Over on Dr. Arya Sharma’s blog, he’s pointing to a debate on whether doctors should stop prescribing weight loss. My first response is, in a word, yes. Need I say more? But more needs to be said. Let me put this into perspective. Imagine you go see a doctor and he says this to you:
“The symptom you have (body size) is not actually the problem of most concern (cardiovascular or metabolic issues). But since they're statistically correlated, we’re going to simply address the symptom, even if it is not currently bothering you or even if you have none of those other health problems. We will attribute every health issue you have to this symptom."
“Although you may see initial respite from the symptoms and any associated health problems, the treatment has a 95% failure rate over 5 years. In a significant number of patients, the problems will become worse after treatment.”
“You will also have a slight chance of developing a potentially health-destroying and life-threatening eating disorder.”
“There is an alternate treatment that carries very little risk we could try first. We will not.”
“If you are one of the 95% for whom this treatment fails, we will assume you are non-compliant and treat you as such. We will not look at other options to manage your health.”
“We reserve the right to withhold other medical treatments, such as fertility treatments and joint replacements, unless this treatment succeeds for you.”
“This will be time-intensive. You will be required to spend a large amount of time logging and recording your food intake and planning meals. You are to disregard any hunger signals your body gives you.”
“This treatment will be required for the rest of your life, particularly if you are one of the patients for whom it makes things worse. You may never be able to eat normally again.”
“Even if you gained weight incredibly rapidly with no change in your eating or activity habits, we will not look at other possibilities for the rapid weight gain until you have tried and failed treatment -- possibly repeatedly, and possibly not until the situation has become severe.”
Ready for treatment?
I'm grateful that the question is being raised in medical circles. I have to say that I will not argue that weight loss is inappropriate in every single instance. I realize doctors see people who have desperate issues that may require an intervention. Similar to leaving a thryoid with benign lumps alone, while removing one that has become cancerous. You don't do the latter lightly, but you do it if the benefits outweigh the risks.
However, in weight loss the risks of not treating are often exaggerated while the risks of treating are disregarded. I believe intentional weight loss is a bad approach for most -- particularly those who are overweight or obese and metabolically healthy. As a first-line treatment, I see no downside to joyful movement and healthful foods, no downside to Health at Every Size, but I see a lot of pitfalls to intentional weight loss.