Multi-component healthy lifestyle interventions

There is strong evidence that multi-component healthy lifestyle interventions improve health outcomes and increase healthy behaviors (Weeldreyer 2025, Nitschke 2022, USPSTF-O'Connor 2020, Abbate 2020, Norbert 2018). Emerging evidence also shows that public health and healthcare interventions focusing on weight and weight outcomes do not typically lead to long-term improvements in health outcomes for communities or individuals, and instead often perpetuate negative outcomes (Weeldreyer 2025, Norbert 2018, Elagizi 2018, Tylka 2014, Barry 2014a).

Healthy lifestyle interventions are effective at increasing physical activity levels and improving diet quality (e.g. increasing fruit and vegetable intake, decreasing unhealthy food consumption) (Nitschke 2022, USPSTF-O'Connor 2020). Increasing these healthy lifestyle habits improves cardiorespiratory fitness (i.e., how well systems in the body work together to supply oxygen during physical activity) and cardiometabolic health (i.e., heart health and metabolic health, or how well the body processes energy), which reduces conditions associated with increased mortality risks, such as insulin sensitivity, cardiovascular disease, inflammation, and more (Weeldreyer 2025, Abbate 2020, Norbert 2018, Elagizi 2018, Barry 2014a). Evidence shows cardiorespiratory fitness and cardiometabolic health have stronger associations with mortality risk than weight and body mass index (BMI) (Weeldreyer 2025, Norbert 2018, Elagizi 2018, Barry 2014a). Positive changes in modifiable behaviors (e.g., regular physical activity and improved diet quality) consistently predict lower mortality and morbidity and reliably improve cardiometabolic markers across all weight categories (Hunger 2020, Weeldreyer 2025, Elagizi 2018, Norbert 2018, Magkos 2016, Unick 2013). Additionally, evidence shows intervention participants are more likely to be successful in changing modifiable behaviors than in reaching weight loss targets (Weeldreyer 2025). Moderate age-adjusted improvements to an individual’s cardiorespiratory fitness can achieve measurable health improvements regardless of weight (Weeldreyer 2025). Compared to weight-loss focused interventions, weight-neutral programs have better physiological (blood pressure, lipids), psychological (self-esteem, depression), and behavioral (diet quality, reduced disordered eating, physical activity) outcomes, as well as lower dropout rates (Calogero 2019).

Research has identified components of health that are most important to measure to predict an individual’s risk of mortality, chronic disease, cardiovascular disease, and other leading causes of death and disability. However, weight-focused research and healthcare practice have largely relied solely on weight and BMI as a proxy for health, despite studies consistently showing they are poor predictors of mortality and disease risk (Weeldreyer 2025, Barry 2014a). BMI fails to capture body composition, fitness, biomarkers, or lifestyle factors, and legitimizes blaming and stigmatizing patients higher on the weight spectrum (Tylka 2014). Furthermore, intentional weight loss is only inconsistently linked with meaningful health gains; experts suggest it does not meet the evidence standard to inform health policy (Hunger 2020, Calogero 2019). Interventions focused on weight loss appear ineffective for long-term healthy changes and are more likely to lead to weight regain and weight cycling, which are associated with adverse health outcomes, decreases in well-being, increases in unhealthy behaviors, and damage to patients’ relationships with their health and their health care providers (Tylka 2014). Weight-focused interventions reinforce the cycle between weight stigma and weight gain (Talumaa 2022, Calogero 2019). Further, interventions focused on weight outcomes ignore the fact that weight is more strongly shaped by genetic and macrosocial factors than by personal choice alone (Talumaa 2022, Calogero 2019, Puhl 2009).

Healthy lifestyle interventions are effective when they are delivered by trained nutrition and exercise professionals (Nitschke 2022). Nutrition education materials included in healthy lifestyle interventions should be tailored to the developmental stage of the intended audience (Rozga 2023). Interventions that include relevant and culturally adapted components have been shown to be most effective for people of color (Seo 2010). There are some clinical cases where weight and obesity may be important factors for clinician decision-making, such as heart failure in morbidly obese patients; however, physicians should rely on the latest evidence on weight loss while incorporating weight-inclusive practices (Elagizi 2018).

Evidence suggests diet and activity behaviors adopted in childhood track throughout life and the potential cumulative effects of small but sustainable changes offer long-term benefits for individuals, communities, and populations (Cochrane-Spiga 2024). Sustainable health improvement depends on reshaping sociopolitical conditions—access to nutritious food, respectful healthcare, safe environments, social support—rather than pursuing largely futile and potentially harmful weight-loss targets (Calogero 2019). This highlights the need to go beyond individual-level behavior change and implement upstream interventions that support individuals and families by changing the environment such that consuming a healthy diet and being physically active are the easy choice (Cochrane-Phillips 2025, Cochrane-Spiga 2024).

The effects of healthy lifestyle interventions on disparities in health outcomes for people higher on the weight spectrum, people of color, and people with low incomes is unclear. There are over 100 interconnected factors that influence weight, including macroeconomic drivers, biological factors, food supply and production, weight stigma and discrimination, media, health care, built environment, transport and recreation, technology, early life experiences and education. These factors act differently in different people. (Cochrane-Spiga 2024). More evidence is needed to understand intervention effects on the health disparities experienced by weight status, income, race/ethnicity, and gender (Talumaa 2022).

Evidence shows weight-neutral healthy lifestyle interventions are effective at not only improving physiological health outcomes, but also mental and physical health behaviors (e.g. self-care practices, therapy, physical activity levels, diet quality) and such interventions have the potential to reduce health disparities (Calogero 2019, Tylka 2014). However, weight-focused interventions have the potential to increase disparities in health outcomes for people higher on the weight spectrum, as this approach ignores the powerful genetic, socioecological, and economic forces—like food access, safe recreation spaces, stress, and socioeconomic status—that limit individuals’ ability to live a healthy lifestyle or control their weight (Talumaa 2022, Calogero 2019). By centering weight loss as both possible and necessary for everyone, it fuels anti-fat bias and stigma, creating health disparities and undermining public health and clinical efforts (Calogero 2019, Talumaa 2022). Anti-fat bias and stigma is prevalent in health care, leading to negative relationships between providers and patients, and decreasing patient’s motivations to make healthy lifestyle changes (Calogero 2019, Tylka 2014, Puhl 2009). Weight discrimination goes beyond the clinic, negatively affecting an individual’s hiring prospects and income, access to education, and social relationships. This harms mental health by increasing risks of depression, low self-esteem, poor body image, and more (Calogero 2019, Tylka 2014, Puhl 2009).

Socioeconomic inequities are associated with increased risk of having a higher weight status in the U.S. (Cochrane-Spiga 2024, Cochrane-Brown 2019). Families and communities with lower incomes may find it impossible to purchase high-quality nutrient-dense foods such as fresh fruits and vegetables given their limited budget and/or access to such foods. Instead, refined grains and added sugars, fats, and preservatives are generally inexpensive and readily available in lower-income communities (Tylka 2014). Furthermore, lower-income neighborhoods have fewer physical activity resources, such as parks, green spaces, bike paths, and recreational facilities when compared to higher income neighborhoods. Crime, traffic, and unsafe playground equipment are also barriers to physical activity in lower-income communities (Tylka 2014). Experts suggest that primary prevention efforts that start early in childhood, include parental involvement, and improve dietary quality, increase physical activity levels and reduce sedentary behaviors may be most effective for reducing health inequities by socioeconomic status (Cochrane-Brown 2019).

People of color are more likely to be higher on the weight spectrum than people who are white (Talumaa 2022). Many systemic factors influence weight status and the ability to adopt and maintain healthy lifestyle habits, for example, racism, sexism, ableism, and more (Calogero 2019). Systemic factors also include income status and residential neighborhood location, since having a low income and living in a neighborhood with fewer physical activity resources, unsafe physical environments, and lack of access to affordable healthy food options greatly increases the likelihood of people being higher on the weight spectrum (Tylka 2014). A review that includes international studies suggests multi-component healthy lifestyle interventions are effective at improving diet (both increasing healthy food consumption and decreasing consumption of unhealthy snack foods and sugar-sweetened beverages), increasing physical activity, and decreasing sedentary time (including reducing screen time) in adolescents from ethnic and racial minority backgrounds (Hayba 2020). There are many differences in preferences and lived experiences between adults who are Black and those who are white that influence healthy lifestyles, demonstrating the need to develop tailored interventions (Kinsey 2022).

Women are particularly impacted by weight-focused interventions and weight stigma, with disadvantages for women higher on the weight spectrum appearing in employment, education, leadership, romantic relationships, and the media (Calogero 2019). For example, women higher on the weight spectrum are more likely to have lower incomes than similarly higher weight men (Calogero 2019, Newton 2017a). These disadvantages contribute to higher levels of negative psychological outcomes, such as low self-esteem and body dysmorphia, among women compared to men. Weight-neutral healthy lifestyle interventions that include clear causal information that emphasizes how hard it is to control weight and adopt a health-focused model that focuses on sustainable modifiable behavioral changes have the potential to help reduce gender disparities in health outcomes (Talumaa 2022).

Negative views of fatness, weight, and body size have existed for several centuries. In the U.S. weight stigma and fatphobia are rooted in racism against people who are Black (Strings 2023). In the 1700s, colonists who were white could no longer rely on skin color alone to draw distinctions between themselves and the people they enslaved and colonized, as generations of rape had produced a wide continuum of skin tones among the population (Strings 2023). They began to use body size and weight to draw such distinctions, labeling indigenous peoples and people who were Black, particularly women who were Black, as fat, prone to gluttony and excess, and claimed whites’ thinness and value of moderation made them superior (Strings 2024). These attitudes persisted in the 1800s, establishing a cultural ideal of thinness and the use of body size and shape as social and cultural standards to judge people and their status (i.e. enslaved, socioeconomic status, immigrants) (Strings 2024).

The 19^th and early 20^th century saw the rise of eugenics, a form of scientific racism (Strings 2024). Eugenicists adapted the Quetelet Index (originally developed in the early 1800s to help study population characteristics based on measurements of a small population of European white men) to establish what an “ideal” and “healthy” height and weight was (Strings 2024). Its proponents claimed that the differences between people who were white and those from other races and ethnicities showed there was a racial propensity to thinness or fatness, and people who were not white were less healthy and physically inferior (Strings 2024).

Health insurance companies, one of the fastest growing industries at the time, chose to incorporate these beliefs in their coverage decision-making by using the index to develop a standardized height and weight table (Strings 2024), effectively placing a white standard on the bodies of people of all races (Strings 2024). This continued even after the medical community directly acknowledged that race is not biological after the devastation of the Holocaust (Strings 2024).

Beginning in the 1950s, these standards also began to be adopted in medicine. They adapted the Quetelet Index as the standard for doctors to use in assessing “healthy weight,” and changed the name to Body Mass Index (BMI) (Strings 2024). By the 1970s, BMI became the norm in medical practice and the research that informed these “universal” standards continued to exclude women, people of color, and people with low incomes, further entrenching racism and discrimination in health care (Strings 2023). Doctors and public health professionals began to claim there was an obesity crisis while ignoring the complex etiology of the human body and blamed overeating as the primary cause. In essence, doctors who worked for insurance companies created medical guidelines that were not evidence-based and only served to intensify the tacit whiteness of medical standards in the U.S. (Strings 2024). The values for BMI used to determine what is a “healthy weight” still meant most people, especially women of color, were defined as overweight and thus “unhealthy,” triggering initiatives to “fix” their bodies (Strings 2023). The standards for what qualifies as a healthy BMI have been revised several times, with each iteration leading to more and more people being defined as unhealthy (Strings 2024). These systematic efforts fuel weight stigma and weight-centric messaging that permeate schools, workplaces, healthcare, and media, harming mental health, educational and economic outcomes, and doctor–patient relationships (Talumaa 2022).

Inspired by civil rights and social justice movements, community leaders and experts started to push back against these sociopolitical constructs of health and weight that are rooted in racism, sexism, and other discriminatory frameworks (Strings 2024). Over time these movements have led to new frameworks that rely on measures and healthy lifestyle habits that not only are more indicative of health but also help dismantle the various -isms related to weight (i.e. racism, sexism, sizeism, ableism) (Calogero 2019).

There are several other contextual factors that influence health in the U.S., including the industrialization of food systems to produce cheap, calorie-dense foods with fewer people cooking meals at home. Simultaneously, sedentary lifestyles and car-dependent environments have decreased physical activity levels (Hall 2018a). Diet culture and health have a market value of over $90 billion and have been fueled by the rise of social media (Clark 2021). Experts recommend continuing to recognize that a patient’s context likely matters the most for health, such as their food environment, socioeconomic status, medical comorbidities, and social support, as well as practical factors (Hall 2018a).

• Are your community and the leading healthcare and public health institutions in your area aware of weight-inclusive practices? Do they have the necessary resources and information to shift their focus from weight-centric care to health-focused care that uses neutral language and emphasizes behaviors over body size?
• Do healthcare practitioners in the area have awareness of weight-inclusive practices that can foster trust and engagement in a mutually beneficial relationship centered on health? What trainings or resources could help them improve their understanding and support their practice?
• Are there weight-inclusive programs available in your community? In neighborhoods with low incomes? Or for racially/ethnically diverse communities? Are they accessible and affordable?
• How can community leaders, public health professionals, and the broader public tailor their communication and efforts to shift their focus from weight-centric to weight-inclusive practices? What efforts can they support to improve access to healthy nutrient-rich foods, increase opportunities for physical activity?

There are an increasing number of resources available to support shifting from weight-centric approaches to weight-inclusive approaches in programs and policies, as well as for healthcare practitioners and public health professionals. Health at Every Size works to support providers so their practice is based on weight inclusivity, health enhancement, respectful care, eating for wellbeing, and life-enhancing movement all to support building healthy habits versus fixating on weight (ASDAH-HAES).

Healthcare institutions and providers are some of the biggest sources of weight stigma (Talumaa 2022). Experts highlight the need for increased education for providers on obesity’s complex etiology and clear causal information emphasizing low personal controllability, empathy-provoking exercises to humanize patients’ experiences, adoption of a health-focused and weight-inclusive care model, as well as mixed-method interventions combining multiple approaches to improve healthy habits (Talumaa 2022). A key opportunity to improve education for healthcare providers is updating medical school curriculums to teach weight-inclusive approaches (Bowden 2024). Additionally, experts highlight the need for public health programs and policies, as well as campaigns, to shift from their focus on weight-centric metrics and language to ones that are weight-inclusive to reduce weight stigma and promote health-enhancing behaviors (Hunger 2020).

Social media is another source that can both alleviate and exacerbate weight bias and stigma, in part because of the ability of users to remain anonymous and free of consequences for harmful behavior (Clark 2021). It can be a positive agent of change, allowing movements like Body Positivity, the Fatosphere, and Health at Every Size to create more inclusive space online that counter negative stereotypes (Clark 2021). Experts highlight the need for public policy development supported by public health professionals, parents, educators, and policymakers to minimize the detrimental effects of social media (Clark 2021). For example, enacting legislation that makes weight-based discrimination illegal, like Michigan and Washington have done (Clark 2021, Hunger 2020). A key intermediate alternative to legislation is industry self-regulation and accountability, including updating community guidelines outlined by social media platforms and training machine learning algorithms to detect potentially discriminatory content (Clark 2021).

‡ Resources with a focus on equity.

ASDAH-HAES^‡ - The Association for Size Diversity and Health (ASDAH). (2024). Health at Every Size (HAES). Retrieved October 23, 2025.

ChangeLab-Healthy communities toolkit - ChangeLab Solutions. How to create and implement healthy general plans: A toolkit for building healthy, vibrant communities.

ChangeLab-Planning guide - ChangeLab Solutions. A roadmap for healthier general plans: A guide & infographic about the planning process.

CI-WOTN - Community Initiatives (CI). The Weight of the Nation (WOTN).

NYS DOH-EWPH - New York State Department of Health (NYS DOH). Eat well play hard (EWPH).

Talumaa 2022 - Talumaa, B., Brown, A., Batterham, R. L., & Kalea, A. Z. (2022). Effective strategies in ending weight stigma in healthcare. Obesity Reviews, 23(10), e13494.

* Journal subscription may be required for access.

Abbate 2020* - Abbate, M., Gallardo-Alfaro, L., Bibiloni, M. D. M., & Tur, J. A. (2020). Efficacy of dietary intervention or in combination with exercise on primary prevention of cardiovascular disease: A systematic review. Nutrition, Metabolism and Cardiovascular Diseases, 30(7), 1080–1093.

ASDAH-HAES - The Association for Size Diversity and Health (ASDAH). (2024). Health at Every Size (HAES). Retrieved October 23, 2025.

Barry 2014a* - Barry, V. W., Baruth, M., Beets, M. W., Durstine, J. L., Liu, J., & Blair, S. N. (2014). Fitness vs. fatness on all-cause mortality: A meta-analysis. Progress in Cardiovascular Diseases, 56(4), 382–390.

Bowden 2024 - Bowden, E. L., & Petty, E. M. (2024). Perspectives on weight stigma and bias in medical education: Implications for improving health outcomes. WMJ: Official Publication of the State Medical Society of Wisconsin, 123(3), 160–162.

Calogero 2019* - Calogero, R. M., Tylka, T. L., Mensinger, J. L., Meadows, A., & Daníelsdóttir, S. (2019). Recognizing the fundamental right to be fat: A weight-inclusive approach to size acceptance and healing from sizeism. Women & Therapy, 42(1–2), 22–44.

CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.

Clark 2021 - Clark, O., Lee, M. M., Jingree, M. L., O'Dwyer, E., Yue, Y., Marrero, A., Tamez, M., Bhupathiraju, S. N., & Mattei, J. (2021). Weight stigma and social media: Evidence and public health solutions. Frontiers in Nutrition, 8, 739056.

Cochrane-Brown 2019 - Brown, T., Moore, T. H., Hooper, L., Gao, Y., Zayegh, A., Ijaz, S., Elwenspoek, M., Foxen, S. C., Magee, L., O’Malley, C., Waters, E., & Summerbell, C. D. (2019). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 2025(8).

Cochrane-Phillips 2025 - Phillips, S. M., Spiga, F., Moore, T. H., Dawson, S., Stockton, H., Rizk, R., Cheng, H.-Y., Hodder, R. K., Gao, Y., Hillier-Brown, F., Rai, K., Yu, C. B., O’Brien, K. M., & Summerbell, C. D. (2025). Interventions to prevent obesity in children aged 2 to 4 years old. Cochrane Database of Systematic Reviews, 2025(6).

Cochrane-Spiga 2024 - Spiga, F., Davies, A. L., Tomlinson, E., Moore, T. H., Dawson, S., Breheny, K., Savović, J., Gao, Y., Phillips, S. M., Hillier-Brown, F., Hodder, R. K., Wolfenden, L., Higgins, J. P., & Summerbell, C. D. (2024). Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database of Systematic Reviews, 2024(7).

Elagizi 2018* - Elagizi, A., Kachur, S., Lavie, C. J., Carbone, S., Pandey, A., Ortega, F. B., & Milani, R. V. (2018). An overview and update on obesity and the obesity paradox in cardiovascular diseases. Progress in Cardiovascular Diseases, 61(2), 142–150.

Hall 2018a - Hall, K. D., & Kahan, S. (2018). Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America, 102(1), 183–197.

Hayba 2020 - Hayba, N., Elkheir, S., Hu, J., & Allman-Farinelli, M. (2020). Effectiveness of lifestyle interventions for prevention of harmful weight gain among adolescents from ethnic minorities: A systematic review. International Journal of Environmental Research and Public Health, 17(17), 6059.

Hunger 2020* - Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An evidence‐based rationale for adopting weight‐inclusive health policy. Social Issues and Policy Review, 14(1), 73–107.

Kinsey 2022* - Kinsey, A. W., Phillips, J., Desmond, R., Gowey, M., Jones, C., Ard, J., Clark, J. M., Lewis, C. E., & Dutton, G. R. (2022). Factors associated with weight loss maintenance and weight regain among African American and white adults initially successful at weight loss. Journal of Racial and Ethnic Health Disparities, 9(2), 546–565.

Magkos 2016 - Magkos, F., Fraterrigo, G., Yoshino, J., Luecking, C., Kirbach, K., Kelly, S. C., de las Fuentes, L., He, S., Okunade, A. L., Patterson, B. W., & Klein, S. (2016). Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism, 23(4), 591–601.

Newton 2017a - Newton, S., Braithwaite, D., & Akinyemiju, T. F. (2017). Socio-economic status over the life course and obesity: Systematic review and meta-analysis. PLOS ONE, 12(5), e0177151.

Nitschke 2022 - Nitschke, E., Gottesman, K., Hamlett, P., Mattar, L., Robinson, J., Tovar, A., & Rozga, M. (2022). Impact of nutrition and physical activity interventions provided by nutrition and exercise practitioners for the adult general population: A systematic review and meta-analysis. Nutrients, 14(9), 1729.

Norbert 2018* - Stefan, N., Häring, H.-U., & Schulze, M. B. (2018). Metabolically healthy obesity: The low-hanging fruit in obesity treatment? The Lancet Diabetes & Endocrinology, 6(3), 249–258.

Puhl 2009 - Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity, 17(5), 941–964.

Rozga 2023 - Rozga, M., & Handu, D. (2023). Nutrition interventions for pediatric obesity prevention: An umbrella review of systematic reviews. Nutrients, 15(24), 5097.

Seo 2010* - Seo D-C, Sa J. A meta-analysis of obesity interventions among U.S. minority children. Journal of Adolescent Health. 2010;46(4):309-23.

Strings 2023 - Strings, S. (2023). How the use of BMI fetishizes white embodiment and racializes fat phobia. AMA Journal of Ethics, 25(7), E535-539.

Strings 2024 - Strings, S., & Bell, C. (2024). BMI is bunk, but fat women are diseased: The hypocrisy of “The normal (white) man.” Social Sciences, 13(6), 276.

Talumaa 2022 - Talumaa, B., Brown, A., Batterham, R. L., & Kalea, A. Z. (2022). Effective strategies in ending weight stigma in healthcare. Obesity Reviews, 23(10), e13494.

Tylka 2014 - Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity, 2014, 1–18.

Unick 2013 - Unick, J. L., Beavers, D., Bond, D. S., Clark, J. M., Jakicic, J. M., Kitabchi, A. E., Knowler, W. C., Wadden, T. A., Wagenknecht, L. E., & Wing, R. R. (2013). The long-term effectiveness of a lifestyle intervention in severely obese individuals. The American Journal of Medicine, 126(3), 236-242.e2.

USPSTF-O'Connor 2020 - O’Connor, E. A., Evans, C. V., Rushkin, M. C., Redmond, N., & Lin, J. S. (2020). Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 324(20), 2076.

UW-LaCrosse HAES - University of Wisconsin-La Crosse, Rec Sports. (n.d.). Embracing Health at Every Size (HAES). Retrieved October 23, 2025.

UW-Madison HAES - University of Wisconsin-Madison, University Health Services. (2024, February 28). What does Health at Every Size (HAES) mean? Retrieved October 23, 2025.

Weeldreyer 2025 - Weeldreyer, N. R., De Guzman, J. C., Paterson, C., Allen, J. D., Gaesser, G. A., & Angadi, S. S. (2025). Cardiorespiratory fitness, body mass index and mortality: A systematic review and meta-analysis. British Journal of Sports Medicine, 59(5), 339–346.