Do Some Doctors Sabotage Obese Patients?

People may not find themselves in total agreement with everything said by Yoni Freedhoff, M.D., but he tunes in to what turns patients off. In the classic Ten Things format, he provides a list of particulars that any conscientious doctor might well take under consideration.

Check your holding area

A patient waiting room can convey many messages. It might say, “I’ve furnished this room with antiques, so you can understand why my fees have to be so high.” It can say, “I basically disapprove of your oversize body, and that’s why we provide skinny little chairs, and subscribe only to magazines with glamorous thin models on the covers.”

The ambiance may even convey a message like, “When it’s your turn, you will find the scale in the hallway, and if you weigh too much for it, a flashing red “TILT!” sign will be activated, within view of other patients, office personnel, and visiting pharmaceutical reps.” (These are not Dr. Freedhoff’s words of course, but a loose interpretation.)

History in the making

Okay, let’s get serious here. The Canadian MD is very much in favor of taking the patient’s history first (which may initially be done by another staff member, but it is for your doctor’s edification.) The point is, no conscientious medical professional should plunge right in by suggesting that you lose a few pounds.

Why? There might be a history of severe eating disorder, and this might be the first thing a doctor needs to know, because this patient needs a compassionate approach. Then, he says,

In other cases, patients’ social determinants of health would make intentional behavior change efforts in the name of weight management an impossible luxury. And sometimes that same patient may in fact be maintaining a clinically meaningful weight loss from their peak weight already.

There is a definite plea here to avoid conventional advice. Most people know the mantra Eat Less Move More. If it was working for them, they wouldn’t be here. Dr. Freehoff writes,

That’s about as useful as telling someone that making money requires them to buy low and sell high. Or telling someone with depression that they should just cheer up and look at the bright side of things.

And a doctor should eschew the temptation to be a diet chauvinist:

The research is clear: There is no one best dietary approach, and one person’s best diet is another person’s worst. Yet, some clinicians are themselves diet zealots and preach one diet over all others. Of course, many of their patients may well have already tried that approach, while others won’t enjoy it, and so promoting it above all others will fail a great many people.

This subject is worth continuing, and the next post will bring in some other voices, too.

(To be continued…)

Your responses and feedback are welcome!

Source: “10 Ways Docs Sabotage Their Patients’ Weight Loss Journeys,”, 07/11/23
Image by Denisbin/CC BY-ND 2.0 DEED

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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