A commentary on the new obesity guidelines from NIH.(National Institutes of Health)

Although dietitians were involved in the development of the National Institutes of Health's (NIH) obesity guidelines (1,2) it would be misleading to imply that all or even most dietetics professionals are eager to implement these guidelines. Many dietitians are concerned about the NIH's unwillingness to recognize and accept the following scientific realities of the current situation with respect to weight management:

* There is no effective long-term safe treatment for obesity, and there is not likely to be any in the near future.

* Pressure on the populace to be thin has resulted in a new set of problems that are impairing the psychological and social wellbeing of people who are overweight and people who are not.

* It may be time for a new paradigm that asks how health professionals can help overweight and obese people be healthy regardless of weight change.

The editors of the New England Journal of Medicine reviewed the same literature that the NIH committee did, and wrote this statement in a January 1, 1998, editorial:

Today, at the start of the new year, millions of Americans will resolve to lose weight, but by tomorrow or next week, or maybe next month, most of them will give up trying. Few will have lost weight, and even fewer will sustain that weight loss (3, p 52).

Research has shown that the vast majority of people who lose weight in formal treatment programs with the elements recommended by the NIH regain that weight within 5 years (4-7).

The NIH guidelines promote traditional didactic approaches to treating obesity. These approaches, with the exception of pharmacotherapy, have been used for decades while rates of obesity have skyrocketed. Most health professionals have had patients who have lost and regained hundreds of pounds over time, returning after each …