Yoni Freedhoff, a physician who writes the Weighty Matters blog has a great post urging doctors to stop telling patients how much weight to lose. He doesn’t really mind doctors having a “respectful discussion” with patients if they think that weight is having a negative impact on the patient. But, he objects to them pulling a specific number out of the air or from a BMI chart. And, he also objects to them simply telling a patient to lose weight without giving them any realistic plan to help them do it. The best quote from the post:
Secondly you need to understand that if you have no useful weight management advice to offer beyond the less than useful, “try to eat less and move more“, all you’re really doing is undermining your doctor-patient relationship as the likelihood of your patients not wanting to lose if their weights are truly affecting their health or quality of life, is likely close to zero, and yet here you are, their doctor, telling them something they already know, inferring quite clearly that you think that if they just put their minds to it they could make it happen, while simultaneously offering them no actionable help or support whatsoever.
This was such a great point on a lot of different levels. First, most doctors in my experience have little to nothing to offer on weight management advice. Years ago, I remember doctors handing out to me some sort of preprinted diet that was very barebones and generic (I remember one that had cottage cheese on it as a frequent food to eat. I hate cottage cheese so I didn’t get very far with that one). In recent years, they haven’t even done that. But, I haven’t seen them giving any advice that was valuable.
The last part of the quote above is really the heart of the matter. So many doctors act like losing weight is so easy. And, if it is so easy, then the only reason you haven’t done it is either that you don’t know you are overweight (ha!) or you haven’t tried. And, since losing weight is so easy, if you try you will lose weight. So, all the doctor has to do is to tell you to try and then it will magically happen. All of which is of absolute no help to you and gives you no tools to accomplish anything.
I am not saying that every doctor does this. I know that many do not. The orthopedic surgeon I saw last week was good I thought. I mentioned that I had lost 35 pounds and he was appropriately encouraging to me. He didn’t try to tell me how much I needed to still lose and didn’t try to tell me what to do. We did discuss how walking had helped my weight loss and he mentioned that, when I got to normal weight walking, was not the best choice for me for activity given my knee. It was clear, in the context, that he thought that I should continue to work on weight loss, but he didn’t try to tell me how much to lose or how to do it. I felt encouraged by that.
My primary care physician that I had before I moved was good. He once made a comment that losing some weight might be beneficial to me. But, he didn’t try to tell me how much to lose. I felt fine with that. It was clear in context that he thought that any weight loss was good. As he saw me losing weight, he did ask me how I was doing it. When I told him I was going to Weight Watchers, he said he thought it was a good program. He said that my weight loss was “great”, even though I was still in the overweight range. I felt very encouraged by that as well. Had he, instead, started harping on me still needing to lose another 20 pounds I wouldn’t have felt as good about the conversation.
As for whether physicians should mention losing weight at all, I have mixed feelings. As Dr. Freedhoff makes clear, most overweight patients usually know that they are overweight. So, it will not be a newsflash for a doctor to tell them. And, I know that many of us are already trying to lose weight or have made many failed attempts. So the doctor telling us again can be annoying. Whenever I was going to the allergist, for awhile the discharge instructions at every visit, always said to see someone for weight management. Since I was already going to Weight Watchers and was working on losing weight this irritated me, particularly when it was on ther3 every time I went. It just seemed to be a constant jab at me for no good reason. I finally asked that it be taken off. It was getting to a point that I hated going there since I was going to read this every time.
On the other hand, I think there are people who get benefit from a doctor mentioning weight. First, some people may not actually realize that they are overweight or may think they are a little overweight when they are actually obese. This may be a bit of a stereotype, but I think that men are more likely to fit into this category. Second, not everyone has a clear understanding of how overweight may affect a particular health condition. If I hadn’t told the orthopedic surgeon that I had lost 35 pounds and was actively working on getting to normal weight, I think it would have been appropriate for him to tell me how excess weight can put stress on my knees. It is easy if you read a lot of blogs or do a lot of online research to think that everyone knows how overweight can negatively impact aspects of health. But, the world is full of people who don’t do any of that and are not that knowledgeable.
There is also a third group of people. This is the group of people who know they are overweight and know that it can have a negative impact on health, but they haven’t really focused on what that means for them. For those people, if a physician really explains it to the patient, then the explanation can be a wake up call. Of course, there is a right way and a wrong way to do that. The wrong way is to just tell someone to get to X amount of weight and to give them no helpful input on how to do it as Dr. Freedhoff explains. Dr. Freedhoff in his post also explains what doctors should do in giving weight management advice. His post is well worth reading.