.org/wiki/Cook_Islanders" class="extiw" title="wp:Cook Islanders" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: Cook Islanders">Cook Islanders</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup> of the <a href="/wiki/Pacific_Ocean" class="mw-redirect" title="Pacific Ocean">Pacific</a>, developed some of the highest rates of obesity after being introduced to a Western lifestyle.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14">[14]</a></sup> </p><p>Increased obesity rates can also arise from epigenetic factors. Famine can significantly alter how <a href="/wiki/Gene_expression" title="Gene expression">genes are expressed</a>, and these changes may be passed on to successive generations. People in utero during the <a href="https://en.wikipedia.org/wiki/Dutch_famine_of_1944%E2%80%9345" class="extiw" title="wp:Dutch famine of 1944–45" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: Dutch famine of 1944–45">Dutch Hunger Winter</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup> of 1944-45 tended to have higher-than-average birth weights, and were also more susceptible to obesity, diabetes, and high cholesterol in later life than people born before or after the famine.<sup id="cite_ref-dutchfamine1_15-0" class="reference"><a href="#cite_note-dutchfamine1-15">[15]</a></sup><sup id="cite_ref-dutchfamine2_16-0" class="reference"><a href="#cite_note-dutchfamine2-16">[16]</a></sup> They also had a higher mortality rate sixty-eight years later.<sup id="cite_ref-dutchfamine1_15-1" class="reference"><a href="#cite_note-dutchfamine1-15">[15]</a></sup> At least one study also found that the grandchildren of Dutch famine victims had higher birth weights.<sup id="cite_ref-dutchfamine3_17-0" class="reference"><a href="#cite_note-dutchfamine3-17">[17]</a></sup> </p><p>Other environmental factors play a role. A meta-analysis of 240 studies found a link between certain plastics (<a href="/wiki/PCB" class="mw-redirect" title="PCB">PCBs</a>, phthalates, and BPA) and increased rates of obesity and diabetes.<sup id="cite_ref-plastics1_18-0" class="reference"><a href="#cite_note-plastics1-18">[18]</a></sup> Another meta-analysis of 100 studies found a link between dietary exposure to <a href="/wiki/Antibiotics" class="mw-redirect" title="Antibiotics">antibiotics</a> used in meat production and an increased risk of obesity, suggesting changes in the <a href="/wiki/Microbiome" class="mw-redirect" title="Microbiome">microbiome</a>, i.e. the <a href="/wiki/Bacteria" title="Bacteria">bacterial</a> ecosystem of the human digestive tract, as a cause.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19">[19]</a></sup> </p> <h3><span id="Healthy_eating_isn't_simple_for_everyone"></span><span class="mw-headline" id="Healthy_eating_isn.27t_simple_for_everyone">Healthy eating isn't simple for everyone</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=3" title="Edit section: Healthy eating isn't simple for everyone">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <p>Maintaining a healthy diet is generally sound advice. However, it presumes that everyone has equal access to good, nutritious food. This isn't always true for marginalized and low-income people. Poverty is associated with an increased risk of obesity.<sup id="cite_ref-poverty1_20-0" class="reference"><a href="#cite_note-poverty1-20">[20]</a></sup> Fresh vegetables and meat can be prohibitively expensive for the poor, leading them to opt for cheaper, unhealthier food choices.<sup id="cite_ref-poverty1_20-1" class="reference"><a href="#cite_note-poverty1-20">[20]</a></sup> These typically include energy-dense foods like potatoes and processed meat products, which are more palatable, have a longer shelf life, and allow poor families to maintain energy intakes at a lower cost than more expensive, less-energy-dense foods.<sup id="cite_ref-poverty1_20-2" class="reference"><a href="#cite_note-poverty1-20">[20]</a></sup><sup id="cite_ref-aus1_21-0" class="reference"><a href="#cite_note-aus1-21">[21]</a></sup> However, energy-dense foods tend to have higher fat and sugar content, and are thus more unhealthy.<sup id="cite_ref-aus1_21-1" class="reference"><a href="#cite_note-aus1-21">[21]</a></sup> Nonetheless, agricultural advancements have made energy-dense foods widely available, and they now comprise 30-50% of the Western diet.<sup id="cite_ref-aus1_21-2" class="reference"><a href="#cite_note-aus1-21">[21]</a></sup> </p><p>Some people live in "<a href="https://en.wikipedia.org/wiki/food_desert" class="extiw" title="wp:food desert" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: food desert">food deserts</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup>" with less access to affordable and nutritious food.<sup id="cite_ref-poverty1_20-3" class="reference"><a href="#cite_note-poverty1-20">[20]</a></sup><sup id="cite_ref-fooddeserts1_22-0" class="reference"><a href="#cite_note-fooddeserts1-22">[22]</a></sup> These areas are typically poor, minority, or rural communities.<sup id="cite_ref-fooddeserts1_22-1" class="reference"><a href="#cite_note-fooddeserts1-22">[22]</a></sup> They often lack supermarkets, leaving residents with less food options and leading them to rely on convenience stores and fast-food restaurants, which offer cheap, energy-dense foods.<sup id="cite_ref-fooddeserts1_22-2" class="reference"><a href="#cite_note-fooddeserts1-22">[22]</a></sup> </p><p>Special dietary needs can also limit one's food options in a way that makes healthy eating more difficult. <a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">Irritable bowel syndrome</a> sufferers may find healthy-diet staples like leafy greens aggravate their symptoms, and may thus favour starchy and low-fiber foods in an attempt to alleviate them.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23">[23]</a></sup> IBS has been linked to an increased risk of obesity by a number of studies.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24">[24]</a></sup> <a href="/wiki/Autism" title="Autism">Autism</a>, with its attendant sensory sensitivities and need for routine, can also cause dietary restrictions that pose challenges for healthy eating.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25">[25]</a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26">[26]</a></sup> Studies have found a link between autism and an increased risk of obesity.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27">[27]</a></sup> </p> <h2><span class="mw-headline" id="Diet_and_weight_loss">Diet and weight loss</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=4" title="Edit section: Diet and weight loss">edit</a><span class="mw-editsection-bracket">]</span></span></h2> <h3><span id="Diets_often_don't_work_and_can_be_harmful"></span><span class="mw-headline" id="Diets_often_don.27t_work_and_can_be_harmful">Diets often don't work and can be harmful</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=5" title="Edit section: Diets often don't work and can be harmful">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <div class="thumb tright"><div class="thumbinner" style="width:167px;"><a href="/wiki/File:HCG_Diet_Products_Are_Illegal_(6419420559).jpg" class="image"><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg/165px-HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg" decoding="async" width="165" height="249" class="thumbimage" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg/248px-HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg/330px-HCG_Diet_Products_Are_Illegal_%286419420559%29.jpg 2x" data-file-width="1848" data-file-height="2784" /></a> <div class="thumbcaption"><div class="magnify"><a href="/wiki/File:HCG_Diet_Products_Are_Illegal_(6419420559).jpg" class="internal" title="Enlarge"></a></div>Putting <a href="/wiki/Pseudoscience" title="Pseudoscience">non-FDA-approved chemicals</a> into your body is probably a bad idea.</div></div></div> <p>Traditional dieting is often ineffective<sup id="cite_ref-28" class="reference"><a href="#cite_note-28">[28]</a></sup> and can be harmful in the long term.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29">[29]</a></sup><sup><span style="white-space: nowrap;">[<i><a href="/wiki/Category:Articles_with_dead_links" title="Category:Articles with dead links"><span title="">dead link</span></a></i>]</span></sup> Recent scientific research has shown that dieting, especially using unhealthy means, is correlated with eating disorders, weight fluctuations, extreme dieting measures (such as laxatives), reduced self-esteem, increased susceptibility to weight gain, and other long-term health issues.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30">[30]</a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31">[31]</a></sup><sup id="cite_ref-32" class="reference"><a href="#cite_note-32">[32]</a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33">[33]</a></sup> </p><p>Willpower alone doesn't explain dieting failure.<sup id="cite_ref-time1_34-0" class="reference"><a href="#cite_note-time1-34">[34]</a></sup> A meta-analysis found that diets generally do not work, and that many dieters regain more weight than they started with initially.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35">[35]</a></sup> Up to 80% of dieters regain some or all of the weight within a year.<sup id="cite_ref-cnn1_36-0" class="reference"><a href="#cite_note-cnn1-36">[36]</a></sup> Diets can alter <a href="/wiki/Metabolism" title="Metabolism">metabolism</a> and hormone balance in ways that contribute to weight gain and retention.<sup id="cite_ref-nytimes2_37-0" class="reference"><a href="#cite_note-nytimes2-37">[37]</a></sup> The human body has seemingly been hardwired by <a href="/wiki/Evolution" title="Evolution">evolution</a> to respond this way to apparent food scarcity (see the discussion of the thrifty gene hypothesis in the <a href="/wiki/Health_at_every_size#Genes_and_environment_play_a_notable_role" title="Health at every size">previous section</a>).<sup id="cite_ref-nytimes2_37-1" class="reference"><a href="#cite_note-nytimes2-37">[37]</a></sup> This "famine reaction" leads to a reduced resting metabolism, meaning the body burns less calories and stores more fat, and this lowered metabolic rate may persist even as weight is regained.<sup id="cite_ref-time1_34-1" class="reference"><a href="#cite_note-time1-34">[34]</a></sup> Major weight loss can be metabolically identical to starvation.<sup id="cite_ref-nytimes1_11-1" class="reference"><a href="#cite_note-nytimes1-11">[11]</a></sup> It can also trigger increased production of ghrelin, a gastric hormone tied to hunger, and decrease peptide YY and leptin, hormones associated with hunger suppression.<sup id="cite_ref-cnn1_36-1" class="reference"><a href="#cite_note-cnn1-36">[36]</a></sup><sup id="cite_ref-nytimes2_37-2" class="reference"><a href="#cite_note-nytimes2-37">[37]</a></sup> These hormonal changes may also persist long after the initial weight loss.<sup id="cite_ref-nytimes2_37-3" class="reference"><a href="#cite_note-nytimes2-37">[37]</a></sup> All this means that not only are lost pounds regained, but subsequent weight loss attempts are more difficult. People who want to stay in shape must also adhere to stricter diets and exercise more than just three decades ago due to an apparent shift in biological and environmental factors.<sup id="cite_ref-1980s_38-0" class="reference"><a href="#cite_note-1980s-38">[38]</a></sup> A study found that people in 2006 had higher <a href="/wiki/Body_mass_index" class="mw-redirect" title="Body mass index">BMIs</a> than people of the same age who followed an identical diet and exercise regimen in 1988.<sup id="cite_ref-1980s_38-1" class="reference"><a href="#cite_note-1980s-38">[38]</a></sup> </p><p>Reduced caloric intake can increase cortisol production and psychological stress.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39">[39]</a></sup> Excessive cortisol, often known as the "stress hormone," can have several health consequences.<sup id="cite_ref-mayoclinic1_40-0" class="reference"><a href="#cite_note-mayoclinic1-40">[40]</a></sup> Not only does it cause weight gain, but it is associated with depression, anxiety, and sleep problems.<sup id="cite_ref-mayoclinic1_40-1" class="reference"><a href="#cite_note-mayoclinic1-40">[40]</a></sup> It can also negatively impact the cardiovascular system, and has been linked to an increased risk of heart disease.<sup id="cite_ref-mayoclinic1_40-2" class="reference"><a href="#cite_note-mayoclinic1-40">[40]</a></sup> </p><p><a href="/wiki/Fad_diet" title="Fad diet">Fad diets</a> are especially awful for losing weight.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41">[41]</a></sup> More dangerous fad diets may even result in death. A woman in the UK died as a result of following a <a href="/wiki/Breatharianism" title="Breatharianism">breatharian</a> diet.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42">[42]</a></sup> Weight cycling, or "yo-yo dieting," increases heart disease and mortality.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43">[43]</a></sup> Some studies have found that the weight fluctuations associated with "yo-yo dieting" may have worse health outcomes than a stable (even overweight) weight.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44">[44]</a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45">[45]</a></sup> </p><p>It can be difficult to measure how strictly someone follows a diet. Dieters may under-report the number of calories that they eat and/or over-report the exercise they do.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46">[46]</a></sup> This means that they may not be following a diet as well as they think they do. </p> <h3><span class="mw-headline" id="New_approaches_to_healthy_living">New approaches to healthy living</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=6" title="Edit section: New approaches to healthy living">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <div class="thumb tright"><div class="thumbinner" style="width:167px;"><a href="/wiki/File:Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg" class="image"><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d9/Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg/165px-Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg" decoding="async" width="165" height="110" class="thumbimage" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/d/d9/Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg/248px-Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/d/d9/Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg/330px-Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg 2x" data-file-width="2784" data-file-height="1848" /></a> <div class="thumbcaption"><div class="magnify"><a href="/wiki/File:Preventing_Childhood_Obesity_with_Nutrition_Basics.jpg" class="internal" title="Enlarge"></a></div>Less focus on shame, more focus on healthy habits.</div></div></div> <p>Due to the lack of positive results associated with diets, experts are now calling for a new paradigm, favoring smaller and sustainable gradual lifestyle changes over strict diets.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47">[47]</a></sup> A meta-analysis found that several practices improve body image and lead to better health: intuitive eating, Cognitive Behavioral Therapy, self-compassion, and exercise.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48">[48]</a></sup> </p><p>Weight-neutral interventions that advocate a shift away from traditional dieting show improvements in mental health and disordered eating habits, as well as positive or neutral effects on biological markers of health.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49">[49]</a></sup> Weight-neutral approaches such as Health at Every Size are a scientifically valid way to improve health, especially with regards to psychological well-being and healthy habits.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50">[50]</a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51">[51]</a></sup><sup id="cite_ref-52" class="reference"><a href="#cite_note-52">[52]</a></sup> </p> <h4><span class="mw-headline" id="Intuitive_eating">Intuitive eating</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=7" title="Edit section: Intuitive eating">edit</a><span class="mw-editsection-bracket">]</span></span></h4> <p>HAES advocates promote intuitive eating, which encourages people to pay attention to their appetite rather than relying on self-imposed rules. One must eat until satisfied, and then stop.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53">[53]</a></sup><sup><span style="white-space: nowrap;">[<i><a href="/wiki/Category:Articles_with_dead_links" title="Category:Articles with dead links"><span title="">dead link</span></a></i>]</span></sup> While intuitive eating sounds like regular behavior, it is something that chronic dieters and eating disorder survivors may need to re-learn. </p><p>Multiple literature reviews have found that intuitive eating is associated with lower BMI, healthier eating habits, and better psychological well-being, while noting that it is still an emerging topic.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54">[54]</a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55">[55]</a></sup><sup id="cite_ref-56" class="reference"><a href="#cite_note-56">[56]</a></sup> </p><p>The practice has a few limitations: it focuses on when to eat (not what to eat), and it may not work well for people who have health conditions that impair their interoception, meaning that they cannot recognize hunger and fullness properly. Interoception issues can occur in a number of conditions, such as eating disorders, depression, autism, anxiety, and more.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57">[57]</a></sup> Someone who cannot recognize hunger properly may need to implement common-sense habits to make sure that they are eating enough.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58">[58]</a></sup> </p> <h3><span class="mw-headline" id="Weight_loss_programs">Weight loss programs</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=8" title="Edit section: Weight loss programs">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <p>"Failed" child obesity reduction programs have improved other measures of health, including athletic skills, time spent exercising, and time spent watching television.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59">[59]</a></sup> Health programs for kids may not significantly change obesity, but they can improve test scores.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60">[60]</a></sup> Seeing weight loss as the end goal of such initiatives can result in overlooking positive changes. </p> <h2><span class="mw-headline" id="Social_issues">Social issues</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=9" title="Edit section: Social issues">edit</a><span class="mw-editsection-bracket">]</span></span></h2> <h3><span id="Negativity_won't_cause_positive_outcomes"></span><span class="mw-headline" id="Negativity_won.27t_cause_positive_outcomes">Negativity won't cause positive outcomes</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=10" title="Edit section: Negativity won't cause positive outcomes">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <div class="thumb tright"><div class="thumbinner" style="width:187px;"><a href="/wiki/File:Fat_Yoga_Class.jpg" class="image"><img alt="" src="/w/images/thumb/3/3f/Fat_Yoga_Class.jpg/185px-Fat_Yoga_Class.jpg" decoding="async" width="185" height="124" class="thumbimage" srcset="/w/images/thumb/3/3f/Fat_Yoga_Class.jpg/278px-Fat_Yoga_Class.jpg 1.5x, /w/images/thumb/3/3f/Fat_Yoga_Class.jpg/370px-Fat_Yoga_Class.jpg 2x" data-file-width="929" data-file-height="622" /></a> <div class="thumbcaption"><div class="magnify"><a href="/wiki/File:Fat_Yoga_Class.jpg" class="internal" title="Enlarge"></a></div>A <a href="/wiki/Yoga" title="Yoga">yoga</a> class designed for heavier individuals. Body-shaming may discourage exercise in communal settings.</div></div></div> <p>Research suggests that negative and stigmatizing approaches to obesity don't lead to better health.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61">[61]</a></sup> A 2014 study found that <a href="/wiki/Shaming" title="Shaming">fat shaming</a> doesn't just fail to motivate weight loss, but, paradoxically, may actually prompt weight gain.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62">[62]</a></sup> This may be because stigma creates a vicious cycle, causing increased stress that triggers binge or comfort eating, thereby leading to more weight gain.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63">[63]</a></sup><sup id="cite_ref-brewis_64-0" class="reference"><a href="#cite_note-brewis-64">[64]</a></sup> In two studies, Schvey et al. found that, in obese women, exposure to weight-stigmatizing content increased caloric consumption and production of cortisol.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65">[65]</a></sup><sup id="cite_ref-66" class="reference"><a href="#cite_note-66">[66]</a></sup> Major et al. (2014) found similar results, concluding that exposure to "weight-stigmatizing news messages" causes obese (but not non-obese) individuals to "consume more calorie-rich snack foods" and "feel less able to control their diet."<sup id="cite_ref-67" class="reference"><a href="#cite_note-67">[67]</a></sup> Obesity and internalized shame have been linked to a greater incidence of depression and anxiety.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68">[68]</a></sup><sup id="cite_ref-69" class="reference"><a href="#cite_note-69">[69]</a></sup> Heavy people who feel discriminated against have shorter lifespans.<sup id="cite_ref-70" class="reference"><a href="#cite_note-70">[70]</a></sup> Around half of girls between ages 3 and 6 are worried about their weight,<sup id="cite_ref-71" class="reference"><a href="#cite_note-71">[71]</a></sup> and preschoolers are less kind to their chubbier peers.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72">[72]</a></sup> </p><p>Weight stigma can also strongly discourage physical activity among obese people.<sup id="cite_ref-brewis_64-1" class="reference"><a href="#cite_note-brewis-64">[64]</a></sup> Harassment, body-shaming, and judgment faced in public facilities like gyms and swimming pools can lead people to avoid them.<sup id="cite_ref-brewis_64-2" class="reference"><a href="#cite_note-brewis-64">[64]</a></sup> In a 2011 study, experience of fat shaming, internalization of "anti-fat attitudes," and internalization of societal beauty standards were all found to be associated with exercise avoidance (particularly at gyms).<sup id="cite_ref-73" class="reference"><a href="#cite_note-73">[73]</a></sup> </p><p>Additionally, fat people often face <a href="/wiki/Discrimination" title="Discrimination">discrimination</a> in hiring and salaries, further leading to marginalization.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74">[74]</a></sup><sup id="cite_ref-75" class="reference"><a href="#cite_note-75">[75]</a></sup> </p> <h3><span class="mw-headline" id="Weight_stigma_leads_to_worse_healthcare">Weight stigma leads to worse healthcare</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=11" title="Edit section: Weight stigma leads to worse healthcare">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <table style="margin: auto; border-collapse:collapse; border-style:none; background-color:transparent;" class="cquote"> <tbody><tr> <td><div style="padding:4px 50px;position:relative;"><span style="position:absolute;left:10px;top:-6px;z-index:1;font-family:'Times New Roman',serif;font-weight:bold;color:#B2B7F2;font-size:36px">“</span><span style="position:absolute;right:10px;bottom:-20px;z-index:1;font-family:'Times New Roman',serif;font-weight:bold;color:#B2B7F2;font-size:36px">”</span>Doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients.</div> </td></tr> <tr> <td style="padding:4px 10px 8px;font-size:smaller;line-height:1.6em;text-align:right;"><cite style="font-style:normal;position:relative;z-index:2">—Joan Chrisler, PhD<sup id="cite_ref-76" class="reference"><a href="#cite_note-76">[76]</a></sup></cite> </td></tr></tbody></table> <p>Stigmatization and shame often follow fat people into the doctor's office. Researchers have found that negative bias can lower the quality of healthcare provided to obese patients.<sup id="cite_ref-77" class="reference"><a href="#cite_note-77">[77]</a></sup> Physicians in one study reported they prefer to spend signficantly less time with obese patients.<sup id="cite_ref-hebl-nature_78-0" class="reference"><a href="#cite_note-hebl-nature-78">[78]</a></sup> They were also more likely to rate them poorly in 12 out of 13 categories, including perceptions of self-discipline and health consciousness.<sup id="cite_ref-hebl-nature_78-1" class="reference"><a href="#cite_note-hebl-nature-78">[78]</a></sup> Another study found that physicians tend to build less rapport with obese patients and are less likely to offer them empathy or reassurance.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79">[79]</a></sup> Nurses can also hold negative attitudes towards heavier patients.<sup id="cite_ref-80" class="reference"><a href="#cite_note-80">[80]</a></sup> </p><p>The issues arising from weight stigma in medicine are two-pronged. Patients may delay or avoid seeking care if they fear being judged, shamed, or dismissed, and doctors may misdiagnose or overlook symptoms if they focus inordinately on weight.<sup id="cite_ref-brewis_64-3" class="reference"><a href="#cite_note-brewis-64">[64]</a></sup><sup id="cite_ref-81" class="reference"><a href="#cite_note-81">[81]</a></sup><sup id="cite_ref-purcell_82-0" class="reference"><a href="#cite_note-purcell-82">[82]</a></sup><sup id="cite_ref-83" class="reference"><a href="#cite_note-83">[83]</a></sup><sup id="cite_ref-84" class="reference"><a href="#cite_note-84">[84]</a></sup> Beyond eroding the doctor-patient relationship, this can lead to serious medical conditions going undiagnosed, or not being caught until they are more severe and possibly untreatable.<sup id="cite_ref-purcell_82-1" class="reference"><a href="#cite_note-purcell-82">[82]</a></sup> A review of 300 autopsy reports found that obese patients were 1.65 times more likely to have previously undiagnosed serious medical conditions.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85">[85]</a></sup> Studies have consistently shown that obese women are less likely to be offered or seek screening for several cancers (breast, cervical, colorectal, and ovarian) and more likely to be diagnosed at a more advanced stage.<sup id="cite_ref-86" class="reference"><a href="#cite_note-86">[86]</a></sup><sup id="cite_ref-87" class="reference"><a href="#cite_note-87">[87]</a></sup><sup id="cite_ref-mullins_88-0" class="reference"><a href="#cite_note-mullins-88">[88]</a></sup><sup id="cite_ref-erondu_89-0" class="reference"><a href="#cite_note-erondu-89">[89]</a></sup> This problem is compounded for women of color.<sup id="cite_ref-mullins_88-1" class="reference"><a href="#cite_note-mullins-88">[88]</a></sup><sup id="cite_ref-erondu_89-1" class="reference"><a href="#cite_note-erondu-89">[89]</a></sup> </p><p>Poor-quality healthcare are particularly concerning in light of the US Preventative Services Task Force's recommendation that regular check-ups and extra support are ideal for patients seeking to lose weight.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90">[90]</a></sup> </p> <h2><span class="mw-headline" id="Issues">Issues</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=12" title="Edit section: Issues">edit</a><span class="mw-editsection-bracket">]</span></span></h2> <h3><span id="HAES_doesn't_address_all_health_concerns"></span><span class="mw-headline" id="HAES_doesn.27t_address_all_health_concerns">HAES doesn't address all health concerns</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=13" title="Edit section: HAES doesn't address all health concerns">edit</a><span class="mw-editsection-bracket">]</span></span></h3> <div class="thumb tright"><div class="thumbinner" style="width:167px;"><a href="/wiki/File:Medical_complications_of_obesity.png" class="image"><img alt="" src="/w/images/thumb/c/cf/Medical_complications_of_obesity.png/165px-Medical_complications_of_obesity.png" decoding="async" width="165" height="225" class="thumbimage" srcset="/w/images/thumb/c/cf/Medical_complications_of_obesity.png/248px-Medical_complications_of_obesity.png 1.5x, /w/images/thumb/c/cf/Medical_complications_of_obesity.png/330px-Medical_complications_of_obesity.png 2x" data-file-width="751" data-file-height="1024" /></a> <div class="thumbcaption"><div class="magnify"><a href="/wiki/File:Medical_complications_of_obesity.png" class="internal" title="Enlarge"></a></div>Diagram of obesity-related medical complications.</div></div></div> <p>Research has shown that obesity is linked to a number of health issues.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91">[91]</a></sup><sup id="cite_ref-92" class="reference"><a href="#cite_note-92">[92]</a></sup><sup id="cite_ref-93" class="reference"><a href="#cite_note-93">[93]</a></sup><sup id="cite_ref-94" class="reference"><a href="#cite_note-94">[94]</a></sup><sup id="cite_ref-95" class="reference"><a href="#cite_note-95">[95]</a></sup><sup id="cite_ref-96" class="reference"><a href="#cite_note-96">[96]</a></sup><sup id="cite_ref-97" class="reference"><a href="#cite_note-97">[97]</a></sup> These include increased risks of cardiovascular disease, diabetes, musculoskeletal disorders (especially <a href="https://en.wikipedia.org/wiki/osteoarthritis" class="extiw" title="wp:osteoarthritis" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: osteoarthritis">osteoarthritis</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup>), and certain <a href="/wiki/Cancer" title="Cancer">cancers</a>.<sup id="cite_ref-who-factsheet_98-0" class="reference"><a href="#cite_note-who-factsheet-98">[98]</a></sup> Childhood obesity carries not only and an increased risk of obesity and its associated health problems in adulthood, but also presents additional risks including breathing difficulties, increased susceptibility to bone fractures, hypertension, and insulin resistance.<sup id="cite_ref-who-factsheet_98-1" class="reference"><a href="#cite_note-who-factsheet-98">[98]</a></sup> </p><p>While some research suggests that an HAES approach may yield better health outcomes than more traditional, diet-centered approaches,<sup id="cite_ref-tylka_9-1" class="reference"><a href="#cite_note-tylka-9">[9]</a></sup> it does not address all of the health risks associated with obesity. Some claims made by HAES advocates lack scientific evidence and veer toward <a href="/wiki/Denialism" title="Denialism">denialism</a>. In particular, some hardline HAES advocates consider <i>any</i> attempt to lose weight by restricting one's caloric intake to be a precursor to, or even a symptom of, <a href="/w/index.php?title=Anorexia&action=edit&redlink=1" class="new" title="Anorexia (page does not exist)">anorexia</a>.<sup id="cite_ref-99" class="reference"><a href="#cite_note-99">[99]</a></sup> This suggests poor understanding of eating disorders. Anorexia involves a compulsive, overriding obsession with weight loss and food restriction, as well as distorted self-perception.<sup id="cite_ref-100" class="reference"><a href="#cite_note-100">[100]</a></sup> This is different from altering one's diet to cut down on or avoid less-healthy foods. Eating healthier food can have positive effects other than weight loss. Research has shown that purposely trying to lose weight, even if unsuccessful, can reduce mortality risk for overweight patients with diabetes.<sup id="cite_ref-101" class="reference"><a href="#cite_note-101">[101]</a></sup> </p><p>Healthy habits are important regardless of size. Matheson et al. (2012) found that four healthy behaviors – not smoking, drinking moderately, exercising regularly, and eating at least five portions of fruit or vegetables per day – were associated with reduced mortality for all weight classes.<sup id="cite_ref-102" class="reference"><a href="#cite_note-102">[102]</a></sup> However, another analysis has shown that flaws in methodology can dramatically understate the mortality risk of obesity.<sup id="cite_ref-103" class="reference"><a href="#cite_note-103">[103]</a></sup> Obese people may be metabolically healthy, but precisely how many are is unclear, as a literature review found numbers ranging from 6% and 75%.<sup id="cite_ref-104" class="reference"><a href="#cite_note-104">[104]</a></sup> This wide range of results is due in part to differences in the definition of metabolically healthy obesity across studies.<sup id="cite_ref-105" class="reference"><a href="#cite_note-105">[105]</a></sup> Some studies categorize individuals with up to two components of metabolic syndrome as metabolically healthy,<sup id="cite_ref-106" class="reference"><a href="#cite_note-106">[106]</a></sup> while a person is considered to have metabolic syndrome if they have at least three risk factors, one of which is obesity.<sup id="cite_ref-107" class="reference"><a href="#cite_note-107">[107]</a></sup> People with a normal BMI with metabolic syndrome are also twice as likely to get diabetes than obese people with healthy blood metabolic indicators, but a higher BMI still increases the risk of diabetes <i>regardless</i> of metabolic indicators.<sup id="cite_ref-108" class="reference"><a href="#cite_note-108">[108]</a></sup> </p> <h4><span class="mw-headline" id="Obesity_paradox">Obesity paradox</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=14" title="Edit section: Obesity paradox">edit</a><span class="mw-editsection-bracket">]</span></span></h4> <p>The <a href="https://en.wikipedia.org/wiki/obesity_paradox" class="extiw" title="wp:obesity paradox" rel="nofollow"><span style="color:#477979 !important;" title="Wikipedia: obesity paradox">obesity paradox</span></a><sup><img alt="" src="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/12px-Wikipedia%27s_W.svg.png" decoding="async" width="12" height="12" srcset="https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/18px-Wikipedia%27s_W.svg.png 1.5x, https://upload.wikimedia.org/wikipedia/commons/thumb/5/5a/Wikipedia%27s_W.svg/24px-Wikipedia%27s_W.svg.png 2x" data-file-width="128" data-file-height="128" /></sup> is a medical <a href="/wiki/Hypothesis" title="Hypothesis">hypothesis</a> which posits that obesity, against conventional wisdom, may be associated with greater survival for certain diseases and/or groups of people. This paradox was first noted in 1999 when it was found that obese hemodialysis patients fared unexpectedly well.<sup id="cite_ref-109" class="reference"><a href="#cite_note-109">[109]</a></sup> It has since been observed in patients with other conditions, including heart failure,<sup id="cite_ref-110" class="reference"><a href="#cite_note-110">[110]</a></sup> acute coronary syndrome,<sup id="cite_ref-111" class="reference"><a href="#cite_note-111">[111]</a></sup> and chronic obstructive pulmonary disease (COPD).<sup id="cite_ref-112" class="reference"><a href="#cite_note-112">[112]</a></sup> One meta-analysis found that "not only overweight but also obesity is protective" for elderly nursing home residents.<sup id="cite_ref-113" class="reference"><a href="#cite_note-113">[113]</a></sup> The cause or causes of this paradox are undetermined. Hong et al. (2011) have proposed that adipose tissue may store fat-soluble pollutant chemicals, thus locking away toxins that would otherwise harm the body.<sup id="cite_ref-114" class="reference"><a href="#cite_note-114">[114]</a></sup> </p><p>The obesity paradox has drawn criticism. Studies that show that obesity reduces mortality rates for certain diseases may neglect to account for <a href="/wiki/Confounding_factor" title="Confounding factor">confounding factors</a>.<sup id="cite_ref-vox-belluz1_115-0" class="reference"><a href="#cite_note-vox-belluz1-115">[115]</a></sup> In a study reviewing 10 years of <a href="/wiki/Centers_for_Disease_Control_and_Prevention" class="mw-redirect" title="Centers for Disease Control and Prevention">CDC</a> data, it was found that the obesity paradox disappeared once weight history was controlled for, i.e. by separating individuals in the normal weight category whose weight had remained stable from those who had previously been obese.<sup id="cite_ref-116" class="reference"><a href="#cite_note-116">[116]</a></sup><sup id="cite_ref-vox-belluz1_115-1" class="reference"><a href="#cite_note-vox-belluz1-115">[115]</a></sup> </p><p>Potential conflicts of interest have also raised suspicions about whether the obesity paradox truly exists. It is strongly suspected that Coca-Cola is championing studies that promote the obesity paradox, has a relationship with cardiologist Carl Lavie who popularised the obesity paradox, and even more suspiciously, is funding researchers that promote the obesity paradox.<sup id="cite_ref-117" class="reference"><a href="#cite_note-117">[117]</a></sup> </p> <h2><span class="mw-headline" id="References">References</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Health_at_every_size&action=edit&section=15" title="Edit section: References">edit</a><span class="mw-editsection-bracket">]</span></span></h2> <div class="references-small" style="-moz-column-count:2; -webkit-column-count:2; column-count:2; font-size:80%;"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-highline-1"><span class="mw-cite-backlink"><a href="#cite_ref-highline_1-0">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/">Everything You Know About Obesity Is Wrong</a></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><a href="#cite_ref-2">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external free" href="https://icd.who.int/browse10/2019/en">https://icd.who.int/browse10/2019/en</a></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><a href="#cite_ref-3">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/19857626">Health-At-Every-Size and eating behaviors: 1-year follow-up results of a size acceptance intervention.</a></span> </li> <li id="cite_note-4"><span class="mw-cite-backlink"><a href="#cite_ref-4">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://theconversation.com/study-finds-fat-acceptance-blogs-can-improve-health-outcomes-2890">Study finds fat acceptance blogs can improve health outcomes</a></span> </li> <li id="cite_note-5"><span class="mw-cite-backlink"><a href="#cite_ref-5">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0378512215300591">Effect of a non-dieting lifestyle randomised control trial on psychological well-being and weight management in morbidly obese pre-menopausal women</a></span> </li> <li id="cite_note-6"><span class="mw-cite-backlink"><a href="#cite_ref-6">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://thisisthinprivilege.tumblr.com/post/41542890848/i-really-want-to-believe-in-your-blog-as-i-am-a">Ask about sleep apnea</a> <i>This is Thin privilege</i></span> </li> <li id="cite_note-7"><span class="mw-cite-backlink"><a href="#cite_ref-7">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.healthline.com/health-news/my-doctor-fat-shamed-me">My Doctor Fat-Shamed Me — And I’m Not the Only One</a> by Marie Southard Ospina at <i>healthline</i></span> </li> <li id="cite_note-8"><span class="mw-cite-backlink"><a href="#cite_ref-8">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386524/">The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward</a></span> </li> <li id="cite_note-tylka-9"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-tylka_9-0">9.0</a></sup> <sup><a href="#cite_ref-tylka_9-1">9.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.hindawi.com/journals/jobe/2014/983495/">The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss</a></span> </li> <li id="cite_note-10"><span class="mw-cite-backlink"><a href="#cite_ref-10">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787002/">Genetic contributors to obesity</a></span> </li> <li id="cite_note-nytimes1-11"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-nytimes1_11-0">11.0</a></sup> <sup><a href="#cite_ref-nytimes1_11-1">11.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nytimes.com/2007/05/08/health/08fat.html">Genes Take Charge, and Diets Fall by the Wayside</a></span> </li> <li id="cite_note-thrifty1-12"><span class="mw-cite-backlink"><a href="#cite_ref-thrifty1_12-0">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.physiology.org/doi/full/10.1152/japplphysiol.00757.2003">Eating, exercise, and "thrifty" genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases</a></span> </li> <li id="cite_note-13"><span class="mw-cite-backlink"><a href="#cite_ref-13">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://web.colby.edu/st297-global18/2018/10/30/has-technology-caused-an-obesity-epidemic/">Has Technology Caused an Obesity Epidemic?</a></span> </li> <li id="cite_note-14"><span class="mw-cite-backlink"><a href="#cite_ref-14">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://academic.oup.com/ije/article/38/1/63/694434">Ethnic variability in adiposity and cardiovascular risk: the variable disease selection hypothesis</a></span> </li> <li id="cite_note-dutchfamine1-15"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-dutchfamine1_15-0">15.0</a></sup> <sup><a href="#cite_ref-dutchfamine1_15-1">15.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nytimes.com/2018/01/31/science/dutch-famine-genes.html">The Famine Ended 70 Years Ago, but Dutch Genes Still Bear Scars</a></span> </li> <li id="cite_note-dutchfamine2-16"><span class="mw-cite-backlink"><a href="#cite_ref-dutchfamine2_16-0">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801462/">Uncertain Inheritance: Transgenerational Effects of Environmental Exposures</a></span> </li> <li id="cite_note-dutchfamine3-17"><span class="mw-cite-backlink"><a href="#cite_ref-dutchfamine3_17-0">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.12136">Transgenerational effects of prenatal exposure to the 1944-1945 Dutch famine</a></span> </li> <li id="cite_note-plastics1-18"><span class="mw-cite-backlink"><a href="#cite_ref-plastics1_18-0">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.independent.co.uk/news/science/chemicals-in-plastic-linked-to-rise-in-obesity-and-diabetes-7578153.html">Chemicals in plastic linked to rise in obesity and diabetes</a></span> </li> <li id="cite_note-19"><span class="mw-cite-backlink"><a href="#cite_ref-19">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867737/">Obesity in the United States – Dysbiosis from Exposure to Low-Dose Antibiotics?</a></span> </li> <li id="cite_note-poverty1-20"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-poverty1_20-0">20.0</a></sup> <sup><a href="#cite_ref-poverty1_20-1">20.1</a></sup> <sup><a href="#cite_ref-poverty1_20-2">20.2</a></sup> <sup><a href="#cite_ref-poverty1_20-3">20.3</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://scholars.org/contribution/why-poverty-leads-obesity-and-life-long-problems">Why Poverty Leads to Obesity and Life-Long Problems</a></span> </li> <li id="cite_note-aus1-21"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-aus1_21-0">21.0</a></sup> <sup><a href="#cite_ref-aus1_21-1">21.1</a></sup> <sup><a href="#cite_ref-aus1_21-2">21.2</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/healthy%20eating/Literature%20Review%20Poverty_Obesity_Food%20Insecurity.ashx">A review of the literature describing the link between poverty, food insecurity and obesity with specific reference to Australia</a></span> </li> <li id="cite_note-fooddeserts1-22"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-fooddeserts1_22-0">22.0</a></sup> <sup><a href="#cite_ref-fooddeserts1_22-1">22.1</a></sup> <sup><a href="#cite_ref-fooddeserts1_22-2">22.2</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ajpmonline.org/article/S0749-3797(08)00838-6/abstract">Neighborhood Environments: Disparities in Access to Healthy Foods in the U.S.</a></span> </li> <li id="cite_note-23"><span class="mw-cite-backlink"><a href="#cite_ref-23">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://gastrocenternj.com/can-ibs-cause-weight-gain/">Can IBS Cause Weight Gain and What Can You Do About It</a></span> </li> <li id="cite_note-24"><span class="mw-cite-backlink"><a href="#cite_ref-24">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302488/">Obesity and Irritable Bowel Syndrome: A Comprehensive Review</a></span> </li> <li id="cite_note-25"><span class="mw-cite-backlink"><a href="#cite_ref-25">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601920/">Food selectivity and sensory sensitivity in children with autism spectrum disorders</a></span> </li> <li id="cite_note-26"><span class="mw-cite-backlink"><a href="#cite_ref-26">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310968/">Changes in food selectivity in children with autism spectrum disorder</a></span> </li> <li id="cite_note-27"><span class="mw-cite-backlink"><a href="#cite_ref-27">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.spectrumnews.org/news/research-adds-heft-link-autism-obesity/">Research adds heft to link between autism and obesity</a></span> </li> <li id="cite_note-28"><span class="mw-cite-backlink"><a href="#cite_ref-28">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S1499404606602479">The National Weight Control Registry: A Critique</a></span> </li> <li id="cite_note-29"><span class="mw-cite-backlink"><a href="#cite_ref-29">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sizediversityandhealth.org/content.asp?id=161">Health At Every Size Fact Sheet</a></span> </li> <li id="cite_note-30"><span class="mw-cite-backlink"><a href="#cite_ref-30">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/21829159">Does dieting make you fat? A twin study.</a></span> </li> <li id="cite_note-31"><span class="mw-cite-backlink"><a href="#cite_ref-31">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0002822306000046">Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?</a></span> </li> <li id="cite_note-32"><span class="mw-cite-backlink"><a href="#cite_ref-32">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/1580453">Methods for voluntary weight loss and control. NIH Technology Assessment Conference Panel. "Several epidemiologic studies have found that weight loss is associated with increased mortality..."</a></span> </li> <li id="cite_note-33"><span class="mw-cite-backlink"><a href="#cite_ref-33">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9">Weight Science: Evaluating the Evidence for a Paradigm Shift</a></span> </li> <li id="cite_note-time1-34"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-time1_34-0">34.0</a></sup> <sup><a href="#cite_ref-time1_34-1">34.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://time.com/magazine/us/4793878/june-5th-2017-vol-189-no-21-u-s/">The Weight Loss Trap: Why Your Diet Isn’t Working</a> - TIME</span> </li> <li id="cite_note-35"><span class="mw-cite-backlink"><a href="#cite_ref-35">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/17469900">Medicare's search for effective obesity treatments: diets are not the answer.</a></span> </li> <li id="cite_note-cnn1-36"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-cnn1_36-0">36.0</a></sup> <sup><a href="#cite_ref-cnn1_36-1">36.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.cnn.com/2011/10/26/health/post-diet-weight-regain/index.html">After dieting, hormone changes may fuel weight regain</a></span> </li> <li id="cite_note-nytimes2-37"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-nytimes2_37-0">37.0</a></sup> <sup><a href="#cite_ref-nytimes2_37-1">37.1</a></sup> <sup><a href="#cite_ref-nytimes2_37-2">37.2</a></sup> <sup><a href="#cite_ref-nytimes2_37-3">37.3</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html">The Fat Trap</a></span> </li> <li id="cite_note-1980s-38"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-1980s_38-0">38.0</a></sup> <sup><a href="#cite_ref-1980s_38-1">38.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.theatlantic.com/health/archive/2015/09/why-it-was-easier-to-be-skinny-in-the-1980s/407974/">Why It Was Easier to Be Skinny in the 1980s</a></span> </li> <li id="cite_note-39"><span class="mw-cite-backlink"><a href="#cite_ref-39">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/20368473">Low calorie dieting increases cortisol</a></span> </li> <li id="cite_note-mayoclinic1-40"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-mayoclinic1_40-0">40.0</a></sup> <sup><a href="#cite_ref-mayoclinic1_40-1">40.1</a></sup> <sup><a href="#cite_ref-mayoclinic1_40-2">40.2</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037">Chronic stress puts your health at risk</a></span> </li> <li id="cite_note-41"><span class="mw-cite-backlink"><a href="#cite_ref-41">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.vox.com/2015/10/29/9639982/low-fat-high-protein-diet">The science is clear: fad diets don't work</a></span> </li> <li id="cite_note-42"><span class="mw-cite-backlink"><a href="#cite_ref-42">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://news.bbc.co.uk/2/hi/uk_news/scotland/453661.stm">UK: Scotland Woman 'starved herself to death</a></span> </li> <li id="cite_note-43"><span class="mw-cite-backlink"><a href="#cite_ref-43">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.thecardiologyadvisor.com/home/topics/prevention/cardiovascular-disease-risk-increases-with-body-weight-fluctuations/">Cardiovascular Disease Risk Increases With Body Weight Fluctuations</a></span> </li> <li id="cite_note-44"><span class="mw-cite-backlink"><a href="#cite_ref-44">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/17283263">Consistently stable or decreased body mass index in young adulthood and longitudinal changes in metabolic syndrome components</a></span> </li> <li id="cite_note-45"><span class="mw-cite-backlink"><a href="#cite_ref-45">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://newsroom.heart.org/news/yo-yoing-weight-blood-pressure-cholesterol-and-blood-sugar-readings-may-raise-heart-attack-and-stroke-risk?preview=6b93">Yo-yoing weight, blood pressure, cholesterol and blood sugar readings may raise heart attack and stroke risk</a></span> </li> <li id="cite_note-46"><span class="mw-cite-backlink"><a href="#cite_ref-46">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.nejm.org/doi/full/10.1056/NEJM199212313272701">Conclusion: "The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis."</a></span> </li> <li id="cite_note-47"><span class="mw-cite-backlink"><a href="#cite_ref-47">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.buzzfeed.com/sallytamarkin/weight-neutral-dietitians?utm_term=.wmYy4Ym3w#.yaBGRBLmZ">13 Experts Explain Why Diets Don't Work And What To Do Instead</a></span> </li> <li id="cite_note-48"><span class="mw-cite-backlink"><a href="#cite_ref-48">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/31077956">The effectiveness of interventions aiming to promote positive body image in adults: A systematic review.</a></span> </li> <li id="cite_note-49"><span class="mw-cite-backlink"><a href="#cite_ref-49">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S1499404614007969">Impact of Non-Diet Approaches on Attitudes, Behaviors, and Health Outcomes: A Systematic Review</a></span> </li> <li id="cite_note-50"><span class="mw-cite-backlink"><a href="#cite_ref-50">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0195666316302343">A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial</a></span> </li> <li id="cite_note-51"><span class="mw-cite-backlink"><a href="#cite_ref-51">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0261561416301406">A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women</a></span> </li> <li id="cite_note-52"><span class="mw-cite-backlink"><a href="#cite_ref-52">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S1499404615000111">Health at Every Size College Course Reduces Dieting Behaviors and Improves Intuitive Eating, Body Esteem, and Anti-Fat Attitudes</a></span> </li> <li id="cite_note-53"><span class="mw-cite-backlink"><a href="#cite_ref-53">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external free" href="http://www.healthateverysize.org.uk/faq.html#intuitive">http://www.healthateverysize.org.uk/faq.html#intuitive</a></span> </li> <li id="cite_note-54"><span class="mw-cite-backlink"><a href="#cite_ref-54">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.researchgate.net/publication/256073762_Review_Article_Relationships_between_intuitive_eating_and_health_indicators_Literature_review">Review Article Relationships between intuitive eating and health indicators: Literature review</a></span> </li> <li id="cite_note-55"><span class="mw-cite-backlink"><a href="#cite_ref-55">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S0195666315300635">A systematic review of the psychosocial correlates of intuitive eating among adult women</a></span> </li> <li id="cite_note-56"><span class="mw-cite-backlink"><a href="#cite_ref-56">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/351A3D01E43F49CC9794756BC950EFFC/S0954422417000154a.pdf/structured_literature_review_on_the_role_of_mindfulness_mindful_eating_and_intuitive_eating_in_changing_eating_behaviours_effectiveness_and_associated_potential_mechanisms.pdf">A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms</a></span> </li> <li id="cite_note-57"><span class="mw-cite-backlink"><a href="#cite_ref-57">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054486/">Interoception and Mental Health: A Roadmap</a></span> </li> <li id="cite_note-58"><span class="mw-cite-backlink"><a href="#cite_ref-58">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://misslunarose.home.blog/2020/05/21/counterintuitive-eating/">Counterintuitive Eating</a> - Autistic Dreams</span> </li> <li id="cite_note-59"><span class="mw-cite-backlink"><a href="#cite_ref-59">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.cornwallhealthyschools.org/documents/Cochrane_Review_June_2013.pdf">School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (Review)</a></span> </li> <li id="cite_note-60"><span class="mw-cite-backlink"><a href="#cite_ref-60">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836343/">Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index and Academic Performance in Low-Income Elementary School Children</a></span> </li> <li id="cite_note-61"><span class="mw-cite-backlink"><a href="#cite_ref-61">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.healthline.com/nutrition/fat-shaming-makes-things-worse">The Harmful Effects of Fat Shaming</a></span> </li> <li id="cite_note-62"><span class="mw-cite-backlink"><a href="#cite_ref-62">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20891">Perceived weight discrimination and changes in weight, waist circumference, and weight status</a></span> </li> <li id="cite_note-63"><span class="mw-cite-backlink"><a href="#cite_ref-63">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24997407/">Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model</a></span> </li> <li id="cite_note-brewis-64"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-brewis_64-0">64.0</a></sup> <sup><a href="#cite_ref-brewis_64-1">64.1</a></sup> <sup><a href="#cite_ref-brewis_64-2">64.2</a></sup> <sup><a href="#cite_ref-brewis_64-3">64.3</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S0277953614005206?via%3Dihub">Stigma and the perpetuation of obesity</a></span> </li> <li id="cite_note-65"><span class="mw-cite-backlink"><a href="#cite_ref-65">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21760636/">The impact of weight stigma on caloric consumption</a></span> </li> <li id="cite_note-66"><span class="mw-cite-backlink"><a href="#cite_ref-66">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24434951/">The stress of stigma: exploring the effect of weight stigma on cortisol reactivity</a></span> </li> <li id="cite_note-67"><span class="mw-cite-backlink"><a href="#cite_ref-67">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S0022103113002047">The ironic effects of weight stigma</a></span> </li> <li id="cite_note-68"><span class="mw-cite-backlink"><a href="#cite_ref-68">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23836723/">Weight bias internalization, core self-evaluation, and health in overweight and obese persons</a></span> </li> <li id="cite_note-69"><span class="mw-cite-backlink"><a href="#cite_ref-69">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17712309/">Obesity and mental disorders in the general population: results from the world mental health surveys</a></span> </li> <li id="cite_note-70"><span class="mw-cite-backlink"><a href="#cite_ref-70">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636946/">Weight Discrimination and Risk of Mortality</a></span> </li> <li id="cite_note-71"><span class="mw-cite-backlink"><a href="#cite_ref-71">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20481395/">Am I Too Fat To Be A Princess? Examining The Effects Of Popular Children's Media On Preschoolers' Body Image</a></span> </li> <li id="cite_note-72"><span class="mw-cite-backlink"><a href="#cite_ref-72">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0193397399800495">Thin is good, fat is bad: How early does it begin?</a></span> </li> <li id="cite_note-73"><span class="mw-cite-backlink"><a href="#cite_ref-73">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2010.234">Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise</a></span> </li> <li id="cite_note-74"><span class="mw-cite-backlink"><a href="#cite_ref-74">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.jeffreyhunger.com/uploads/3/4/4/8/34481134/27._major_tomiyama___hunger.pdf">The Negative and Bidirectional Effects of Weight Stigma on Health</a></span> </li> <li id="cite_note-75"><span class="mw-cite-backlink"><a href="#cite_ref-75">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.marketwatch.com/story/only-15-of-hiring-managers-would-consider-hiring-an-overweight-woman-2017-12-11">Only 15% of hiring managers would consider hiring an overweight woman</a></span> </li> <li id="cite_note-76"><span class="mw-cite-backlink"><a href="#cite_ref-76">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.apa.org/news/press/releases/2017/08/fat-shaming">Fat Shaming in the Doctor's Office Can Be Mentally and Physically Harmful</a></span> </li> <li id="cite_note-77"><span class="mw-cite-backlink"><a href="#cite_ref-77">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">Impact of weight bias and stigma on quality of care and outcomes for patients with obesity</a></span> </li> <li id="cite_note-hebl-nature-78"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-hebl-nature_78-0">78.0</a></sup> <sup><a href="#cite_ref-hebl-nature_78-1">78.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nature.com/articles/0801681">Weighing the care: physicians' reactions to the size of a patient</a></span> </li> <li id="cite_note-79"><span class="mw-cite-backlink"><a href="#cite_ref-79">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20384">Physicians build less rapport with obese patients</a></span> </li> <li id="cite_note-80"><span class="mw-cite-backlink"><a href="#cite_ref-80">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://sciencenordic.com/nurses-biased-against-obese-patients">Nurses biased against obese patients</a> - Science Nordic</span> </li> <li id="cite_note-81"><span class="mw-cite-backlink"><a href="#cite_ref-81">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.tandfonline.com/doi/abs/10.1080/21604851.2016.1213066?journalCode=ufts20">Sizeism is a health hazard</a></span> </li> <li id="cite_note-purcell-82"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-purcell_82-0">82.0</a></sup> <sup><a href="#cite_ref-purcell_82-1">82.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://longreads.com/2017/10/26/no-fatties-when-healthcare-hurts/">"No Fatties": When Health Care Hurts</a></span> </li> <li id="cite_note-83"><span class="mw-cite-backlink"><a href="#cite_ref-83">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.cbc.ca/radio/thecurrent/the-current-for-august-1-2018-1.4769487/how-fat-shaming-from-doctors-is-leading-to-misdiagnoses-for-obese-patients-1.4769569">How 'fat shaming' from doctors is leading to misdiagnoses for obese patients</a></span> </li> <li id="cite_note-84"><span class="mw-cite-backlink"><a href="#cite_ref-84">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.today.com/health/medical-weight-bias-causes-misdiagnosis-pain-depression-t153840">'It wasn't about my weight': How weight bias in medicine can lead to missed diagnosis and physical and mental pain</a></span> </li> <li id="cite_note-85"><span class="mw-cite-backlink"><a href="#cite_ref-85">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedaily.com/releases/2017/08/170803092015.htm">Fat shaming in the doctor's office can be mentally and physically harmful</a></span> </li> <li id="cite_note-86"><span class="mw-cite-backlink"><a href="#cite_ref-86">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.23408">Obesity and screening for breast, cervical, and colorectal cancer in women</a></span> </li> <li id="cite_note-87"><span class="mw-cite-backlink"><a href="#cite_ref-87">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nature.com/articles/0803105?foxtrotcallback=true">Barriers to routine gynecological cancer screening for White and African-American obese women</a></span> </li> <li id="cite_note-mullins-88"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-mullins_88-0">88.0</a></sup> <sup><a href="#cite_ref-mullins_88-1">88.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.32451">Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study</a></span> </li> <li id="cite_note-erondu-89"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-erondu_89-0">89.0</a></sup> <sup><a href="#cite_ref-erondu_89-1">89.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900212/">The Association Between Body Mass Index and Presenting Symptoms in African American Women with Ovarian Cancer</a></span> </li> <li id="cite_note-90"><span class="mw-cite-backlink"><a href="#cite_ref-90">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-interventions1">Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions</a> - US Preventive Services Task Force</span> </li> <li id="cite_note-91"><span class="mw-cite-backlink"><a href="#cite_ref-91">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks">Health Risks of Overweight & Obesity</a></span> </li> <li id="cite_note-92"><span class="mw-cite-backlink"><a href="#cite_ref-92">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/abs/pii/S0939475306001505">The link between abdominal obesity, metabolic syndrome and cardiovascular disease</a></span> </li> <li id="cite_note-93"><span class="mw-cite-backlink"><a href="#cite_ref-93">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.cdc.gov/healthyweight/effects/index.html">The Health Effects of Overweight and Obesity</a></span> </li> <li id="cite_note-94"><span class="mw-cite-backlink"><a href="#cite_ref-94">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10511607/">Body-mass index and mortality in a prospective cohort of U.S. adults</a></span> </li> <li id="cite_note-95"><span class="mw-cite-backlink"><a href="#cite_ref-95">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10546691/">The disease burden associated with overweight and obesity</a></span> </li> <li id="cite_note-96"><span class="mw-cite-backlink"><a href="#cite_ref-96">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://serval.unil.ch/resource/serval:BIB_7AB5D2D95C6A.P001/REF.pdf">Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE)</a></span> </li> <li id="cite_note-97"><span class="mw-cite-backlink"><a href="#cite_ref-97">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11434789/">Impact of overweight on the risk of developing common chronic diseases during a 10-year period</a></span> </li> <li id="cite_note-who-factsheet-98"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-who-factsheet_98-0">98.0</a></sup> <sup><a href="#cite_ref-who-factsheet_98-1">98.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight">WHO obesity factsheet</a></span> </li> <li id="cite_note-99"><span class="mw-cite-backlink"><a href="#cite_ref-99">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external free" href="http://i.imgur.com/0lvAG5r.jpg">http://i.imgur.com/0lvAG5r.jpg</a></span> </li> <li id="cite_note-100"><span class="mw-cite-backlink"><a href="#cite_ref-100">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://everydayfeminism.com/2013/04/five-differences-between-diets-and-anorexia/">Five Subtle Differences Between Diets and Anorexia</a></span> </li> <li id="cite_note-101"><span class="mw-cite-backlink"><a href="#cite_ref-101">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://care.diabetesjournals.org/content/27/3/657.abstract?ijkey=d9207ae2a896a0c29926a719d9f86dd676dc2647&keytype2=tf_ipsecsha">Trying to Lose Weight, Losing Weight, and 9-Year Mortality in Overweight U.S. Adults With Diabetes</a> <i>Diabetes Care</i></span> </li> <li id="cite_note-102"><span class="mw-cite-backlink"><a href="#cite_ref-102">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/22218619">Healthy lifestyle habits and mortality in overweight and obese individuals.</a> EM Matheson, DE King, CJ Everett, J Am Board Fam Med. 2012 Jan-Feb;25(1):9-15. doi: 10.3122/jabfm.2012.01.110164.</span> </li> <li id="cite_note-103"><span class="mw-cite-backlink"><a href="#cite_ref-103">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-12-6">Using maximum weight to redefine body mass index categories in studies of the mortality risks of obesity</a> <i>Population Health Metrics</i></span> </li> <li id="cite_note-104"><span class="mw-cite-backlink"><a href="#cite_ref-104">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pubmed/25040597/">The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used.</a></span> </li> <li id="cite_note-105"><span class="mw-cite-backlink"><a href="#cite_ref-105">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30458177/">Metabolically healthy versus metabolically unhealthy obesity</a></span> </li> <li id="cite_note-106"><span class="mw-cite-backlink"><a href="#cite_ref-106">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/31524630/">Metabolically healthy obesity: facts and fantasies</a></span> </li> <li id="cite_note-107"><span class="mw-cite-backlink"><a href="#cite_ref-107">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome">Metabolic Syndrome</a></span> </li> <li id="cite_note-108"><span class="mw-cite-backlink"><a href="#cite_ref-108">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731253/">Cardiometabolic Disease Risk in Metabolically Healthy and Unhealthy Obesity: Stability of Metabolic Health Status in Adults</a></span> </li> <li id="cite_note-109"><span class="mw-cite-backlink"><a href="#cite_ref-109">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1525-139X.2007.00349.x">Cardiovascular And Survival Paradoxes In Dialysis Patients: Obesity-Survival Paradox — Still a Controversy?</a></span> </li> <li id="cite_note-110"><span class="mw-cite-backlink"><a href="#cite_ref-110">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://escholarship.org/uc/item/3cs2f652">Reverse Epidemiology of Conventional Cardiovascular RiskFactors in Patients With Chronic Heart Failure</a></span> </li> <li id="cite_note-111"><span class="mw-cite-backlink"><a href="#cite_ref-111">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220102">The obesity paradox in acute coronary syndrome: a meta-analysis</a></span> </li> <li id="cite_note-112"><span class="mw-cite-backlink"><a href="#cite_ref-112">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427325/">Body Mass Index and Mortality in Chronic Obstructive Pulmonary Disease: A Meta-Analysis</a></span> </li> <li id="cite_note-113"><span class="mw-cite-backlink"><a href="#cite_ref-113">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://liu.diva-portal.org/smash/record.jsf?pid=diva2%3A855374&dswid=mainwindow">Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects</a></span> </li> <li id="cite_note-114"><span class="mw-cite-backlink"><a href="#cite_ref-114">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.nature.com/articles/ijo2011187">The association between obesity and mortality in the elderly differs by serum concentrations of persistent organic pollutants: a possible explanation for the obesity paradox</a></span> </li> <li id="cite_note-vox-belluz1-115"><span class="mw-cite-backlink">↑ <sup><a href="#cite_ref-vox-belluz1_115-0">115.0</a></sup> <sup><a href="#cite_ref-vox-belluz1_115-1">115.1</a></sup></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.vox.com/2015/3/25/8290261/obesity-paradox">The author of a new obesity book says we shouldn't try to lose weight. She's wrong.</a>, <i>Vox</i></span> </li> <li id="cite_note-116"><span class="mw-cite-backlink"><a href="#cite_ref-116">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-12-6">Using maximum weight to redefine body mass index categories in studies of the mortality risks of obesity</a></span> </li> <li id="cite_note-117"><span class="mw-cite-backlink"><a href="#cite_ref-117">↑</a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.vox.com/2015/10/20/9572295/coca-cola-obesity-paradox">The obesity paradox: Why Coke is promoting a theory that being fat won't hurt your health</a> by Julia Belluz at <i>Vox.</i></span> </li> </ol></div></div>    </div></div><div class="printfooter">Retrieved from "<a dir="ltr" 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