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Ethical Obesity Management in India



Weight-Loss-Secret-IndiaThis evening, I will be presenting a brief talk on obesity to my colleagues here in New Delhi.

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.

AMS
New Delhi, India

7 Comments

  1. This is completely true , and I am facing this problem here in Egypt where my clients expectations are so great , beyond what guidelines offering

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  2. I think they will find your truthfulness a breath of fresh air. To hear from an authority that they, the individual dieters, as they have struggled and failed, have been normal all along, and that the diet pushers have been and are frauds . . . well, what’s not to love about that message. Break a leg!

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  3. Has there really been any progress in the research on obesity in the last 10 years? It appears not as we are still at square 1.

    Its assumed that obesity is *easy* to induce, I.e. simply over-eating, Many scientists still believe this. But then, its nigh impossible to reverse that same obesity.

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  4. “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 I have managed to lose about of 40 pounds,and still losing, from 276 to 232, non-the-less every Dr I see whines about my weight. When I remind them of the “weights” on my chart I just get a glassy stare and the observation that it is not enough. I then ask them to compare my blood work (which is much better, actually normal and good in every way–I have Type2 Diabetes which I now control with diet and my blood pressure which has never been high, but has been even lower) I am then told the best thing I can do is limit calories. OK, am I talking to a brick wall here?
    What is their problem, how do I talk to them about my weight in a way that acknowledges their professionalism, and at the same time validates my experience and the huge likely hood that I will not lose more or heaven forbid, just gain it back?
    You are right, it is not just the patients, but the Doctors that just can not deal with reality.

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    • Yes Vic, I receive plenty of e-mails from patients describing similar situations – unprofessional demands to lose weight, well beyond what can even (at the best of times) be achieved by bariatric surgery. I certainly cannot help but wonder about the professional competency of these practitioners – a quick glance into the medical literature on obesity should make it clear that virtually no obesity treatment (including the use of pharmacotherapy) leads to anything more than 5-10% sustained weight loss. Anyone, who recommends that patients achieve more without also suggesting surgery, simply does not know what he/she is talking about.

      AMS

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  5. …”Few patients would be willing to pay for a 10-15lb weight loss-and keep paying for your help to keep it off. ” So we health professionals need to “sell” the benefits of modest weight loss and continue to fight the good fight against the weight loss industry that so strongly, and morally wrongly successfully sells. As an RD I am trying to sell the former -but thankfully it is not my bread and butter. Or I’d be in big trouble.

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