Doctors have traditionally recommended lifestyle interventions to achieve weight loss for people with a high body mass index (BMI). However, rigorous evidence has indicated that lifestyle interventions, which involve a change in behaviour with a focus on restriction of energy intake and increased physical activity, have little to no effect on sustained weight loss and no benefits on hard outcomes such as cardiovascular events or mortality. Moreover, a focus on weight loss may contribute to discrimination and internalised stigmatisation, which are related to other social inequalities based on factors such as gender, sexuality, class, and ethnicity.
Limited evidence for lifestyle interventions
Lifestyle interventions have for many decades been the mainstay recommendation to reduce weight in people with obesity. However, such an approach has important limitations. A systematic review published in 2022 encompassing 13 trials found that adults with a BMI ≥25 randomised to lifestyle and weight loss interventions lost 1.8 kg on average after two years (95% confidence interval 2.8 to −0.8 kg), compared with usual care.
As doctors shouldn’t we rethink before recommending only ‘lifestyle modification’ as the first step for reducing weight? is it more beneficial to recommend ‘lifestyle modification’ plus a ‘medication’ ?
Beyond body mass index: rethinking doctors’ advice for weight loss BMJ 2025; 389 doi: https://doi.org/10.1136/bmj-2025-084654 (Published 25 June 2025)
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