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Treatment Hurdles: Obesity as a Chronic Disease



Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

TREATMENT HURDLES

Before recommending weight management programs or strategies, it is important to identify and deal with barriers that may make weight loss more difficult for particular patients, or undermine their efforts at weight-loss maintenance. Pre-emptive management of these barriers can increase the likelihood of long-term success and protect the patient from the emotional and physical consequences of weight cycling.

HURDLE 1: OBESITY IS NOT RECOGNIZED AS A CHRONIC CONDITION

Even among health care professionals, there is a pervasive attitude that obesity is simply a failure of individual willpower rather than a condition that requires chronic treatment. As a result, patients too often fail to accept the need for long-term lifestyle changes, medication and/or surgery, and health care professionals too often fail to recommend them.

Educating both patients and health care workers is essential to increase awareness of the chronicity of obesity as a disease, thereby improving adherence and increasing the recommendation of long-term treatments.

Many people believe that there is in fact a cure for obesity: simply lose the weight. They forget that the more difficult component of weight management is actually keeping the weight off. Patients are usually prepared to go through the first stage and reduce their weight, but they are not prepared to assume the life-long measures needed to maintain that weight loss.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.

7 Comments

  1. “Even among health care professionals, there is a pervasive attitude that obesity is simply a failure of individual willpower rather than a condition that requires chronic treatment.”

    The word people in your profession use with one another is “noncompliant,” I believe. It is so demoralizing and unhelpful for patients. We sense the attitude, even if we do not know the vocabulary to describe it.

    “As a result, patients too often fail to accept the need for long-term lifestyle changes, medication and/or surgery, and health care professionals too often fail to recommend them.”

    No. This is another false assumption. The reason patients don’t accept medication is that obesity meds have a well publicized BAD track record. They frequently don’t work to any significant degree or, worse, are found to be dangerous or fatal and then removed from the market. Even when they work to some feeble degree, as soon as the prescription is withdrawn weight regain will happen, and patients DO understand how demoralizing that process is. They won’t enter into it lightly. Patients aren’t stupid.

    The reason patients don’t accept the need for surgery is similar to drugs. It’s dangerous, possibly fatal, and the results are not guaranteed to be long-lasting. Moreover, many patients KNOW that the long-term “lifestyle changes” that accompany surgery are onerous.

    The reason patients don’t accept the need for “long-term lifestyle changes” sans surgery is because those changes are never presented honestly, and there is no support in place to sustain those changes. They are assumed. Many patients lose weight short term because “healthy lifestyle” is presented as such a zippy and delightful thing to do. (And, during a short honeymoon period, it is.) In reality, living healthfully is work (though not entirely joyless), and it is damned hard work for those maintaining a weight loss. Maintaining a weight loss, in fact, is tricky in addition to being hard (to the point of feeling unfair) and can strip the joy from the work of maintaining health. If doctors simply acknowledged this, they might start becoming more helpful. When a weight slide happens, and a patient is encouraged, tersely, to just return to the agreed upon lifestyle changes and work harder (indicating the doctor thinks she’s “noncompliant” or, worse, a liar, when that may not be the case), that just worsens matters.

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  2. In response to DebraSY: “The reason patients don’t accept medication is that obesity meds have a well publicized BAD track record. They frequently don’t work to any significant degree or, worse, are found to be dangerous or fatal and then removed from the market. Even when they work to some feeble degree, as soon as the prescription is withdrawn weight regain will happen, and patients DO understand how demoralizing that process is. They won’t enter into it lightly. Patients aren’t stupid.”

    From your comment I get the strong feeling that you are looking for some “magic pill” to take and viola, your excess weight will be gone forever. Plain and simply, there is no “magic pill.”

    As you correctly state later, is darn hard work and it involves a permanent commitment to lifestyle change(s). For example, there are certain things a diabetic must do for the rest of his/her life if he/she wants to have a long life. It’s no different for someone suffering from obesity. Once one understands, embraces, accepts and admits that, it’s really not so bad.

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  3. Precluding what I said above, I do agree wholeheartedly that the average GP is of very little assistance in the battle against obesity. Mine just kept telling me to lose weight, with absolutely no suggestion as to how this might be achieved. I even had a Neurologist at a very prominent Edmonton hospital literally scream at me for five minutes. His opening salvo at the top of his lungs was, “Do you want to die?” Another of his more choice comments was, “I want you to lose weight every day of your life.” That was really inspiring, let me tell you. I’ll never forget this guy and I’ll never forget his name, either.

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  4. Non-compliant, and iatrogenic. Except physicians won’t say the latter, and deny that anything they did could cause obesity. Statins cause pancreatitis and diabetes. They are the most prescribed drug in the world. Check any insurance company’s records. I share information with thousands of statin injured who do not know how they went from athletic to iatrogenic disease, and when they find out, they become ‘non-compliant” with their statin prescribing physician and start looking for us.

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  5. @Jim: Far from being one to look for the “magic pill,” I am a radical weight-loss maintainer. I decline the adjective “inspirational,” however. I won’t go into gory detail here, but if you are interested in my thoughts about what weight loss maintenance entails, feel free to click on my name and you’ll end up at my blog. The “About” entry will link you to a Readers’ Digest Condensed Summary. Oh, and don’t ever accuse me of saying maintenance “involves a permanent commitment to lifestyle change(s).” That’s not my language. That is the current popular language of the mainstream and women’s media. Whenever I use the word “lifestyle” I put it in quotes, because it’s an understatement, at best. In any event, it’s not an accurate desciptor.

    Am I to understand from your comments that you are a maintainer too? That you are one who “understands, embraces, accepts and admits” that you must do “certain things” since you are someone “suffering from obesity” and you have decided for yourself that those “certain things” are “really not so bad”? (I’m scrambling your words, of course, and I apologize if I misinterpret.) If I have you right, and you are a maintainer, then you would be a particularly valuable participant, if you so chose, at my blog. I would welcome you with open arms. If, however, you’re just parroting what the media have told you, and yet have NOT maintained radical weight loss yourself, then you make my point: it’s not merely “a permanent commitment to lifestyle change(s).” It is something much more complicated. And it is especially too complicated for an everyday GP to address with patients (even a kinder-hearted one than the one you describe) in addition to all the other things he or she must treat.

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