In the course of discussing a Fat IQ Test, we got onto the subject of whether doctors do or do not warn their patients about the dangers of obesity, or make helpful suggestions. (The answers differ, depending on who is asked.) This led to an article by Dr. Elisabeth Poorman, who appears to be a fan of backing up a step and questioning premises.
For instance, there is currently a lot of discussion about the method that medical professionals should use to tell patients that they are obese. Dr. Poorman refers to Dr. Roger Ladouceur:
Do doctors “believe that those who are overweight don’t realize it?” he asks. “They have been called fat since their early childhood.”
Dr. Poorman, a primary care physician, explains why she stopped advising patients to lose weight. Several years ago, she discussed diet and exercise with a young woman, and asked her to see a nutritionist. This patient came back months later, having lost five pounds, but complaining of a racing heart.
It turned out that she was taking diet pills supplied by a friend. Dr. Poorman says:
Since then, I have worried that telling patients to lose weight is harming them. These conversations fail to acknowledge how rare weight-loss success is: Fewer than 1 in 100 obese people will achieve a normal weight.
When I tell patients that they should lose weight, without providing them the resources to do so or being honest about how difficult it is, I leave them vulnerable to messages that they are lazy if they can’t, and that even dangerous methods of weight loss are worth the risk.
Another hazardous side effect of the “toxic culture of weight loss” is that any reduction in poundage is too likely to be welcomed with joy, masking what might be the danger sign of one of an astonishing list of illnesses, some of which can be fatal.
In some quarters, there is a feeling that brief, incomplete, or misleading counseling does more damage and is worse than no counseling at all. It is spurious to expect patients to get by on willpower. If that worked, they probably wouldn’t be visiting the doctor today. Even with the best intentions, physicians often dispense futility and frustration on the part of the patient. Doctors feel that frustration and that helplessness too.
This is what could be called a basic lose/lose situation. Nobody comes out ahead. What does Dr. Poorman recommend?
First, we need to stop pretending that what we are doing is working. Our brief counseling sends the wrong message that weight loss is simple and easy, even though we know it’s not. We have to be frank with patients and tell them the truth: If they are willing to make weight loss a central goal of their lives, they can lose about 5 percent of their body mass. They can even keep it off if they change their lifestyle dramatically, and forever.
No general practitioner can effectively guide a weight loss course, because it’s time- and labor-intensive. Given the speed of technological advancement, that may not be as true tomorrow as it is today. The world being what it is, however, Dr. Poorman feels that the brief time allotted to a patient is best spent in warning them off amphetamines.
Your responses and feedback are welcome!