weight loss

Doctors and unwanted weight loss advice

Why do doctors weigh patients and offer weight loss advice? Other than “eat less and move more” which is kind of like the weight loss equivalent of “buy low and sell high,” what recommendations do they make and why?

I’ve wondered about this before. See Well-intentioned lies and doctors and concluded that,

Doctors shouldn’t prescribe weight loss to overweight/obese patients, especially not without mentioning the long term likely effect. Would we recommend any other treatment with these odds of success? Medical professionals should spend more time emphasizing weight maintenance. Second, especially if you’re a normal weight or overweight person, the last thing you should try to do is lose weight. That looks like a clear fast train to getting fatter.

Here’s the more interesting question, if doctors know this, why don’t they act on it? Here is my guess at an answer. Doctors hate problems they can’t solve. I saw that when they were dealing with a family member with incurable illness. They want to hold out hope.

So that’s part of it. Doctors are also human and reason as everyone does. The simple mathematical model of “eat less, move more” seems obviously true. Weight loss looks like just simple math plus will power. How could it go wrong?

Finally, doctors also know that healthy eating does matter and so too does exercise. Indeed a recent study in the British Journal of Sports Medicine concluded that  for women and heart health exercise matters more than any other factor including obesity. (See Study: Exercise Trumps Body Weight When It Comes To Women and Heart Health.) Doctors fear that without the promise of weight loss, no one would be motivated to eat well and stay physically active. As the article about the impossibility of weight loss says, “Health experts are also afraid people will abandon all efforts to exercise and eat a nutritious diet — behaviour that is important for health and longevity — even if it doesn’t result in much weight loss.” But I worry that this reasoning gets it exactly wrong. People aren’t idiots. Tell them to exercise and eat well in order to lose weight. What happens if they don’t lose weight? They’ll quit exercising and quit eating well. That’s because you told them to do it to lose weight. And clearly it wasn’t working so why stick with it?

I’ve written about this recently. See If inactivity matters more than weight, why the focus on the scale?

And then there’s a great letter in the British Medical Journal here, Why there’s no point telling me to lose weight?

I am one of over 97% of people for whom dieting does not lead to sustained weight loss.1 2 3

I’ve experienced health benefits from increased exercise, and from switching to a wholemeal vegetarian diet. My blood pressure’s normal, as are my fasting glucose and my lung function—as far as I can tell, my health is great. But my body mass index (BMI) has been above 30 my entire adult life.

When I worry that I might be unwell, I often try to avoid visiting a general practitioner. Almost every consultation I’ve ever had—about glandular fever, contraception, a sprained ankle—has included a conversation about my weight; and that’s inevitably the conversation that destroys any rapport or trust that might have existed between me and my doctor.

Fighting “the obesity epidemic” is supposed to be about making me—as a “severely obese” person—more healthy; but the impact of obesity rhetoric on my life has been quite the opposite

 

Go read the whole letter. It’s great.

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And now there’s this, from doctors themselves:

Expecting all obese people to lose weight solely by “eating less and moving more” misunderstands the nature of the condition and will never solve the obesity epidemic, leading doctors have said.

In a staunch rebuttal to commentators who argue obese people have brought the problem on themselves and should rely only on diet and exercise, experts from leading American universities said that, even after actively losing weight, biological mechanisms kick in that make it extremely difficult for previously obese people to stay a healthy weight.

Writing in The Lancet, they say recommendations just to cut back on high calorie foods might be “no more effective for the typical patient seeking weight reduction that would be a recommendation to avoid sharp objects for someone bleeding profusely”.

11 thoughts on “Doctors and unwanted weight loss advice

  1. It may be informing patient that they may lose some weight rather an absolute you will lose weight. More importantly is for doctor to focus on scarier consequences of not lowering high blood pressure, high blood sugar or losing a lot of weight because your knees already are feeling pain and you can’t walk far (I know a work colleague in this category and she’s under 65 yrs.).

    Some patients do need an outright message from a doctor in person (there’s no one else reasonably qualified) that they need make changes to diet to lose some weight or work towards that. Some people prefer to hear that message from a doctor, not from their partner, family members nor good friends. I have known people (this includes my partner) who made major lifestyle health changes when the message came from their doctor. That was the final message/medical directive end point for them.

    There is no one else to deliver that medical advice especially a patient who hasn’t even tried to make changes in lifestyle….until a heart attack, stroke or diabetes 1 or 2 reading to scare the patient literally.

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  2. I’m commenting in two capacities,as a Doctor and as someone who is struggling with weight issues..
    I totally agree with most of what you have written and I have equally blogged about a similar issue.But here is another way of looking at it. Weight loss sounds glamorous and sounds good to the ears and is something visible but most patients don’t get excited if you tell them to lower their triglycerides or cholesterol levels (those are changes taking place inside the body).So we promise weight loss because there is a more than likely chance that u will give it a shot.
    So though I agree that promoting exercise and healthy habits should come before promising weight loss,I think the idea of weight loss gets the job done quicker(even if for s short time).The goal at the end of the day is to keep you alive for longer..Great post btw.

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  3. Reblogged this on Allthingshealth and commented:
    I agree with most of this post.But as a Doctor is think selling weight loss gets people more excited and atleast give it a shot.Even though lowering your triglycerides,cholesterol,blood pressure is way more beneficial,these are changes that occur internally (in your blood stream).They are neither tangible nor visible.So we go for weight loss most times and only speak of your cholesterol decreasing as a reward you get from loosing weight.Most people just like the idea of looking skinnier.But beware of being that skinny -fat person(a person who is skinny but ridiculously unhealthy).
    Be sure to share your opinions in the comment section

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    1. HI Pearl2803– I’m so glad that at least one doctor is reading this blog and blogging about health issues; we need all the enlightened medical perspectives we can get. My worry here (as a person struggling with weight and as a researcher on obesity, behavior change, and pub health ethics) is this: offering weight loss as a goal of a very difficult and usually massively oversimplified diet process is flat-out misleading.

      Failure to adhere to a prescribed diet (which is almost always a set of unsustainable eating behaviors, which also haven’t been customized for the patient’s eating patterns and life constraints) and failure to lose the weight that the diet promises (success of which is simply not supported by long-term evidence, even in study populations) erodes self-esteem, erodes motivation to eat more healthy foods, and distracts us from retooling our goals to process ones (develop habits of regular fun and functional activity) and experiential ones (e.g. the feeling that climbing stairs isn’t so hard anymore so I’ll do it all the time). Of course you know this as well as I do. The hard part is convincing your medical colleagues to retool their goals, too.

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  4. I was able to successfully lose and keep off about 20 lbs last year, due mostly to shifting from cardio to building muscle. Another factor is taking Metformin, which counteracts some of the metabolic syndrome that contributes to weight gain, especially as we get older. My doctor hasn’t told me to lose weight by eating less and moving more, but the nutritionist I don’t respect much has said that more than once. On the contrary, my doctor has suggested modifying my diet to be less carb-heavy and include more fibrous vegetables and lean proteins. Some days I do better than others.

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  5. Hey Sam, very good points. I think doctors should be more transparent about weight loss in general. I recently wrote a detailed post that you might be interested in. Check it out and let me know what you think:
    http://goo.gl/XweYJv

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