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. 2024 Sep 17;13(4):832–842. doi: 10.1007/s13679-024-00587-8

Debating Weight Loss vs. Weight Neutral Strategies for Improvements of Health

Berit L Heitmann 1,2,3,, Rasmus Køster-Rasmussen 3, Lene B Meyer 3, Sofus C Larsen 1,3, Fanney Thorsteinsdottir 1,3, Catharina T Sandholdt 3, Kirstine N Bojsen-Møller 4,5, Gritt Overbeck 3, Frans B Waldorff 3, Marius B Kousgaard 2, Ina O Specht 1,3, Carsten Dirksen 4,5
PMCID: PMC11522117  PMID: 39289256

Abstract

Purpose of Review

Despite decades of development and testing of weight-loss interventions, the adult populations worldwide have witnessed a continuous rise in body weight. There is an ongoing debate about how to move forward. Some argue that this rise calls for more intensive and possibly life-long treatments, including the new effective GLP1 weight loss medications, while others have called for a fundamental shift away from weight and on to a broader understanding of health. The two strategies are represented as a weight-centric health strategy and a weight neutral health strategy. This paper debates the benefits and potential harms related to the use of these two strategies.

Recent Findings

While major weight loss may have substantial health benefits, many individuals will need intensive treatment including weight loss medication to achieve it, as generally few are able to sustain a lifestyle induced weight loss in the long term.

Summary

Both the weight loss and the weight-neutral health strategies have advantages and limitations emphasizing the need for further research comparing the two strategies. Currently, not everyone is offered, can afford, will tolerate or even desire treatment with weight loss medication, and weight neutral health strategies may be a desirable alternative intervention offering a more holistic approach to health and addressing psychological and social issues including the burden of experienced and internalized weight stigma. However, this method still needs to be tested for effectiveness with regards to both physical and long-term psychological benefits.

Keywords: Weight loss, Weight neutral, Obesity, Weight loss medication, Health at every size

Introduction

In recent decades, the adult populations worldwide have witnessed a concerning rise in weight. Along with aging of the populations, the rise in body weight have contributed to a simultaneous surge in health complications, like type 2 diabetes (T2D), hypertension, dyslipidaemia, cardiovascular morbidity, certain cancers as well as psychosocial related social stigmatisation and lower labour market attachment [1].

The traditional strategies to obesity management emphasize weight loss as a primary path to health improvement, and health authorities are advocating weight reduction through lifestyle-based methods to alleviate the adverse health effects of obesity and improve public health. Nevertheless, while weight loss is associated with improvements in several cardiometabolic risk factors in people living with obesity, traditional lifestyle-based weight loss interventions have proven ineffective in clinical practice [2] and are frequently followed by weight regain leading to possibly harmful weight cycling [3, 4].

At the other end of the treatment spectrum, bariatric surgery that includes a range of surgical procedures designed to induce weight loss by altering the gastrointestinal anatomy, is now widely accepted, and offered by healthcare systems around the world to highly selected patients. The most popular procedures, namely gastric bypass and sleeve gastrectomy are associated with weight loss of 25–35%, massive improvements in a broad range of obesity-related conditions, and reductions in mortality and improved life expectancy [5]. However, availability of surgery is generally very limited, and there are concerns related to risk of complications.

During the past decade, pragmatic trials using total dietary replacement (TDR) based on low energy, nutritionally complete formula products have shown promising results with large weight loss and marked improvements in metabolic risk factors at 1–5 years follow-up [6, 7]. Consequently, TDR is now being implemented in some countries in routine healthcare e.g. by NHS England [8]. Alongside, the emergence of gut-hormone-based therapies such as liraglutide, semaglutide and tirzepatide for treatment of T2D and more recently also obesity have been showing average weight loss of 14–15% after 1–2 years of treatment and associated improvements in several cardiometabolic risk factors including reductions in HbA1c, blood pressure, blood lipid profile, and inflammatory markers [9], as well as a reduction in cardiovascular disease and mortality in those patients with established CVD [6].

Yet, it is important to acknowledge that not everyone may desire, afford, or tolerate these treatments. The drugs are expensive and availability often limited, and rapid weight regain is generally seen following discontinuation of treatment, thereby raising the question if life-long treatment is required to maintain weight loss [10]. Thus, while promising, further research is required to optimise the use of these drugs including in combination with less costly interventions.

In the face of this, alternative strategies are gaining support. Proposed already in the in 1980s, the weight-neutral health strategy has increasingly gained attention as an alternative way to improve health for people living in larger bodies. Weight neutral health is founded on the principles of Health at Every Size (HAES) that promotes body respect and acceptance of body diversity [11]. The intended health outcome is independent of weight loss and includes improving mental and physical well-being irrespective of body size. HAES supports participants in fostering a collaborative relationship with their bodies and encourages body acceptance, intuitive eating and joyful movement.

Scope of the Paper

With this paper, we aim to discuss and compare the evidence for beneficial and potentially harmful effects of these two radically different strategies to health care for adults living with obesity. It is worth noting here that the two strategies draw on different research fields and thus frame health in different ways. The weight-management strategy primarily refers to biomedical research, while the weight-neutral strategy also integrates research from the fields of psychology, anthropology and sociology. We, thereby, hope to contribute to the ongoing international debate on how health should be approached for people living in larger bodies.

The Evidence

It is important to note that there is a major asymmetry in the magnitude of the body of evidence for the weight loss and the weight neutral health strategies. Thousands of scientific articles have explored and discussed weight loss interventions, whether based on lifestyle interventions alone, weight loss medications often in combinations with lifestyle changes, or bariatric surgery, whereas comparatively fewer traditional medical research studies have been conducted in the field of weight neutrality. Instead, the weight neutral health approaches are backed by research from psychology and other academic fields. Therefore, the discussion below draws on evidence from a broad palette of study designs and research fields.

Weight Loss Management Strategies

Several international guidelines for improving health by managing overweight and obesity have been published over the last decade [12]. Generally, they recognize overweight as a chronic condition and recommend weight reduction in people with a Body mass index (BMI) > 30 kg/m2 or a BMI > 25 kg/m2 with weight-related comorbidities. Most guidelines recommend that weight reduction is achieved through a multifactorial, comprehensive lifestyle intervention for at least 6 to 12 months based on (a) reduced calorie intake through an individualised, balanced and healthy diet, (b) increased physical activity with a focus on activities of daily living (walking, cycling etc.) and a reduction in sedentary activities, and (c) supportive behavioural measures including motivational interviewing, stimulus control, and cognitive restructuring. Some guidelines also give specific recommendations for the use of weight loss medications, which is typically recommended in people not achieving weight reduction through lifestyle intervention alone. An example is the Canadian Adult Obesity Clinical Practice Guidelines that was published in 2020 and recommends a 5-step approach, which includes recognizing medical nutrition therapy and physical activity as core treatment options [13].

A number of large trials with long-term follow-up (7–20 years) have shown that a lifestyle interventions for weight loss consisting of a calorie-reduced diet and increased physical activity can improve hypertension as well as diabetes control [14, 15] and can reduce diabetes incidence (46–58%), an effect that is maintained also after discontinuation of the lifestyle intervention programs, [1618] providing solid support for long-term health benefits of weight loss. However, trials also showed that intensive lifestyle interventions for weight loss did not reduce cardiovascular mortality, nor the rate of microvascular or macrovascular complications in patients with type 2 diabetes or pre-diabetes [14, 19]. Also, adverse treatment effects were also reported on body composition, especially bone mineral density, and a related increased incidence of frailty fracture [15, 20, 21].

An effective method to achieve rapid weight loss is total dietary replacement (TDR) based on low energy, nutritionally-complete formula products for 2–5 months that when combined with behavioural programmes can lead to greater weight loss than lifestyle interventions without TDR [22]. Generally, however, guidelines have been reluctant to recommend TDR for routine use due to concerns related to safety and risk of weight regain. These concerns have been somewhat challenged by recent pragmatic trials in which TDR has been shown to be tolerated by most patients, associated with few and transient adverse effects, while resulting in an initial weight loss of > 10 kg and clinically relevant improvements in cardiovascular risk factors for up to 1–2 years follow-up [2325]. However, in these programmes the benefits on cardiovascular risk factors are strongly associated with the magnitude of weight loss, and weight loss maintenance remains a challenge [3, 24].

Weight maintenance after TDR-induced weight loss was addressed in the Diogenes trial, where an ad libitum diet with a modest increase in protein content and a low glycaemic index over a 26-week period led to better weight maintenance than the four other diets tested [26]. A recent small trial where maintenance of a TDR-induced weight loss over a 52-week period was obtained by either a structured exercise programme or daily injection with the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide compared to a weight regain of 6.1 kg in participants randomised to no intervention (placebo-injections without exercise) [27], found that participants randomised to combined exercise and liraglutide lost an additional 3.4 kg in the period following the initial TDR-induced weight loss.

Liraglutide was approved for treatment of obesity in adults in 2014 under the commercial name Saxenda® and marked the beginning of a new era of gut-hormone-based weight loss medications. Although only resulting in a modest weight loss of ~ 5 kg compared to placebo [28], liraglutide allows weight loss maintenance for up to 3 years [29]. Yet, within the last 3 years authorities have approved semaglutide (Wegovy®) and tirzepatide (Zepbound®) for treatment of obesity based on even more promising results. Semaglutide is an ultra-long-acting GLP-1 receptor agonist that has led to 12–13 kg weight loss when compared to placebo [9] and been shown to be able to sustain weight loss for at least 2 years [30]. In the recently published SELECT trial, semaglutide showed a reduction in cardiovascular events by 20%(NNT 65) and all-cause mortality after an average 8.5% placebo-subtracted weight loss over a follow-up period of 40 months in patients older than 45 years with a BMI > 27 kg/m2 and pre-existing cardiovascular disease but without diabetes [6]. Tirzepatide is a first-in-class GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonist that results in a weight loss of up to ~ 22 kg when compared to placebo [9]. Clinical trials are ongoing to evaluate the effect of tirzepatide on cardiovascular outcomes both in patients with and without T2D [31].

Weight Neutral Health Strategies

A larger body size, or a high BMI, does not necessarily equal poor health, and research suggests that health improvements can occur independently of weight loss through behaviors such as adopting a healthy diet, reducing alcohol consumption, quitting smoking, and engaging in physical activity. For instance, studies have shown that interventions like the Mediterranean diet (CORDIPREV) [32] can reduce cardiovascular events by27% (NNT 20) compared with low-fat diet, while exercise training can alleviate pain from knee arthritis, regardless of weight changes [33].

The Health at Every Size (HAES) movement promotes a weight-neutral health approach as an alternative to conventional weight-centric strategies [11]. HAES acknowledges the role of social, emotional, spiritual, and physical elements in health and supports size diversity and advocates for ending weight stigma. About a decade ago, the HAES principles were critically revised to better reflect the social determinants of health [34], thus acknowledging that health is not equally attainable for all people, especially not marginalised groups and people who face multiple forms of inequality or disadvantage, including weight stigma. Recently, the HAES principles have been revised yet again, this time to better support those who are most affected by weight stigma in medical settings [11].

There are three cornerstone methods and focus points of a HAES-aligned approach: Intuitive eating, joyful movement and body respect, referring to internalized weight stigma, experienced weight stigma, and body acceptance [11].

In intuitive eating the individual is supported in tuning into internal cues of hunger and satiety and eating in accordance with these rather than external rules and guidelines. In a meta-analysis, intuitive eating was found to be related to improved psychological symptoms including positive body image, self-esteem, and wellbeing [35], and, at eight-year follow-up, results from the EAT cohort study found that a higher baseline intuitive eating score and increments in the score from baseline to follow-up were associated with a lower risk of depressive symptoms, low self-esteem, high body dissatisfaction, and binge eating [36].

Joyful movement refers to physical activity that the individual finds enjoyable and that is not motivated by weight-loss. Rather, joyful movement may be motivated by an appreciation of what the body can accomplish and the experiences and sensations that the body can bring the person, for instance finding joy in feeling the pulse beating and fresh air on one’s cheeks [37, 38].

Reduction of the experienced burden of weight stigma and internalized weight stigma is a key component of weight-neutral interventions. Weight bias internalisation appears to mediate the harmful impact of experienced weight stigma on physical and psychological health [39] and has been found to be modifiable through health interventions at an individual level [4043]. Language plays a crucial role in weight neutrality. Phasing BMI categories like “overweight” and “obesity” are viewed as contributing to weight stigma, as they imply normative judgments about body size. Experimental evidence shows that merely being labelled as ‘overweight’ can increase internalized weight stigma and body dissatisfaction [44]. Instead, the weight-neutral perspective favours neutral descriptors like “a person with a larger body” or “a person with a high BMI”.

Weight neutral strategies acknowledge the experiences of weight stigma in society and in healthcare settings and supports participants in challenging these injustices and biases. Acceptance and Commitment Therapy (ACT) has shown promise in reducing internalized weight stigma and promoting body acceptance by helping individuals develop psychological flexibility and engage in value-consistent behaviours. ACT is a cognitive therapy that focuses on participants’ connection with their thoughts rather than the content of their thoughts and on activating value-consistent behaviour [45]. ACT promotes psychological flexibility using acceptance strategies, mindfulness techniques, and dedicated action, with the goal of empowering individuals to act effectively in the face of uncomfortable symptoms.

Weight-neutral interventions have been compared with usual care or conventional behavioural-based weight management strategies in three systematic reviews and meta-analyses [4648], each including nine [47], eight [46] or ten [48] studies. The three systematic reviews have some overlap in studies. The systematic reviews suggested that in the short term, weight-neutral interventions improved intuitive eating and resulted in positive changes on dietary quality [4951] but highlighted the need for further well-designed and long-term studies also including men, who were underrepresented in the most of the studies [48, 5254]. While weight loss was not part of the weight-neutral strategy, the meta-analyses showed no between-group differences in weight-related or cardiometabolic outcomes, diet quality, physical activity and most psychosocial and behavioural outcomes, but demonstrated an improvement in the bulimia subscale of the Eating Disorder Inventory in two studies, compared with conventional weight management interventions [47]. The meta-analyses generally included few and non-randomised studies only, and in a further subgroup analysis of long-term (≥ 1 year) studies between-group differences disappeared for all outcomes [46].

A few of the previous weight-neutral interventions have aimed to minimize internalized weight bias by using ACT combined with mindfulness- and compassion-based group interventions and showed reductions in internalized weight stigma [4042, 55]. However, so far, no studies have reported long-term effects of stigma reduction interventions.

Summary of the Potential Benefits and Harms of Weight Loss and Weight Neutral Health Management

Potential Benefits Using Weight Loss Strategies (Table 1)

Table 1.

Comparative analysis of intensive weight loss and weight neutral health strategies for health improvement

Aspect Intensive Weight Loss Strategies Weight Neutral Health Strategies
Improved Cardiometabolic Risk Factors and Hard Endpoints - Substantial improvements in blood pressure, and glycemic control. Reduction in major cardiovascular disease or death (MACE) in high- risk populations using GLP-1 analogues. - Limited evidence for direct impact on cardiometabolic risk factors.
Potential for major weight loss - High potential for major weight loss, with bariatric surgery and newer medications like GLP-1 analogues. - No focus on weight loss.
Disease Remission - Possibility of remission for conditions such as Type 2 Diabetes (T2D), sleep apnea, and hypertension. - No evidence
Positive Psychological Effects -Quality of life may be improved with weight loss - Emphasis on self-acceptance, reduces internalized weight stigma, and may prevent symptoms of eating disorders in short-term but long-term effectiveness is unknown.
Increased Physical Activity - Weight loss strategies often encourage increased physical activity as part of lifestyle changes. - Promotes joyful and intuitive movement, focusing on enjoyment rather than physical outcomes.
Difficulty in Sustaining Weight Loss - Common experience of weight regain after interventions, highlighting challenges in maintaining weight loss. - No focus on weight loss.
Potential Side Effects - Possible side effects and risks, particularly with surgical interventions. Loss of BMD with increased risk for frailty fracture. - No known side effects.
Cost - High costs associated with new medications and surgical procedures. - Costs associated with patient education and implementation of HAES principles can be substantial.
Dependency on Medications - Likely long-term dependency on weight loss medications to maintain weight loss. - No reliance on medications for achieving or maintaining health outcomes.
Psychological Impact - Risk of contributing to weight stigma and internalized weight stigma through the emphasis on weight loss. - Aims to reduce internalized weight stigma and improve body image through a focus on self-acceptance.
Prevention of Eating Disorders - Often do not effectively address psychological issues underlying eating disorders. - Supports a healthy relationship with food and body, potentially reducing the risk of eating disorders.
Sustainable Lifestyle Changes - Often weight relapse and lack of long-term behavioral change. - Encourages long-term, sustainable lifestyle changes not tied to weight loss, but evidence for long-term effects missing.
Evidence Level - Robust evidence supports the effectiveness of bariatric surgery and treatment with GLP-1 analogues for weight loss but long-term sustainability remains a challenge. - Limited evidence; need for more rigorous, long-term studies to establish effectiveness for both physical and psychological benefits.
Cultural and Societal Challenges - Does not primarily aim to change society’s focus on weight loss or reduce stigma. - Seeks to change societal norms and reduce weight stigma, advocating for acceptance and diversity in body sizes.

Weight loss interventions, particularly bariatric surgery and newer weight loss medications like GLP-1 analogues, can result in substantial weight loss, often exceeding 15%. This level of weight loss is associated with physical health benefits if sustained.

Lifestyle based weight loss strategies have been demonstrated to improve cardiometabolic risk factors but not hard CVD outcomes. Weight loss strategies, using weight loss medications and bariatric surgery, have also been shown to lead to improvements in various cardiometabolic risk factors such as reduced blood pressure, improved lipid profiles, and better glycaemic control and can significantly reduce the risk of cardiovascular disease (MACE) in people with existing CVD, and lead to remission of conditions like T2D, hypertension and sleep apnea [56], offering relief from the burden of these diseases.

Weight loss can have positive psychological effects as successful weight loss can improve self-esteem, body image, and overall psychological well-being, leading to enhanced mental health. Weight loss from bariatric surgery has been found to improve quality of life, although with greater positive influence on physical quality of life compared to mental quality of life [57]. Furthermore, weight loss interventions often encourage increased physical activity, which can have positive effects on fitness, mobility, and overall quality of life.

Potential Harms Using Weight Loss Strategies (Table 1)

Maintenance of weight loss has proven difficult, and most people find it challenging to maintain weight loss over the long term. Weight regain is common and often leading to a cycle of losing and regaining weight, known as weight cycling or yo-yo dieting. While there does not seem to be known physical adverse effects of yo-yo dieting on body weight, composition, or metabolic rate a potential adverse psychological impact is still subject of ongoing research [58].

Weight loss medications may have side effects and risks and studies have yet to be conducted on the potential long-term side effects and risks of these drugs including potential loss of bone mineral density or fracture risk. Although major side effects have not been described using the newer GLP-1 analogues, as evidenced from many years of experience with using these drugs in treatment for T2D, we still need studies beyond 3 years of use to know about the no long-term side effects from weight loss trials where dosage of GLP-1 often is higher than doses used for treatment of T2D. Side effects with surgical procedures are well known and include gastrointestinal issues, nutritional deficiencies, and complications from surgery. Also, post-bariatric surgery patients seem to have higher self-harm/suicide attempt risk compared with controls [59].

The expenses associated with the use of the new GLP-1 analogues can be quite substantial, potentially reaching nearly 10,000 Euros per year in the United States. In Denmark and the United Kingdom, the prices for 2.4 mg/ml doses of Semaglutide are approximately 4,000 to 5,000 Euros per year. Consequently, in many countries, these new medications may not be accessible or affordable for everyone. Moreover, the costs of using these drugs over just 3–4 year are comparable to the expenses associated with bariatric surgery, which is often considered a long-term treatment for obesity.

Weight regain is very common after discontinuing the weight loss medications and many individuals will potentially need to take medication indefinitely [60, 61]. Relapse after discontinuity of medication can further lead to frustration and emotional distress, which can negatively affect mental health. Also, the long-term use, in addition to being burdensome for some people, may also lead to concerns about dependency. Long-term studies are needed to evaluate how best to continue weight loss medication dose and prescription pattern.

Considering the pervasiveness of weight stigma and diet culture, it is also possible that the emphasis on weight loss, perhaps fuelled by increased public awareness of pharmacological and surgical treatment options, may contribute to stigmatisation of people living with obesity and, thereby, to increased internalised weight stigma. Such weight stigma may have detrimental effects on health including disordered eating, sleep disturbances, avoidance of exercise, psychological problems (e.g. depression, anxiety, and poor self-esteem), physiological stress, and potentially an increased risk of mortality [62, 63].

Finally, in addition to high cost of weight loss medication, weight loss may not be desired, suitable or tolerated by everyone, and some individuals may have personal preferences for weight management or may not respond to or tolerate these new drugs.

Potential Benefits Using Weight Neutral Health Strategies (Table 1)

Weight-neutral health strategies focus on overall health and well-being independently of size. This can reduce internalised weight stigma, helping individuals feel more accepted and less stigmatized based on their weight or body size, thus improving important health measures.

By emphasizing self-acceptance and reducing internalized weight stigma, weight neutral health strategies can have positive psychological effects by leading to improved body image, self-esteem, and mental health.

There is some indication that weight neutral strategies may further reduce the risk of developing eating disorders by discouraging restrictive dieting and promoting a healthy relationship with food.

By encouraging long-term, sustainable lifestyle changes that are not dependent on achieving or maintaining a specific weight, weight neutral strategies may also lead to sustained lifestyle changes, although this awaits further studies.

Potential Harms Using Weight Neutral Health Strategies (Table 1)

Weight neutral strategies still have few and small interventions with limited follow up. Thus, the evidence for effects is weak compared to weight loss interventions, making it challenging to compare and assess their effectiveness. In particular, published studies were generally not randomised, included few participants and were of short follow up, and although some short-term interventions compare effects on cardiovascular risk factors effects of weight neutral strategies with usual care/weight loss, the long-term impacts of weight neutral strategies on physical health outcomes, such as cardiometabolic risk factors is absent. To advance this strategy further, there is a need for large randomised controlled studies comparing the long-term physical and mental health benefits from weight neutral and weight centric interventions.

Interventions rooted in weight-neutral health strategies may not be desired, suitable or tolerated by everyone. Weight-neutral health acknowledges that experienced and internalised weight stigma may contribute to the desire to lose weight, and some individuals may have personal goals or specific health conditions that require weight reduction. Further, overcoming societal emphasis on weight loss and body size acceptance can be difficult, as it requires changing deeply ingrained cultural norms.

Some comprehensive weight neutral strategies draw on multi-professional teams of dieticians, physiotherapists and psychologists to support flexible eating and movement and improve body acceptance. In those instances, expenses associated with learning and practising HAES principles can be high, and not everyone may be able to afford or access weight neutral health treatment.

Finally, lack of desired effects during, or relapse after intervention may lead to frustration and emotional distress, which can negatively affect mental health.

Conclusion

Both the weight loss and the weight-neutral health strategies have their advantages and limitations, emphasizing the need for further research comparing the two strategies and gaining a deeper understanding of their long-term effects on both physical and mental health outcomes.

While a larger weight loss (> 10%) obtained with GLP-1 use or bariatric surgery is associated with health improvement, weight loss regain is very common and bariatric surgery or lifelong medication may be needed to maintain loss in the long term. With their focus on health rather than weight, the weight neutral interventions offer an alternative strategy that may be both relevant and attractive for some individuals.

Conducting comprehensive state-of-the art comparisons and analyses of these two health strategies through adequately powered randomized controlled trials can provide valuable insights to inform public health policies and clinical practices in addressing the obesity epidemic and enhancing overall public health. Therefore, there is an urgent need for large-scale, methodologically rigorous randomized controlled trials that utilize weight-neutral strategies for health improvement in individuals with overweight and obesity. These studies should thoroughly evaluate long-term physiological, cardiometabolic, psychosocial, and behavioral outcomes, alongside assessing intervention safety and comparing their cost-effectiveness with conventional weight management strategies. Only through such rigorous research can we determine whether weight-neutral interventions might represent a viable alternative to traditional dietary or weight-reduction-focused strategies. An example of this is the Lighthouse Consortium on Obesity Management, which is a Danish-UK research project that brings researchers from both paradigms together to provide a strong evidence base for future health management of people living with obesity [64]. The project’s mission is to improve, develop, test and evaluate new obesity management programmes. This includes three pragmatic randomised controlled trials (LightCARE NCT06321432, LightWAY NCT06321458, and LightBAR NCT06309238) in primary and secondary care across the two countries. These trials compare personalized intensive weight loss interventions with existing obesity management strategies. Additionally, a smaller feasibility study set in Denmark only, explores a weight-neutral health approach focusing on healthy living and addressing weight stigma without emphasizing weight loss. If feasible, a trial to compare the two treatment paradigms will be designed.

As always, the decision between employing one strategy or another for improving health should be tailored to the individual, with healthcare professionals considering factors such as the individual’s health goals, preferences, and unique circumstances.

Key References

  • *Madigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G, et al. Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;377:e069719.
    • Review showing traditional lifestyle-based weight loss interventions have proven ineffective in clinical practice
  • *Stubbs RJ, Duarte C, O’Driscoll R, Turicchi J, Kwasnicka D, Sniehotta FF, et al. The H2020 "NoHoW Project": A Position Statement on Behavioural Approaches to Longer-Term Weight Management. Obes Facts. 2021;14(2):246-58.
    • Calls for new approaches to obtain long weight management
  • **Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine. 2023;389(24):2221-32.
    • Positive effects of GLP-1 analogs on MACE in patients with established CVD
  • **Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol. 2024;12(4):233-46.
    • Five year follow up positive effects of total dietary replacement on weight loss and metabolic risk factors
  • **Alkhezi OS, Alahmed AA, Alfayez OM, Alzuman OA, Almutairi AR, Almohammed OA. Comparative effectiveness of glucagon-like peptide-1 receptor agonists for the management of obesity in adults without diabetes: A network meta-analysis of randomized clinical trials. Obesity Reviews. 2023;24(3):e13543.
    • Review showing large weight loss improvements in several cardiometabolic risk factors
  • *Thorp HH. More questions than answers. Science. 2023;382(6676):1213.
    • Discusses if life-long treatment with GLP-1 is required to maintain weight loss
  • *Wing RR. Does Lifestyle Intervention Improve Health of Adults with Overweight/Obesity and Type 2 Diabetes? Findings from the Look AHEAD Randomized Trial. Obesity (Silver Spring). 2021;29(8):1246-58.
    • Long -term followup benefits and harms
  • *Zucatti KP, Teixeira PP, Wayerbacher LF, Piccoli GF, Correia PE, Fonseca NKO, et al. Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care. 2022;45(11):2787-95.
    • Rewiev showing that intensive lifestyle interventions for weight loss did not reduce cardiovascular mortality, or rate of microvascular or macrovascular complications in patients with type 2 diabetes or pre-diabetes
  • *Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nature Medicine. 2022;28(10):2083-91.
    • Sustained large weight loss for 2 years using Semaglutide
  • *Kaneko S. Tirzepatide: A Novel, Once-weekly Dual GIP and GLP-1 Receptor Agonist for the Treatment of Type 2 Diabetes. touchREV Endocrinol. 2022;18(1):10-9.
    • Ongoing clinical trials to evaluate the effect of tirzepatide on cardiovascular outcomes in patients with and without T2D
  • **Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876-85.
    • Demonstrates behaviour related health improvements independently of weight loss
  • *Linardon J, Tylka TL, Fuller-Tyszkiewicz M. Intuitive eating and its psychological correlates: A meta-analysis. Int J Eat Disord. 2021;54(7):1073-98.
    • Review showing that intuitive eating is related to positive body image, self-esteem, and wellbeing
  • *Levin ME, Krafft J, Twohig MP. An Overview of Research on Acceptance and Commitment Therapy. Psychiatr Clin North Am. 2024;47(2):419-31.
    • Review providing plausible evidence for the efficacy of acceptance and commitment therapy (ACT) for a wide range of mental disorders
  • *Babbott KM, Cavadino A, Brenton-Peters J, Consedine NS, Roberts M. Outcomes of intuitive eating interventions: a systematic review and meta-analysis. Eat Disord. 2023;31(1):33-63.
    • Review suggesting that in the short term, weight-neutral interventions may improve intuitive eating and diet quality
  • *Hensley-Hackett K, Bosker J, Keefe A, Reidlinger D, Warner M, D’Arcy A, et al. Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review. J Nutr Educ Behav. 2022;54(12):1099-115.
    • Review suggesting positive or neutral effect on diet quality following intuitive eating interventions
  • *Sanaya N, Janusaite M, Dalamaga M, Magkos F. The Physiological Effects of Weight-Cycling: A Review of Current Evidence. Current Obesity Reports. 2024;13(1):35-50.
    • Review showing that weight-cycling (yo-yo effect) is not associated with adverse effects in body weight, body composition, or metabolic rate.
  • *Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-64.
    • Suggesting that ongoing treatment of weight loss medication is required to maintain improvements in weight and health.

Acknowledgements

This manuscript was partially funded by the LightCOM grant from the Novo Nordisk Foundation (NNF22SA0080921).

Author Contributions

B.L.H, C.D and R.K-R wrote the main manuscript text. All authors reviewed the manuscript. All authors were involved in writing the article and had final approval of the submitted and published versions.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Conflict of Interest

Berit L Heitmann, Frans B Waldorf and Carsten Dirksen: Are principal or Co-principal investigators of the LightCOM project that was financed by a grant to the University of Copenhagen and The greater Copenhagen Hospital Corporation from the Novo Nordic Foundation (NNF22SA0080921). Rasmus Køster-Rasmussen, Lene B Meyer, Marius B Kousgaard, Gritt Overbeck and Catharina Thiel Sandholdt: Are part of the LightCOM project that was financed by a grant to the University of Copenhagen from the Novo Nordic Foundation. Rasmus Køster-Rasmussen is further employed as a regular associate professor (50%) at the University of Copenhagen to develop and test a weight-neutral health intervention. Receives a standard consultant fee for teaching courses about weight-neutral health for nurses and staff in general practice. The Danish Medical Association (the National Association of General Practitioners) organizes the courses. Kirstine N Boysen-Møller received funding from the Novo Nordisk Foundation, The Independent Research Fund Denmark and The Amager Hvidovre Hospital research fund. Research grants are administered by The greater Copenhagen Hospital Corporation. Carsten Dirksen: Further received funding from University of Copenhagen and from the Novo Nordic Foundation’s pre-graduate scholarship. Research grants are administered by The greater Copenhagen Hospital Corporation. Consults for Novo Nordic Denmark A/S (2022-2026). Received payment or honoraria for lectures or presentations from Novo Nordisk A/S, Novo Nordisk Denmark A/S, Novo Nordisk France (2024-02) and AstraZeneca A/S. Has received support for attending meetings and/or travel from Novo Nordisk Denmark A/S. Participation in Advisory Board for Novo Nordisk Denmark A/S. Chairperson for the Capital Region’s Endocrine Specialist Forum, sponsored by Novo Nordisk Denmark A/S. Received DexCom CGM sensors and receivers for the LightCOM trial (NCT06309238). All other authors have no conflict of interest to declare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Footnotes

Publisher’s Note

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References

  • 1.Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Madigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G, et al. Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2022;377:e069719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Stubbs RJ, Duarte C, O’Driscoll R, Turicchi J, Kwasnicka D, Sniehotta FF, et al. The H2020 NoHoW Project: A position Statement on behavioural approaches to longer-term Weight Management. Obes Facts. 2021;14(2):246–58. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Rössner S. Weight cycling — a ‘new’ risk factor? J Intern Med. 1989;226(4):209–11. [DOI] [PubMed] [Google Scholar]
  • 5.Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide and Cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221–32. [DOI] [PubMed] [Google Scholar]
  • 7.Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. 5-year follow-up of the randomised diabetes remission clinical trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol. 2024;12(4):233–46. [DOI] [PubMed] [Google Scholar]
  • 8.NHS. NHS Type. 2 Diabetes Path to Remission Programme England; 2024. https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/ [DOI] [PubMed]
  • 9.Alkhezi OS, Alahmed AA, Alfayez OM, Alzuman OA, Almutairi AR, Almohammed OA. Comparative effectiveness of glucagon-like peptide-1 receptor agonists for the management of obesity in adults without diabetes: a network meta-analysis of randomized clinical trials. Obes Rev. 2023;24(3):e13543. [DOI] [PubMed] [Google Scholar]
  • 10.Thorp HH. More questions than answers. Science. 2023;382(6676):1213. [DOI] [PubMed] [Google Scholar]
  • 11.ASDAH. Committed to Size Inclusivity in Health; 2020 [cited 2024 04–04]. https://asdah.org/
  • 12.Semlitsch T, Stigler FL, Jeitler K, Horvath K, Siebenhofer A. Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines. Obes Rev. 2019;20(9):1218–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. Can Med Assoc J. 2020;192(31):E875–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Wing RR. Does Lifestyle Intervention Improve Health of Adults with Overweight/Obesity and type 2 diabetes? Findings from the look AHEAD randomized Trial. Obes (Silver Spring). 2021;29(8):1246–58. [DOI] [PubMed] [Google Scholar]
  • 16.Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish diabetes Prevention Study. Lancet. 2006;368(9548):1673–9. [DOI] [PubMed] [Google Scholar]
  • 17.Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44. [DOI] [PubMed] [Google Scholar]
  • 18.Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the diabetes Prevention Program outcomes Study. Lancet. 2009;374(9702):1677–86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Zucatti KP, Teixeira PP, Wayerbacher LF, Piccoli GF, Correia PE, Fonseca NKO, et al. Long-term effect of Lifestyle interventions on the Cardiovascular and all-cause mortality of subjects with prediabetes and Type 2 diabetes: a systematic review and Meta-analysis. Diabetes Care. 2022;45(11):2787–95. [DOI] [PubMed] [Google Scholar]
  • 20.Johnson KC, Bray GA, Cheskin LJ, Clark JM, Egan CM, Foreyt JP, et al. The Effect of Intentional Weight loss on fracture risk in persons with diabetes: results from the look AHEAD randomized clinical trial. J Bone Min Res. 2017;32(11):2278–87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Seimon RV, Wild-Taylor AL, Keating SE, McClintock S, Harper C, Gibson AA, et al. Effect of weight loss via severe vs Moderate Energy Restriction on lean Mass and Body Composition among Postmenopausal Women with obesity: the TEMPO Diet Randomized Clinical Trial. JAMA Netw Open. 2019;2(10):e1913733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Parretti HM, Jebb SA, Johns DJ, Lewis AL, Christian-Brown AM, Aveyard P. Clinical effectiveness of very-low-energy diets in the management of weight loss: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2016;17(3):225–34. [DOI] [PubMed] [Google Scholar]
  • 23.Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, et al. Doctor referral of overweight people to low energy total diet replacement treatment (DROPLET): pragmatic randomised controlled trial. BMJ. 2018;362:k3760. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344–55. [DOI] [PubMed] [Google Scholar]
  • 25.Taheri S, Zaghloul H, Chagoury O, Elhadad S, Ahmed SH, El Khatib N, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2020;8(6):477–89. [DOI] [PubMed] [Google Scholar]
  • 26.Larsen TM, Dalskov S-M, Mv B, Jebb SA, Papadaki A, Pfeiffer AFH, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363(22):2102–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Lundgren JR, Janus C, Jensen SBK, Juhl CR, Olsen LM, Christensen RM, et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or both combined. N Engl J Med. 2021;384(18):1719–30. [DOI] [PubMed] [Google Scholar]
  • 28.Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of Pharmacological Treatments for Obesity with Weight Loss and adverse events: a systematic review and Meta-analysis. JAMA. 2016;315(22):2424–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.le Roux CW, Astrup A, Fujioka K, Greenway F, Lau DCW, Van Gaal L, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389(10077):1399–409. [DOI] [PubMed] [Google Scholar]
  • 30.Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Kaneko S, Tirzepatide. A Novel, once-weekly dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes. touchREV Endocrinol. 2022;18(1):10–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876–85. [DOI] [PubMed] [Google Scholar]
  • 33.Skou ST, Roos EM. Good life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord. 2017;18(1):72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.WHO. Social determinants of health; 2024. https://www.who.int/health-topics/universal-health-coverage/social-determinants-of-health#tab=tab_1
  • 35.Linardon J, Tylka TL, Fuller-Tyszkiewicz M. Intuitive eating and its psychological correlates: a meta-analysis. Int J Eat Disord. 2021;54(7):1073–98. [DOI] [PubMed] [Google Scholar]
  • 36.Hazzard VM, Telke SE, Simone M, Anderson LM, Larson NI, Neumark-Sztainer D. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010–2018. Eat Weight Disord. 2021;26(1):287–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Carlucci C, Kardachi J, Bradley SM, Prager J, Wyka K, Jayasinghe N. Evaluation of a community-based program that Integrates Joyful Movement into Fall Prevention for Older Adults. Gerontol Geriatr Med. 2018;4:2333721418776789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Alleva JM, Tylka TL, Martijn C, Waldén MI, Webb JB, Piran N. I’ll never sacrifice my well-being again: the journey from negative to positive body image among women who perceive their body to deviate from societal norms. Body Image. 2023;45:153–71. [DOI] [PubMed] [Google Scholar]
  • 39.Bidstrup H, Brennan L, Kaufmann L, de la Piedad Garcia X. Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review. Int J Obes (Lond). 2022;46(1):1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Potts S, Krafft J, Levin ME. A Pilot Randomized Controlled Trial of Acceptance and Commitment Therapy guided self-help for overweight and obese adults high in Weight Self-Stigma. Behav Modif. 2022;46(1):178–201. [DOI] [PubMed] [Google Scholar]
  • 41.Palmeira L, Cunha M, Pinto-Gouveia J. Processes of change in quality of life, weight self-stigma, body mass index and emotional eating after an acceptance-, mindfulness- and compassion-based group intervention (Kg-Free) for women with overweight and obesity. J Health Psychol. 2019;24(8):1056–69. [DOI] [PubMed] [Google Scholar]
  • 42.Palmeira L, Pinto-Gouveia J, Cunha M. Exploring the efficacy of an acceptance, mindfulness & compassionate-based group intervention for women struggling with their weight (Kg-Free): a randomized controlled trial. Appetite. 2017;112:107–16. [DOI] [PubMed] [Google Scholar]
  • 43.Ramos Salas X, Forhan M, Caulfield T, Sharma AM, Raine KD. Addressing internalized Weight Bias and changing damaged Social identities for people living with obesity. Front Psychol. 2019;10:1409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Essayli JH, Murakami JM, Wilson RE, Latner JD. The impact of Weight labels on Body Image, Internalized Weight Stigma, affect, Perceived Health, and intended weight loss behaviors in normal-weight and overweight College women. Am J Health Promot. 2017;31(6):484–90. [DOI] [PubMed] [Google Scholar]
  • 45.Levin ME, Krafft J, Twohig MP. An overview of Research on Acceptance and Commitment Therapy. Psychiatr Clin North Am. 2024;47(2):419–31. [DOI] [PubMed] [Google Scholar]
  • 46.Khasteganan N, Lycett D, Furze G, Turner AP. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: a systematic review and meta-analysis. Syst Rev. 2019;8(1):200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Dugmore JA, Winten CG, Niven HE, Bauer J. Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psychological health outcomes: a systematic review and meta-analysis. Nutr Rev. 2020;78(1):39–55. [DOI] [PubMed] [Google Scholar]
  • 48.Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: systematic review and meta-analysis. Obes Rev. 2019;20(11):1619–27. [DOI] [PubMed] [Google Scholar]
  • 49.Babbott KM, Cavadino A, Brenton-Peters J, Consedine NS, Roberts M. Outcomes of intuitive eating interventions: a systematic review and meta-analysis. Eat Disord. 2023;31(1):33–63. [DOI] [PubMed] [Google Scholar]
  • 50.Hensley-Hackett K, Bosker J, Keefe A, Reidlinger D, Warner M, D’Arcy A, et al. Intuitive eating intervention and Diet Quality in adults: a systematic literature review. J Nutr Educ Behav. 2022;54(12):1099–115. [DOI] [PubMed] [Google Scholar]
  • 51.Ulian MD, Aburad L, da Silva Oliveira MS, Poppe ACM, Sabatini F, Perez I, et al. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018;19(12):1659–66. [DOI] [PubMed] [Google Scholar]
  • 52.Hoare JK, Lister NB, Garnett SP, Baur LA, Jebeile H. Weight-neutral interventions in young people with high body mass index: a systematic review. Nutr Diet. 2023;80(1):8–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Grider HS, Douglas SM, Raynor HA. The influence of mindful eating and/or intuitive eating approaches on Dietary Intake: a systematic review. J Acad Nutr Diet. 2021;121(4):709–e271. [DOI] [PubMed] [Google Scholar]
  • 54.Guest E, Costa B, Williamson H, Meyrick J, Halliwell E, Harcourt D. The effectiveness of interventions aiming to promote positive body image in adults: a systematic review. Body Image. 2019;30:10–25. [DOI] [PubMed] [Google Scholar]
  • 55.Pearl RL, Hopkins CH, Berkowitz RI, Wadden TA. Group cognitive-behavioral treatment for internalized weight stigma: a pilot study. Eat Weight Disord. 2018;23(3):357–62. [DOI] [PubMed] [Google Scholar]
  • 56.Al Oweidat K, Toubasi AA, Tawileh RBA, Tawileh HBA, Hasuneh MM. Bariatric surgery and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath. 2023;27(6):2283–94. [DOI] [PubMed] [Google Scholar]
  • 57.Lindekilde N, Gladstone BP, Lübeck M, Nielsen J, Clausen L, Vach W, et al. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Rev. 2015;16(8):639–51. [DOI] [PubMed] [Google Scholar]
  • 58.Sanaya N, Janusaite M, Dalamaga M, Magkos F. The physiological effects of Weight-Cycling: a review of current evidence. Curr Obes Rep. 2024;13(1):35–50. [DOI] [PubMed] [Google Scholar]
  • 59.Castaneda D, Popov VB, Wander P, Thompson CC. Risk of suicide and self-harm is increased after bariatric Surgery-a systematic review and Meta-analysis. Obes Surg. 2019;29(1):322–33. [DOI] [PubMed] [Google Scholar]
  • 60.Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Weghuber D, Barrett T, Barrientos-Pérez M, Gies I, Hesse D, Jeppesen OK, et al. Once-weekly semaglutide in adolescents with obesity. N Engl J Med. 2022;387(24):2245–57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Batterham RL. Weight stigma in healthcare settings is detrimental to health and must be eradicated. Nat Reviews Endocrinol. 2022;18(7):387–8. [DOI] [PubMed] [Google Scholar]
  • 63.Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of Mortality. Psychol Sci. 2015;26(11):1803–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.The Lighthouse Consortium on Obesity Management. https://www.regionh.dk/lightcom/uk/Pages/default.aspx

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Data Availability Statement

No datasets were generated or analysed during the current study.


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