These are additional points made by Yoni Freedhoff, M.D., who is very empathetic toward patients traumatized by many of his professional colleagues. For one thing, he believes that pharmaceuticals were invented for a reason, so people could take them if needed, and no unnecessary barriers ought to be set up.
In “10 Ways Docs Sabotage Their Patients’ Weight Loss Journeys” he wrote,
If a patient meets clinical criteria for a medication’s approved indication and a doctor won’t prescribe it because of their personal beliefs, in my opinion that’s grounds for a regulatory complaint.
Dr. Freedhoff is perturbed by what he characterizes as “fearmongering” about the new GLP-1 and related anti-obesity meds. To his way of thinking, the patients who take them just need to be watched over (exactly like when somebody is prescribed a medication against hypertension). He says these meds are “very well tolerated […] when dose titration is slow, monitored, and adjusted appropriately.”
He is also okay with the idea that a patient will probably need to stay with these remedies forever. To put it plainly,
Chronic conditions require ongoing long-term treatment.
One of Dr. Freedhoff’s warnings concerns a matter that more professionals ought to take into consideration. Certain drugs — from atypical antipsychotics to antidepressants to certain antiseizure medications to some blood pressure medications — inevitably cause their users to gain weight.
And the problem here is, apparently, there are doctors who…
[…] will still regularly prescribe them to patients with obesity without first trying patients on available alternatives that don’t lead to weight gain, or without at least monitoring and then considering the prescription of an antiobesity medication to try to mitigate iatrogenic gain.
Ideally, a physician facing an obese patient will be sufficiently informed to refrain from dictating “ridiculous and unrealistic weight loss goals.” Dr. Freedhoff writes,
The goal should be whatever weight a person reaches living the healthiest life that they can honestly enjoy.
This item should go without saying: A patient should be informed of all possible treatment options, and their implications, meaning that doctors should not function as gatekeepers standing between the patient and possible therapeutic interventions. Dr. Freedhoff writes,
Our job as physicians is to fully inform our patients about the risks and benefits of all treatment options and then to support our patients’ decisions as to what option they want to pursue (including none, by the way).
To finish up, Dr. Freedhoff speaks of “the dearth of effective treatments which in turn probably contributed to the overall lack of education for physicians in obesity management despite its extremely high prevalence.” But now that there are effective treatments, it is a good time to get on board with the idea that obesity is just another chronic noncommunicable disease, and people should have a choice in what to do about it.
As for another of Dr. Freedhoff’s desiderata, “patient-centered care free from judgment and blame” — who could be against that?
Your responses and feedback are welcome!
Source: “10 Ways Docs Sabotage Their Patients’ Weight Loss Journeys,” medscape.com, 07/11/23
Image by Karen H./CC BY 2.0 DEED