Physicians should no longer recommend weight lose

[Nutria]

Was that all he/she said?

[snip]

But I also counsel them to increase physical activity, stop smoking, drink less caffeine and alcohol, lose weight, and take their medication every day. Sodium is part of the problem but it's not the whole problem.

Yes, because we'd already talked about everything else you mentioned...

[disneysteve]

Yes, because we'd already talked about everything else you mentioned...

Sounds like all good advice.

[creditcardfree]

The more specific and detailed instructions are, the less likely they are to be followed. At least that's the case in my patient population.

Wow! I sure don't want my physician to assume I can't handle detailed instructions. If I asked specifically how to make a change I should be able to get that information from them or be referred to someone who can.

I do understand that you likely know some of your patients well enough to know if they will follow through or not and would, of course, tailor your advice accordingly.

[disneysteve]

Wow! I sure don't want my physician to assume I can't handle detailed instructions. If I asked specifically how to make a change I should be able to get that information from them or be referred to someone who can.

I do understand that you likely know some of your patients well enough to know if they will follow through or not and would, of course, tailor your advice accordingly.

Agreed. You need to understand the patient population that I deal with. My office is in one of the poorest cities in America, very low education level, high levels of illiteracy, a great deal of drug and alcohol abuse as well as untreated mental health conditions, and huge socioeconomic challenges all around. It is also a "food desert" as far as easy access to nutritious foods. We do what we can and that often means taking baby steps and celebrating small victories. If I can get someone to cut back from smoking 2 packs a day to 1-1/2 packs a day, that's a win. If someone goes from drinking a 12-pack a night to a 6-pack, that's a win. If as a result of seeing me, they switch from putting salt on everything they cook to using Mrs. Dash, that's a win.

When I have a motivated patient, by all means I give them all of the information and support that I can, but those patients are few and far between.

[hamchan]

This certainly isn't new, and it's lunacy IMO.

Society has decided that we should ignore people's physical appearance and just love everybody for who they are and encourage them to love themselves as they are rather than making any effort to deal with the outrageous damage they are doing to their bodies every day.

I deal with this every single day in my medical practice. Quite honestly, it is one significant reason that I am leaving family practice next month after 24 years. Not only do patients no longer care about their weight, they get highly offended when I broach the topic. I'm sorry but when you are coming to see me because your knees hurt, your low back hurts, your sleep apnea is keeping you awake, your heartburn is worsening, or you are getting out of breath when you go up the stairs, it's insane to think I'm not going to mention the fact that you are 5-foot-6 and weigh 285 pounds. I guarantee you 100% that if you weighed 150 like you are supposed to, you wouldn't have any of those problems.

But no, it's no longer politically correct to tell people they need to lose weight. What is odd is that one of the "quality metrics" for which I and other doctors are tracked by the insurance companies is calculating and documenting every patient's BMI. What the hell is the point of doing that if we aren't going to do a damn thing to address it?

Sorry, but this is a huge pet peeve of mine.

Steve, the problem is that outside of gastric bypass surgery there is not a proven method of losing a significant amount of weight and keeping it off permanently. Your body doesn't care if you need to lose weight. It thinks you are starving and will employ dozens of hormonal and biological processes to make you want to eat more and move less. This can still be happening up to seven years after the initial weight loss, even if you have already regained the weight. The end result is that the majority of people who lose weight regain more than they lost in the first place, and if you do this a few dozen times over your life you just keep getting bigger.

See this video for just a snippet of the science behind it: https://www.google.com/url?sa=t&sour...ptugYD0h9HiP6g

There are some times where it does work, usually if the weight was gained recently, because in that case your body is wanting to maintain homeostasis and get back to where you were. But the longer you maintain the weight gain the less likely you are to be able to successfully lose it.

There are a handful, statistically speaking, who manage to lose large amounts of weight and keep it off in the long term, but unfortunately they tend to trade one problem for another. My husband is one of them, and his eating and exercise habits are pretty disordered to the point where his doctors are starting to have concerns about it.

[Nutria]

Steve, the problem is that outside of gastric bypass surgery there is not a proven method of losing a significant amount of weight and keeping it off permanently.

You're ignoring the fact that morbidly obese people weren't born morbidly obese. We did it to ourselves.

[~bs]

what about consuming the recommended calorie intake for your sex/age/height and exercising. If your body burns say 200 calories more than it intakes per day, you'll lose weight and keep it off. I don't think crash diets work because it tricks your body into thinking it's starving, afterwards your body then does everything possible to store calories as fat. But eating properly + exercise will do it without the need for a magic pill.

I worked with 2 obese ladies at my old job. they constantly complained about how hard it was to lose weight and diet and such, but every day for lunch they'd consume enormous amounts of food. I'm a relatively young guy, relatively athletic, but there's no ways I could consume as much food in a single meal as they were putting down regularly. They'd be doing a big mac meal, supersized (diet coke of course), and a second big mac on the side. And to top it off, they'd eat something for dessert. This is just an example, but their eating habits for non fast food was equally as bad. I'd have to guess that their meals were maybe 1500-2000 calories, which is obscene. Even 1000 calories per meal is already a lot unless you're extremely active.

[~bs]

Doctors now have to be politically correct and not give obese patients sound medical advise because it may hurt their feelings.

not surprised. The rest of western society follows that model, so why not medicine? Today, obese people are glorified in ads for "plus sized models", criticizing weight (even constructively) is berated as "fat shaming", and they come up with cute words like "curvy" to ensure that overweight people feels good about themselves and is as narcissistic as some of their "less endowed" counterparts.

[hamchan]

You're ignoring the fact that morbidly obese people weren't born morbidly obese. We did it to ourselves.

Did you read the rest of what I wrote? Statistically dieting leads to long term weight gain, not loss. The average female starts their first diet in elementary school, and as a nation we keep getting bigger. There's most definitely a connection.

[hamchan]

what about consuming the recommended calorie intake for your sex/age/height and exercising. If your body burns say 200 calories more than it intakes per day, you'll lose weight and keep it off. I don't think crash diets work because it tricks your body into thinking it's starving, afterwards your body then does everything possible to store calories as fat. But eating properly + exercise will do it without the need for a magic pill.

I worked with 2 obese ladies at my old job. they constantly complained about how hard it was to lose weight and diet and such, but every day for lunch they'd consume enormous amounts of food. I'm a relatively young guy, relatively athletic, but there's no ways I could consume as much food in a single meal as they were putting down regularly. They'd be doing a big mac meal, supersized (diet coke of course), and a second big mac on the side. And to top it off, they'd eat something for dessert. This is just an example, but their eating habits for non fast food was equally as bad. I'd have to guess that their meals were maybe 1500-2000 calories, which is obscene. Even 1000 calories per meal is already a lot unless you're extremely active.

Physiologically speaking, it doesn't matter if you lose weight by crash dieting or a more modest deficit. Once you go a certain amount below your starting weight your body starts fighting tooth and nail to get you to gain it back. Crash diets have been studied as well as moderate reductions in caloric intake plus a modest increase in activity. The results are the same with the vast majority of participants regaining most or all of the weight within a years' time, and a good number winding up heavier.

Gina Kolata who is a science writer for the NYT wrote a book called Rethinking Thin which goes into a lot of depth on the studies that have been done on this. That's not the only book out there, but it's a good start.

[hamchan]

Here's a recent article from the CDC explaining the reasoning behind this recommendation more.

https://www.cdc.gov/pcd/issues/2017/17_0006.htm#

It's so weird to me how rabidly antiscience people get when you tell them long term weight loss is all but impossible and that other measures should be taken to improve health.

For the record, I'm not obese, morbidly or otherwise. I'm a size 6 to 8, vegan, I work out six days a week, and my biometrics are perfect. Would I like to be a size 2? Sure, I guess. It gets you a lot of privilege in society. But I know I wouldn't be able to sustain it if I got there.

[~bs]

Physiologically speaking, it doesn't matter if you lose weight by crash dieting or a more modest deficit. Once you go a certain amount below your starting weight your body starts fighting tooth and nail to get you to gain it back. Crash diets have been studied as well as moderate reductions in caloric intake plus a modest increase in activity. The results are the same with the vast majority of participants regaining most or all of the weight within a years' time, and a good number winding up heavier.

Gina Kolata who is a science writer for the NYT wrote a book called Rethinking Thin which goes into a lot of depth on the studies that have been done on this. That's not the only book out there, but it's a good start.

The perception of the general public is that no one ever succeeds at long-term weight loss. This belief stems from Stunkard and McLaren-Hume's 1959 study of 100 obese individuals, which indicated that, 2 y after treatment, only 2% maintained a weight loss of 9.1 kg (20 lb) or more (1). More recently, a New England Journal of Medicine editorial titled Losing Weight: An Ill-Fated New Year's Resolution (2) echoed the same pessimistic message.

The single best predictor of risk of regain was how long participants had successfully maintained their weight loss (Table 1⇓). Individuals who had kept their weight off for 2 y or more had markedly increased odds of continuing to maintain their weight over the following year. This finding is encouraging because it suggests that, if individuals can succeed at maintaining their weight loss for 2 y, they can reduce their risk of subsequent regain by nearly 50%.

Not surprisingly, those who regained weight reported significant decreases in their physical activity, increases in their percentage of calories from fat, and decreases in their dietary restraint. Thus, a large part of weight regain may be attributable to an inability to maintain healthy eating and exercise behaviors over time. The findings also underscore the importance of maintaining behavior changes in the long-term maintenance of weight loss.

Findings from the registry suggest six key strategies for long-term success at weight loss: 1) engaging in high levels of physical activity; 2) eating a diet that is low in calories and fat; 3) eating breakfast; 4) self-monitoring weight on a regular basis; 5) maintaining a consistent eating pattern; and 6) catching “slips” before they turn into larger regains. Initiating weight loss after a medical event may also help facilitate long-term weight control.

http://ajcn.nutrition.org/content/82/1/222S.long

TLDR version: people regain the weight because they regress to a state of eating too much and exercising too little.

Logically, it makes sense. If you go back to consuming 4k calories a day and getting almost no exercise, of course you'll gain the weight back. The greater issue is more that the person isn't used to maintaining a healthy lifestyle, so has trouble sticking to it for the long term. If you look at my 2 big mac a lunch example, these ladies go on fad diets/exercise every year. They lose weight, then gain it all back once they're back on the no-exercise, 2 big mac a lunch meals. No surprise.

your body isn't a machine, it takes time for your body to adjust to something new. Say you haven't ran in years, but all of a sudden you decide to run 5 miles, you'll send your body into shock after 1 day! Similarly, for someone who doesn't do it, dieting and exercise does the same. Consider if you make it a routine to run regularly. Your body starts to adjust to the new "normal" over the period of a month, 6 months, year, years, and before you know it, your body is more than in condition to do the regular runs. Same process for eating healthy and getting enough physical activity.

[~bs]

Here's a recent article from the CDC explaining the reasoning behind this recommendation more.

https://www.cdc.gov/pcd/issues/2017/17_0006.htm#

It's so weird to me how rabidly antiscience people get when you tell them long term weight loss is all but impossible and that other measures should be taken to improve health.

For the record, I'm not obese, morbidly or otherwise. I'm a size 6 to 8, vegan, I work out six days a week, and my biometrics are perfect. Would I like to be a size 2? Sure, I guess. It gets you a lot of privilege in society. But I know I wouldn't be able to sustain it if I got there.

You are used to eating a healthy diet (I assume) and exercise. Therefore, you are used to maintaining a body size of 6 to 8. An individual currently a size 2 may be comfortable there (possibly not) because their body allows it, they're used to eating and exercising in the proportions to maintain that size. You would have to make significant, permanent lifestyle adjustments to go to size 2 and stay there.

On the flip side, what if you were used to eating extremely unhealthy and not exercising? Of course after you lose interest in your eating healthy and exercising regimen, you'll revert to form and gain all the weight back. This is why I think things like weight loss shouldn't be approached as temporary yearly diets, but as a permanent lifestyle change.

[hamchan]

You are used to eating a healthy diet (I assume) and exercise. Therefore, you are used to maintaining a body size of 6 to 8. An individual currently a size 2 may be comfortable there (possibly not) because their body allows it, they're used to eating and exercising in the proportions to maintain that size. You would have to make significant, permanent lifestyle adjustments to go to size 2 and stay there.

On the flip side, what if you were used to eating extremely unhealthy and not exercising? Of course after you lose interest in your eating healthy and exercising regimen, you'll revert to form and gain all the weight back. This is why I think things like weight loss shouldn't be approached as temporary yearly diets, but as a permanent lifestyle change.

The National Weight Control Registry (which has strong direct ties to the diet and weight loss industry) is a master manipulator of data. You have to lose at least 30 lbs and keep it off for a year in order to join the registryin the first place (they have no requirements that your BMI be under a certain amount either, so you could go from 330 lbs to 300 and still join). So these are people, a very small percentage, who manage to beat the odds, and not regain within a year. Even so, according to NWCR's own data, in a given year they lose over 40% of their participants because they regain some or all of the weight.

There is one thing you said I can agree with, and that is that people regain because they revert to their prior habits. But what you're not understanding is WHY. It's not out of laziness or not caring. It's because biology is forcing their hand. Read this article for a good explanation as to why this happens. https://mobile.nytimes.com/2012/01/0...-fat-trap.html

As for me, my weight stays fairly stable regardless of what I do. The only thing that really changes much is my body fat and lean mass percentage.

[disneysteve]

hamchan, I worked 12 hours today so haven't been online. I haven't had a chance to look at the links you posted so I'm not sure if they address this question.

If, as you say, obesity is all biology based and losing weight is impossible, what explains the dramatic increase in obesity over the past couple of decades? Nothing has changed in our biology to my knowledge. Humans are pretty much the same as they were 20 or 30 years ago. So if it can't be explained by increased calorie intake and decreased physical activity, why are so many people so much heavier today?