Conflict of interest: None.
The emperor’s tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America
I can easier teach twenty what were good to be done than to be one of the twenty to follow mine own teaching. The brain may devise laws for the blood, but a hot temper leaps o’er a colddecree. Portia, Merchant of Venice .
Article first published online: 5 APR 2009
© 2009 Blackwell Publishing Ltd
Diabetes, Obesity and Metabolism
Volume 11, Issue 6, pages 557–570, June 2009
How to Cite
Puterbaugh, J. S. (2009), The emperor’s tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America. Diabetes, Obesity and Metabolism, 11: 557–570. doi: 10.1111/j.1463-1326.2009.01019.x
[This article, loaded on 08 May 2009, after first online publication, replaces the version originally published online, and several corrections have been made to the references.]
- Issue published online: 6 MAY 2009
- Article first published online: 5 APR 2009
- Received 14 October 2008; returned for revision 23 October 2008; revised version accepted 05 November 2008
During the past century, the medical profession has developed a paradigm for the treatment of obesity, which prescribes specific exercise and dietary goals under the umbrella of ‘lifestyle change’. It has three components, all of which evolved from origins that had nothing to do with weight control. First, it is individually prescriptive, that is weight loss is considered the responsibility of the individual as contrasted to a societal or group responsibility. Second, it recommends exercise aimed towards structured, or non-functional, activities with a variety of physiological end-points. Last, dietary goals are defined by calories, exchanges, food groups and various nutritional components. Diets are usually grouped by these goals. This model is unique to America, it is not working and it has also played a causal role in the obesity it is attempting to eliminate. A new model must be developed, which contains an observationally based societal prescription and links activity with functional outcomes and diets, which are food rather than nutritionally based.