Wednesday, May 16, 2012

Doctors and weight loss

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.


  1. Brilliantly put - I wish I could be so articulate in these matters! The world needs to wake up to the fact that pushing a medical intervention that was proven to only work in 5% of cases half a century ago is illogical at best and for the most part incredibly damaging to one's mental and physical health.

  2. Low calorie regimen diets are also referred to as balanced percentage diets. Due to their minimal detrimental effects, these types of diets are most commonly recommended by nutritionists. Thanks.
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  3. I do not dispute many diets result in weight loss in the short term but balanced or not, the vast majority fail in the long term. The body fights back. And if you can find studies not showing jut weight loss in the short term (1-2 years), but significant weight loss maintained at 5 years by all but a small fraction of participants, please share. I have yet to see a study showing successful significant weight loss that tracks participants more than a year or two. (Perhaps we can post dueling studies...when I have more time to look more of them up.)

    I also have no doubt that if you go from a poor quality, high calorie diet to a low calorie, high quality diet, you may improve your consumption of micronutrients. I believe a high quality, non-restrictive diet, however, is going to give you a better shot at getting everything in. You might be surprised at the quality of my diet. I just do not restrict or log (or obsess) or eat few enough calories that I am left constantly hungry and in danger of slowing my metabolism to where I can never eat normally again.