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How should doctors approach the treatment of obesity?

Commented on September 30, 2013
Created September 28, 2013 at 3:45 PM

Listening to a CBC radio show , "White Coat, Black Art", about the complications doctors have in treating the obese.

Two anecdotes stand out: 1. An obese mom had a very difficult C-Section, and 2. Doctors have come up with slang to refer to obese patients within earshot (the Iowa Unit, or IU, which is 200lbs/unit - i.e. "that patient is 2.5 IU's" for 500lbs)

I'm curious how resigned medical professionals are to the issue of obesity? Wondering on the inside perspective from the nurses and doctors who frequent this site and are generally in tune with a low carb/paleo style diet.

Is the lack of consensus on how best to treat the obese a contributing factor to the lack of progress?

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 30, 2013
at 11:52 AM

A doctor can't "enforce" anything. A problem is there's little negative associated with being fat. You can be fat (and sassy) and simply take pills for whatever ails you: BP meds, ED meds, diabetes meds, etc... You can avoid a daily pill regimen by eating well, being physically active, etc... but in terms of time and value, most folks will simply pick the pill. Sad, but true.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 29, 2013
at 09:00 PM

We're going to disagree on the responsibilities of doctors then, education on health is very much their job.

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 07:16 PM

you hit the nail on the head, but how can someone who only interacts with someone for less than %1 of their life enforce such 'suggestions' or 'advice', unless this person is living at the hopital. i think there needs to be a larger cultural shift to give perspective (think cigarettes) then run some kind of AA for the obese, or more structured government type 'rehabilitation' programs.

lecturing someone for 15 minutes is not a treatment, and probably will do little to convince someone to change.(even if they spent that time really laying it on thick/mean)

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 07:09 PM

im not a religious man and i dont believe everyone can or should be saved, while i am empathetic and believe we are our brothers keepers to some degree, there is a point where the cost far outweighs any benefit an individual or a society will receive. assuming a non-religious view i dont see a problem with my perspective. (although i do agree it is not politically correct)

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 07:09 PM

fortunately the addicts vice doesnt allow them to continue their self abuse to the degree of morbidly obese people. people who are so out of touch are beyond pity (IMO) why should we care about them or help them when they are so unwilling to care or help themselves?

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 06:58 PM

should be treated in schools or via some government health call then. its not a doctors job to educate patients, its their job to treat them.

Medium avatar

(238)

on September 29, 2013
at 05:20 PM

Some people are addicted to food, same was a a drug addict or cigarette smoker gets hooked. You obviously have never walked in those shoes so you can't empathize with obese people. It can be a combination of life events coupled with the satiation of eating certain foods like sugar, salt, carbs and other trigger foods.

Some of us have been there and understand, you need show compassion and then maybe you will see the light.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 29, 2013
at 04:00 PM

I don't think doctors need necessarily limited to cutting and pill pushing. Obesity most definitely is a health problem and falls within the medical realm and should be treated by a doctor, largely through education.

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 03:41 PM

its not that they "cant" its that they are not qualified and not required to by their profession. that being said maybe they should be referring patient to psychiatrists more often... for all i know maybe they are. as far as referring them to sources to educate people about diets, im not sure if paleo folks even see that as viable, because a mainstream doctor would almost undoubtedly refer a patient to the food pyramid.

but maybe we are just arguing semantics rather than differences in ideology.

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 03:41 PM

i dont see how medical doctors can treat obesity, almost by definition; unless they are performing a procedure or prescribing a pill. if a doctor concerns himself mostly with education or mental health then he should change his profession to teaching or psychiatry.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 29, 2013
at 03:12 PM

Doctors are very well able to treat obesity, the sad thing is they simple fail. They fail their patients. I think someday you might outgrow the callous attitude towards obese folks. It's definitely a multi-faceted problem that is not all psychological, not all biological, not just a matter of economic forces either. It's all of them working in synergy that has resulted in a obesity "epidemic".

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 02:38 PM

gave most of that documentary a watch, dont really see how it was applicable to the OP, didnt really change any of my views. wasnt even in line with paleo principles.

and i assumed the doctors they are talking about are medical, i dont think psychiatrists are airlifting heavy patients onto their couches. :D .... but i guess you are technically correct.

F291857fa12a0291688ea994343156dc

(720)

on September 29, 2013
at 07:55 AM

@wtfgod If you have access to Netflix take a look at "Fat, Sick & Nearly Dead". After you've seen let me know whether it had an impact on your point of view. A person who is uneducated or extremely unintelligent is very easily manipulated by advertising. Couple those conditions with the fact the humans evolved to minimize enegry expenditures & maximize energy storage. Now, marry that to the easy & cheap availability of sweet, salty, tasty refined carbs and you have the perfect storm that is driving the obesity problem. FWIW psychiatrist is an MD.

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5 Answers

0
2271d683e399f1c43931291d58e927b3

on September 30, 2013
at 01:43 AM

Prevention is the only cure, IMO, and this is the job of society, not the doctor. Obesity is a de facto incurable, lifelong chronic illness for most victims. Once the system's initial settings are screwed up they don't seem to ever reset properly, and require non-stop monitoring thereon.

0
Medium avatar

(154)

on September 29, 2013
at 06:41 PM

I guess the doctors have to keep their original oath in mind "First do no harm" and decide if their action/inaction is leading their patients down the wrong path. I would rather a doctor prescribe explicitly a vegetarian diet to a patient than nothing at all beyond "lose some weight", because at least the patient, coming off of a SAD diet will benefit from the buy-in, regardless of what style of eating. I think a doctor should definitely monitor the patient, and as the results stop improving, then the doctor looks into something else (i.e. add meat, remove soy, etc.)

For the self-directed of us who do their research online, we can do the whole N=1 thing for the most part and find what works, but for those who are very dependent on doctors, any buy-in prescribed by the doctor where people give up sugars and non-foods, and at the very least drastically taper their grain consumption and increase their fat intake, will do wonders for those with a lot of weight to lose. As they get closer to their ideal weight range, they'll realize that what worked before is not as effective without placing additional stress on the body (excess exercise), and that's where a doctor worth his/her weight will step in and do wonders.

0
Medium avatar

(238)

on September 29, 2013
at 05:26 PM

Doctors seem to mostly rely on the guidelines of The AMA or whatever medical group or organizations they are affiliated with. Stepping outside those bounds requires a risk taker who isn't afraid of getting sued or being dinged financially for not sticking to procedures. Going to be hard to find those doctors in conventional medical world. No doctor ever had a real discussion with me regarding weight other than an off the cuff "you should lose some weight" type of comment. I don't blame them as it is mostly on me and had I asked for guidance they might have helped. I really didn't need anybody to tell me how to lose weight, I find it rather simple, the trick was keeping it off. Paleo has been the easiest and most natural method for me to lose and maintain the loss.

0
32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 29, 2013
at 05:25 PM

Not having listened to the episode you mention, it sounds like Peter Attia's TED talk or at least some of the comments/attitudes he initially had when dealing with obese/diabetic patients.

http://www.tedmed.com/speakers/show?id=18028

I think the problem doctors have with treating obesity is that the solution is not surgical or pharmaceutical in nature. It's educational, and many doctors often neglect that aspect of their practice. Doctors read the standard line: 'eat less, move more', but don't have advice beyond that. It's all rather nebulous advice that leaves patients not knowing what really to do. It's terribly generic as well, idiotic doctors telling every overweight woman to 'just eat 1200 calories per day', when 1200 calories per day is well under BMR and probably impossible to attain adequate nutrition on when consuming a processed food diet.

Doctors need to collectively grow a pair and take a hardline with their patients. No coddling. If you're over-fat, you're abusing your body as bad as, if not more than, a drug addict does. A nutrient dense diet with moderate activity levels is, as best, simply not abusing your body, that's the bar doctors need to set as a minimum.

7904c7276d7e48f1be887fabd263bfd9

(300)

on September 29, 2013
at 07:16 PM

you hit the nail on the head, but how can someone who only interacts with someone for less than %1 of their life enforce such 'suggestions' or 'advice', unless this person is living at the hopital. i think there needs to be a larger cultural shift to give perspective (think cigarettes) then run some kind of AA for the obese, or more structured government type 'rehabilitation' programs.

lecturing someone for 15 minutes is not a treatment, and probably will do little to convince someone to change.(even if they spent that time really laying it on thick/mean)

0
7904c7276d7e48f1be887fabd263bfd9

(300)

on September 28, 2013
at 04:15 PM

dont think doctors are equipped to treat obesity, its not a disease its a lifestyle 'disorder'/issue/problem.i imagine the only way doctors can treat obesity is cutting it out or giving you some kind of 'diet' drug or digestive surgery.

this issue is going to need to be addressed at the cultural level. imo the best thing a doctor can do is try to get the patient back to reality by giving them perspective/information.

i side more with the bias against the morbidly obese, unless you have a serious serious medical condition i cant imagine any reason why someone would let themselves get to that kind of weight. imo we shouldnt be equipping hospitals to deal with people the weight of livestock, i have almost no sympathy for extremely overweight individuals.

tl: DR- treating obesity should be done in the psychiatrists office. anyone whos that obese surely has serious physical or mental issues. (protect the doctors!)

F291857fa12a0291688ea994343156dc

(720)

on September 29, 2013
at 07:55 AM

@wtfgod If you have access to Netflix take a look at "Fat, Sick & Nearly Dead". After you've seen let me know whether it had an impact on your point of view. A person who is uneducated or extremely unintelligent is very easily manipulated by advertising. Couple those conditions with the fact the humans evolved to minimize enegry expenditures & maximize energy storage. Now, marry that to the easy & cheap availability of sweet, salty, tasty refined carbs and you have the perfect storm that is driving the obesity problem. FWIW psychiatrist is an MD.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on September 29, 2013
at 03:12 PM

Doctors are very well able to treat obesity, the sad thing is they simple fail. They fail their patients. I think someday you might outgrow the callous attitude towards obese folks. It's definitely a multi-faceted problem that is not all psychological, not all biological, not just a matter of economic forces either. It's all of them working in synergy that has resulted in a obesity "epidemic".

Medium avatar

(238)

on September 29, 2013
at 05:20 PM

Some people are addicted to food, same was a a drug addict or cigarette smoker gets hooked. You obviously have never walked in those shoes so you can't empathize with obese people. It can be a combination of life events coupled with the satiation of eating certain foods like sugar, salt, carbs and other trigger foods.

Some of us have been there and understand, you need show compassion and then maybe you will see the light.

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