Shifting Beliefs About Obesity
Friday, November 23, 2018
There should not be any misconceptions about how many misconceptions about obesity, its causes, its consequences, and its treatments exist – not just in the general public but also amongst people living with obesity (not to mention health professionals, most of who also have a very limited understanding of this chronic disease).
Thus, as we found in our extensive interviews with patients and providers, published in Clinical Obesity, the importance of providing credible evidence and shifting beliefs about obesity is a key step in any obesity consultation.
Not only is it important for patients to understand the chronic (life-long) nature of obesity but also the limitations of treatments, which in turn is fundamental to managing expectations.
“Frequently, the conversation uncovered areas in patients’understanding of obesity that were misaligned with current medical knowledge. In response, providers assessed and explained drivers of weight gain such as medications, sleepapnea, emotional issues and metabolic processes. Providers coached patients in focusing on functional outcomes instead of weight, adopting realistic expectations for weight loss and maintenance, and choosing sustainable goals. A number of participants shared how lowered weight-loss expectations resulted in both relief but also asense of grief.”
Overall, the goal has to be to shift patients (and providers) away from a primarily weight-focussed approach, to a whole-person approach focussed on health.
“The focus on improving whole-person health was crucial as, in many cases, diet and exercise behaviour wasintimately linked to comorbidities, life events, emotional trauma, workplace stress, finances, relationships or loss of meaningful occupation. In addition, it offered renewed motivation and courage for patients who were discouraged by repeated experiences of weight loss and regain.”
Overall, the better the patient (and provider) understand the complex psycho-social-biology of obesity and the limitations of current obesity therapies, the better we can manage expectations and focus on whole-person health rather than just massaging numbers on the scale.
@DrSharma
Edmonton, AB
Friday, November 23, 2018
Does the ‘difficulty to treat’ show that perhaps you are treating the wrong problem?
Monday, November 26, 2018
Dr. Sharma – Have you developed any patient resources (or do you know of any available)that provide a synopsis re: the factors impacting obesity?
Thanks
Sunday, November 25, 2018
What you are saying is, basically, when treating obesity, don’t focus on obesity.
Did I get that right? Does that seem like a legit medical approach to you?
What if I said, when treating hypertension, don’t focus on the blood pressure. Focus instead on “functional outcomes” (whatever those are). Or, when treating diabetes, forget about glucose levels. Focus on emotional wellbeing and workplace stress instead.
That’s no medical treatment at all.
Tuesday, November 27, 2018
The goal of diabetes and hypertension management is to reduce cardiovascular risk and other complications not just tweaking blood sugars or blood pressure. It is possible to lower blood glucose levels and blood pressure and not reduce cardiovascular risk – this is not good management of either diabetes or hypertension.
Tuesday, November 27, 2018
Good point. But if you are going to focus on general health and longevity while ignoring the weight issue, then don’t call it bariatric medicine.
Again, if the diabetologist does to look at blood glucose at all, but instead focuses on other determinants of health, then he is not treating diabetes. That approach might still improve the patient’s health (compared to doing nothing) but it is not a treatment for diabetes.
I understand there is no truly effective, scalable treatment for obesity. I would rather see doctors fighting to get more research done than publishing feel-good guidelines pretending to treat obesity while ignoring it.
Wednesday, November 28, 2018
Bariatric medicine encompasses the entire medical care of people living with obesity – this may or may not involve weight loss. In this context the medical use of the term “bariatrics” is similar to the use of “geriatrics”, which is the medical care of the elderly – there goal here is not make old patients younger but to improve their overall health. Any health care delivered to someone with obesity falls under bariatric medicine – if you are managing patients living with obesity, you can be practicing bariatric cardiology, bariatric psychiatry or even bariatric orthopedic surgery.