What Do Doctors Advise Patients About Losing Weight?
Thursday, December 2, 2010
Obesity is a medical problem and obesity treatments should be initiated by trained health professionals.
This solid piece of advice, of course assumes that trained health professionals actually know something about obesity treatment.
But is this assumption really valid?
We addressed this issue in a study just published in the Journal of Obesity, in which we surveyed 33 Canadian medical practices (36 physicians) regarding their obesity management recommendations in a total of 1788 consecutive overweight/obese adult patients.
It turns out that none of the evidence-based obesity management strategy was recommended by physicians in more than 50% of patients.
The most common recommendation/referral was for exercise (49% of cases) closely followed by dietary advice (46%).
Only 5% of patients meeting current eligibility criteria for bariatric surgery were referred for surgery.
Male patients were 30% less likely to be initiated or continued on anti-obesity pharmacotherapy than female patients.
Each BMI point was associated with a 2% increased chances of being prescribed an anti-obesity drug and private coverage increased the chances of a prescription by almost 80%.
Notably, one of the common reasons that weight management efforts were not initiated was “patient refusal”.
Interestingly, these results may actually be painting a much rosier picture than the reality: of the over 2000 doctors that were contacted to participate in this study, only 50 agreed to participate, but only 36 (from 27 primary care and 6 specialist practices) actually recruited any patients.
I am not sure, but it may be fair to assume that these participating practices actually had higher levels of interest and expertise in weight management and were therefore more likely to initiate weight management strategies than your average physician.
Obviously, we did not measure whether patients actually followed any of the advice or were in any way successful in managing their weight as a result of any advice they did receive.
Nevertheless, we think that this study clearly documents that before we can cheerfully advise all patients with excess weight to address this issue with their doctors, we better ensure that doctors (and other health professionals) can actually give appropriate advice that will indeed help patients better manage their weight.
If you have stories about appropriate or in-appropriate advice that you have received from a health professional, I’d love to hear about it.
AMS
Acapulco, Mexico
Padwal RS, Damjanovic S, Schulze KM, Lewanczuk RZ, Lau DC, & Sharma AM (2011). Canadian Physicians’ Use of Antiobesity Drugs and Their Referral Patterns to Weight Management Programs or Providers: The SOCCER Study. Journal of obesity (Online), 2011 PMID: 21113310
Thursday, December 2, 2010
Thank you Doc for sharing this important info.I wonder about all the criticism you must get from your fellow Doctors. So much has been said lately about their lack of concern.
I am sure your interest in obesity bothers many people.
I often wondered, in the last few years, if patients really understand all that is going on inside their bodies and if asking there Doctor was making a difference? You answer part of my question.
My own personal physician for the last 15 years has been going severely downhill, from a customer-patient relationship. My wife and I use to get all the time we wanted with him. Who gets that kind of treatment today?
Not even I, and I really care about me. What do ordinary people do?
Food for thought Doc.
Thanks so much for being there.
Pierre William Trudel
Thee Quest for Perfect health
Thursday, December 2, 2010
This less an explicit story and more a series of reactions to the post.
I wonder if there are hidden assumptions in the study itself – for example the idea seems to be couched in there that giving advice based on evidence-based treatments is actually effective in promoting weight loss, healthy eating or increasing frequency of exercise. Personally and professionally, though this is completely anecdotal, I tend to doubt that this is true.
What I tend to see more is that physicians, even seemingly very well informed ones, diagnose overweight or obesity as they would any medical condition, and “prescribe” changes in diet or exercise as the treatment – mostly without much exploration of the complex history many people living with overweight/obesity have – numerous, failed attempts at diet for example, or considering the possible implications of inherent differences between a person who has struggled with weight since childhood or adolescence compared to the person who has seen significant weight changes only as an adult. I believe these approaches add to the shame frequently felt by people who are overweight or obese, as it seems to assume both a simplicity to the conditiona dn the “treatment” and it ignores the multifaceted emotional and psychological realities of the individual who is showing up in the office – e.g. it assumes problem+advice=appropriate treatment, without considering the impact of that interaction or the advice.
Here’s a bit of what I mean – many people who are overweight or obese actually tend to know how they “should” be eating and that they “should” be exercising – having their physician tell them these things as if they don’t know them can contribute to the patient now feeling the doctor thinks they’re ignorant – a shameful state if there ever was one!
Given the infrequency with which many people see their doctors, then get advice, I’d love to see everyone with a weight problem who shows up at the doctor’s office be well interviewed about their history with weight loss and gain (I know this takes time), the doctor to be able to be compassionate enough to hear some of their feelings about times in their life when they’ve felt good about what weight they were at/what shape they were in (not always the same thing, right?!) for the physician to get a sense of the person’s family history of weight, eating styles etc. and to inquire perhaps about what the patient wants in terms of weight loss and management, and to start from that point, even if it means the physician saying as part of the consultation – “I know you would be personally happy if you ended up at X point, but medically I would still be concerned about you, given what I know about your individual/familial medical history”.
Then I’d like to see this followed up by a recommendation to keep in touch, even if means leaving a message through the office once a month, to let the physican know how the patient feels it’s going, and to note any significant changes at all.
Then, I’d like to see how the “patient refusal” statistic would look.
Thank you for your posts and the opportunity to comment.
Sincerely,
Linda
Thursday, December 2, 2010
Last week I saw an orthopedic surgeon about my knee problems — a rip in the tendon and a displaced knee cap. As expected, he took one look at me, an obese person, and gave the very sage advice, “You need to lose weight”. While I wasn’t terribly impressed with the depth of thought put into that assessment, I do have to say that he immediately followed up by telling me about Dr. Sharma’s Adult Weight Management program here in Edmonton and suggesting I look into it. (Unfortunately, I don’t think he was aware that there is a two-year wait to get into it).
I think this experience indicates two things: 1) yes, it’s still very easy for physicians to settle for a superficial conclusion when diagnosing obese people, but 2) the word is spreading that simply saying “lose weight” before sending a patient off is insufficient. This is perhaps a move in the right direction, although it’s still far from the day where time is spent asking the obese person about other possible contributing factors. As always, thanks to Dr. Sharma for the valuable information he provides to professionals and lay persons.
Thursday, December 2, 2010
To keep this short, I have spent the last three years of my life, semi-retirement, learning about food science and weight loss, and have lost over 100 pounds. I will say the nutrition advise and information provided by Weight Wise was wrong for me. I cannot live hungry.
I stumbled across Maffetone, Gary Taubes, N=1 self testing, Ross, and many others and found how wrong for me the standard nutritional advise was and is. It is all driven by funding and in the US by agri-business. Once I started to look at the mathematics of food from Atwater forward, much became clear. Satiation and Burn rate are important concepts to understand for diet design, which ultimately, is required by each obese person to do for their recovery, in my opinion.
Occasionally your blog has new useful to me information in it. Keep up the fine work.
Thursday, December 2, 2010
The fact that only 2.5% of the doctors contacted agreed to participate is a clear indicator that doctors do not feel confident in their practice around obesity. Something like a survey that a patient could fill out in advance that would screen for the different contributing factors to weight gain might help doctors determine what information or resources would be more useful. Keep distributing your book Dr. Sharma, it would be a good starting point if all the MDs got to read it.
Thursday, December 2, 2010
Now add the dimension of poverty to the problem, and you get poor fat people being told to join Weight Watchers/a gym/the Y/ and take these supplements/protein shakes/meal replacements all of which cost $$$$ that a person struggling to pay the rent can’t afford.
Saturday, December 4, 2010
In a retrospective study published in 2005, by Abid, Galuska, Ford, et all.
The objective was: “Are Healthcare Professionals Advising Obese Patients to Lose Weight?
They examined trends in physician counseling for weight loss during 1994-2000. In 1994, 42.3% of obese persons who had visited their physician during the last 12 months reported that a healthcare professional had given them advice to lose weight. The percentage dropped to 40.3% in 2000. The authors observed declines in receipt of advice for almost all subgroups. Those with the largest significant declines were seen in the youngest and oldest age groups and in those without health insurance. A decline of 6.2% in receipt of advice was also present in those who perceived their health status as poor; however, this decline was not statistically significant.
Personally this is worrisome; maybe there are not enough prevention strategies in susceptible subjects who might develop comorbidities.
Tuesday, December 7, 2010
I used to have a BMI of over 37 and did not receive any weight loss advice from my doctor. This may have been because she knew I had a prior history of eating disorder (which I developed after dieting to lose weight when my BMI reached 37 the first time!). In fact, when I started losing weight she was concerned about whether I was doing it through disordered eating, and was relieved to learn I was doing it through regular visits to an R.D. She is glad to see that my blood pressure is decreasing and has lowered my dose of blood pressure meds. (I am now nearing a BMI of 25, and will hopefully not regain this time.)
I am amazed to learn from your blog that with a BMI of over 35 I would have been qualified for bariatric surgery! It was certainly never mentioned and I always assumed it was for those much heavier than me. I wouldn’t have done it anyway.
I personally wouldn’t have wanted weight loss advice from my doctor. Especially because it is not so much a question of not knowing I needed to eat less, as a question of how to lose weight in a manner that is physically and psychologically healthy. I know that doctors have very little training in nutrition. And in any case I would have been horribly embarrassed if my doctor had told me to lose weight, and might even have switched doctors (or perhaps not, given the doctor shortage).