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Should Doctors Advise Overweight or Obese Patients About Weight Loss?

By Jennifer Sage On January 31, 2013 Under Medical, Weight Loss

As teachers of one of the best ways to improve general fitness and to lose weight, Spinning instructors/indoor cycling instructors are an important link to help millions of people in the world improve their quality of life. Many instructors I know take the next step to become educated as health coaches, personal trainers, and nutritional experts in order to help even more people. The number of success stories from instructors, trainers, and students I’ve heard is overwhelming. Sure, there are many who fall through the cracks, who never come back, who fail to lose weight, but that does not mean we give up or stop inspiring.

But what about the medical community? What is their obligation to counsel overweight or obese patients to lose weight and/or improve their diet? I’ve got a few interesting articles to share with you on the subject.

The American Council on Exercise posted an article today that highlights the troubling trend of fewer physicians offering weight counseling to overweight patients. They say:

Despite the fact that more and more Americans are obese or overweight, fewer physicians are offering weight-loss counseling to their patients, highlighting a growing need for qualified health coaches to fill the void.

The ACE article states that it is unknown why doctors are not heeding task force recommendations to counsel patients, stating:

Researchers aren’t entirely clear on the reasons behind the significant drop in weight-related counseling from physicians, but highlight barriers such as time limitations during appointments and doctors thinking that their training for lifestyle counseling is inadequate.

Other reasons may be that counseling services are not reimbursed, the researchers said, or that as physicians see rising rates of obesity among their patients, they offer less counseling because of a perceived lack of success.

I have to ask the question they are not asking…is it possible that more and more doctors are also overweight? And as such, do they feel uncomfortable giving advice they are not following themselves? Or perhaps if they are overweight, perhaps they are in a state of denial that their level of overweight is something to be concerned about? I don’t know the answer to this question, but it would be interesting to see if this is a trend in the larger medical community. I’ve seen it firsthand, but that doesn’t mean it’s ubiquitous.

Then you’ve got doctors out there like Arya M. Sharma, M.D., who write that giving weight loss advice is unethical. While he does have a few points worthy of contemplation (such as the fact that doctors are not trained to give the advice in a sensitive and professional manner), I completely disagree with the claim that doctors should not be encouraging their patients to lose weight. Scroll down to the comments and read what Dr. Dike Drummond writes in response to Dr. Sharma’s article. Here is one of his comments (he has several excellent ones; you’ll have to scroll down Dr Sharma’s post for more):

An interesting spin Dr. Sharma. Don’t agree. It is not unethical to recommend weight loss for a hundred evidence based reasons you choose to ignore that are indeed based on quality of life. I also know you have a number of patients in your practice that have basically “cured” their type II diabetes and HTN with weight loss — as well as a number who have kept their weight off for decades without bariatric surgery. We all have a couple of them in our practice. Aren’t they an inspiration?

So let’s set aside the false argument that weight loss doesn’t make a difference to the patient.

What is true is that doctors are abysmal in inspiring the patient to lose weight and maintain that weight loss. In fact, we are perhaps worse than anyone else they could get professional weight loss advice from. This is for two simple reasons.

1) On the surface … I hope it is clear that we are not trained to deliver and monitor an effective weight loss program. If we were, we would be doing it in every office across the country.

2) At a deeper level, our patient’s weight is NOT OUR RESPONSIBILITY. It is a decision made by the patient every time they lift a fork to their mouth and every time they take a step (or don’t).

We are advisors to our patients. We have an ethical responsibility to advise them of the consequences of being overweight and the truth about weight loss.

There is no magic pill. No magic surgery or superfood.

It is one less bite and 1000 more steps — done over and over and over again. It is a day to day decision to choose a lower weight and take effective action. It is not a pharmaceutical, or a LAP Band or hypnosis. It is us, supporting our patients making good choices and realizing — in our modern civilization of too many calories and too many opportunities to be entertained by doing things that do not burn calories — 90% and more will not be able to maintain an ideal weight.

Does this mean we give up on the few who succeed? Does this mean we stop talking about it? That we stop telling the truth? THAT would be unethical.

My two cents,

Dike Drummond MD

How about you? Do you believe a doctor is ethically bound to advise an overweight/obese patient on weight loss and nutrition? In my opinion, I do. But one important change that must happen is that they must be taught more about nutrition and fitness and how it impacts overall health in medical school. Also, if it’s not their specialty they should refer the patient to someone else who can counsel them professionally and correctly, just like they would refer the patient to a specialist for any other symptom which does not fall under their specialty. But I agree with Dr. Drummond, it is unethical to ignore the symptom, which could be the contributing factor to a whole host of dangerous medical conditions, a poor quality of life, and even death.

 

2 Comments Add yours

  1. Bill Jenks
    February 5, 2013
    3:59 pm #comment-1

    An article from the Los Angles Times. A real prescription from your Doctor to drop a few pounds and a weight loss program to back it up. More doctors are prescribing the Diabetes Prevention Program, a 12-week regimen, to ward off Type 2 diabetes.

    http://www.latimes.com/health/la-sci-weight-loss-medicine-20130109,0,3650559.story

  2. pascal
    February 5, 2013
    4:49 pm #comment-2

    Medecine have change a lotsince a few decade, it is now more and more specialized and you can barelly find a physician with REAL multidisciplinary knowledge.
    Having work more than 10years in the field in Belgium and now living in US sonce more than 5, I see a HUGE difference of medecine, more speciaization in US with no real multidisciplinary knowledge AND really soft way to practice ( so many ridiculous laws suit in US !!! make physician really scare or not taking real responsability).
    When I left the medical field, I was part of a weight management program in the Hopital I was working.
    This program had multiple orientation, and there was different specialities, familly physician, endocrinologue, dieteticien, physical therapist, cardiologist and a psychologist; we had differents objectives:
    -educating patients,
    -proposing meeting where we would intruduce our program to the public and the medical field,
    -and treatement and follow up.
    We start with diabetic than different categories up to pediatry (school).
    This is the best way to do it … now why it is hard … medecine is now a business ! Is a projetc like that make money ? NO. It save money to the social service and the society but are the big compagnies making money with it ? NO
    To go back to your question, I will just repeat what I said earlier, physician in US walk on theyr toes … the day there would not be any more crazy law suit it would may be change … but than what would the physician do when they would have to respond to pharmaceutical and food industry … there are too much money involve unfortunatly to see major change.

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