Ethical Obesity Management in IndiaFriday, May 24, 2013
As readers will have noted, obesity is an increasing problem in the Indian subcontinent, with urban prevalence (based on the lower definition of BMI 25) reaching rates comparable to the West.
In the overwhelmingly private healthcare system in India, ethical and evidence-based obesity management becomes an even bigger challenge than in a country like Canada, where we have publicly funded healthcare.
While, in a public system, we can point to the health benefits of modest weight loss and take a long-term approach based on the principles of chronic disease management, in a private health care system, where the customer is king, people will only pay for what they want – and that is to lose as much weight as quickly as possible.
As in Canada, it is hard convincing patients (and even most health professionals) that just losing 5% of your weight has significant health benefit. Indeed few patients would be willing to pay for a 10-15 lb weight loss – and keep paying for your help to keep them off.
Unless you can (at least claim to) offer 25 or 50% weight loss, it is unlikely that you will have many clients – there is simply no money in ethical obesity management. I have yet to find the patient who would pay me to simply help them stop gaining weight.
In the end, weight loss is really what everyone is after – I guess this is why surgeons still refer to bariatric surgery as “weight-loss surgery” – weight-loss sells!
For my colleagues in India, where they have to compete with an entirely unregulated and ruthless commercial weight-loss industry that promises a seemingly unlimited number of “slimming miracles”, practicing “evidence-based” obesity management is simply not a viable way to make a living.
This, perhaps is the greatest challenge to health professionals who wish to offer ethical weight management to their clients – they simply have no treatments that can match the weight-loss expectations of their potential clients.
Thus, I know that my talk this evening will disappoint most of my listeners, who may well be hoping that I can reveal the latest “magic solution” for weight-loss.
I truly wish I had a happier message for them.
New Delhi, India