Doctors are told to “get serious” about obesity

Trigger warning: Discussion of weight loss recommendations and weight loss surgery.

This article on Yahoo! news and this one on MedPage Today had me laughing and crying at the same time. I mean, really, since when have doctors not been telling their patients that they’re fat and need to lose weight?

The medical profession has issued new guidelines for fighting the nation’s obesity epidemic, and they urge physicians to be a lot more aggressive about helping patients drop those extra pounds.

New guidelines? What new guidelines? Telling us about the Nightmare on ELMM Street? I’ve been hearing about that for the last 38 years. Can’t say as it’s helped me get any thinner or any more fit. In fact, it’s done the opposite, I’ve gotten fatter and less fit the older I get and the more I’ve dieted. I think I’m probably not the only one who’s had that experience either.

Doctors should calculate your body mass index, a weight-to-height ratio. And if you need to lose weight, they should come up with a plan and send you for counseling.

You know who needs to go for counseling? These doctors who think eating less and moving more is the magic express train to permanent weight loss. They need to be counseled on how to relate and empathize with their fat patients. They need to be counseled on the fact that there are things fat people can do to improve their health without restricting calories and feeling deprived. They need to be counseled on the fact that fat people can incorporate joyful movement into their lives that improves their physical, mental, and emotional well-being. They need to be counseled that all of this can be done without losing weight, and that making weight loss the priority leaves fat people disappointed and feeling like failures when these prescribed options don’t result in a large amount of weight loss, even when their health does improve.

Doctors are well aware that excess weight can trigger diabetes and lead to heart disease and other health problems. Yet surveys have shown that only about a third of obese patients recall their doctor talking to them about their BMI or counseling them about weight loss.

Excess weight can trigger diabetes and lead to heart disease and other health problems? What about all the thin people who get these same diseases? What leads to these not-fat people getting them, since it can’t be “excess” weight? Could it be that fat people get these diseases for the same reasons as thin people? Genetics, sedentary lifestyle, poor eating habits? Why can’t fat people be given the same treatment as thinner people? Thinner people aren’t told it’s their weight that caused their illnesses. So why should fat people be told that weight is the cause, and that losing weight will “cure” those diseases?

When my doctor told me that I had high blood pressure, he was going strictly by my blood pressure readings during my visits to him in spite of the fact that he had asked me to check my blood pressure at home every day, at different times, for a month, and write those numbers down. I did that and my blood pressure was never high at home. I tried to tell him that I had “white coat hypertension” and blood pressure medication wasn’t going to change that. He prescribed it anyway, I take it, and my blood pressure numbers at office visits are the same now as they were before the BP medication. But now that I’m taking that BP medication, for some odd reason my blood pressure is “good” or “passable,” even though the numbers haven’t changed one fucking bit. Would he have told a thin person the same thing, given the same circumstances (BP in office of 138/84, BP at home in range of 118/70 to 124/74)? Somehow, I don’t think so. Oh, and now that I’m taking that medication, my blood pressure at home runs anywhere from 68/40 (severe hypotension) to 112/60 — a bit low at times, don’t you think?

And when I tell him that, I’m ignored. So yeah, pardon me if I’m just a bit skeptical about the efficacy of these new “guidelines.”

Could it be that doctors don’t talk to most of their “obese” patients about weight loss because most of those patients don’t look like the “headless fatties” that illustrate the obesity epipanic? Could it be that, unless a doctor actually calculates a patient’s BMI, he can’t tell by looking that the patient is clinically “obese”? Could it be that, unless a patient is obviously fat, a doctor just doesn’t realize some of his patients are clinically “obese” and “need to be counseled about weight loss”?

This thing about obesity leading to diabetes and heart disease, along with other health problems, totally ignores the fact that fat people survive all of those diseases better than thinner people. Obesity “paradox” indeed.

The guidelines advise doctors to:

• At least once year, calculate patients’ BMI, measure their waists and tell them if they are overweight or obese.
• Develop a weight-loss plan that includes exercise and moderate calorie-cutting.
• Consider recommending weight-loss surgery for patients with a BMI of 40 or for those with a BMI of 35 who also have two other risk factors for heart disease such as diabetes or high blood pressure.
• Refer overweight and obese patients who are headed for heart problems to weight-loss programs. Specifically, discuss enrolling them in at least 14 face-to-face counseling sessions over six months with a registered dietitian, psychologist or other professional with training in weight management.

Web or phone-based counseling sessions are considered a less effective option.

I really don’t see any of this being any more effective at permanent weight loss than what doctors have been doing all along. Counseling may help some people lose weight, along with the “moderate” calorie cutting (who determines what’s moderate?) and exercise, but is counseling really going to help them maintain that weight loss? Is counseling going to help them ignore the signals their bodies are sending them that they’re hungry, that they need those cut-out calories? And what about all the fat people who don’t “overeat” and have no excess calories to cut? What about all the fat people who get adequate amounts of exercise? Are they going to be told that they still need to cut back on the calories and up their exercise? How is any of that going to be helpful?

Don’t even get me started on doctors who recommend weight loss surgery (WLS). I’ve had a couple of them tell me I need to have my vertical banded gastroplasty (VBG) revised to a Roux en-Y or sleeve gastrectomy since the VBG didn’t make me thinner. My response is that they’ve had their one chance to kill me and didn’t succeed, I’ll be damned if I give them another chance. With the complications I already have from my first WLS, I sure as hell don’t want to add any more complications on top of them. That path leads to suicide, and it’s not a path down which I want to travel.

The good news? By next year, most insurance companies are expected to cover counseling and other obesity treatments, following in the steps of the Medicare program, which began paying for one-on-one help last year.

More than a third of U.S. adults are obese, and that’s been the case since the middle of the last decade. Officials define someone with a BMI of 30 or higher as obese. A 5-foot-9 person would be obese at 203 pounds.

This is the part that I find really sad — the fact that most insurance companies will cover counseling and other “obesity” treatments. When you look at the success rate for diets, with and without counseling, what makes them think this is going to be cost-effective? How many times are they going to be willing to pay for a fat person to lose weight, only to regain what they’ve lost (and maybe more)? How long will it take them to figure out that they might as well flush that money down the toilet and save fat people the pain and heartache of thinking themselves failures at dieting/losing weight? Oh, and that 5′ 9″, 203 lb “obese” person? I can only wish I was so “obese.” At twice that weight and an inch shorter, I’m not just “obese,” I’m super morbidly obese (and I still haven’t gotten my cape for that).

I thought there was a ray of hope in the MedPage Today article when I saw that some doctors disagree with these new guidelines, but it was a false hope:

Not all groups, however, agree with the guidance. Jeffrey Mechanick, MD, of Mount Sinai Icahn School of Medicine in New York, and president of the American Association of Clinical Endocrinologists, said his organization reviewed the guidelines and did not endorse them.

Alan Garber, MD, of Baylor College of Medicine, and a former past-president of AACE, said the guidelines don’t accurately reflect the literature.

“It’s a very narrow slice of a highly pre-specified kind of evidence base, which doesn’t necessarily extrapolate to the whole of the at-risk population and therefore leaves many patients untreated or at residual risk,” Garber said. “To be blunt, it’s inadequate.”

Inadequate? “It’s inadequate” is all he had to say? If it’s so inadequate, then what are his recommendations for improvement? I don’t see any of those, and I’m betting that whatever they are, they sure as hell don’t agree with my recommendations.

What I think would be more effective, from a health perspective, is counseling fat people on how to add joyful movement to their lives, taking into consideration abilities and disabilities. How about counseling fat people on healthy food choices and how to work those into their meal plans, taking into consideration what people can afford, what options are accessible for them, what they like to eat, and how much time they have to actually cook them? How about counseling fat people on how to improve their health without worrying about whether they lose X amount of pounds or not? Seems to me that all of that would work much better to improve health without harming mental and emotional health in the bargain. But that’s just a pipe dream I have, and I don’t think I’ll live long enough to see that kind of thing become common practice within the medical profession.