I had this exact situation this morning with a patient - the conversation was essentially “I think a lot of my problems wouldn’t be as bad (depression, anxiety, hip pain) if I was smaller.”
We talked extensively about the fact that we don’t have any good evidence for a method of weight loss that is more permanent or long lasting than one to maybe two years, and that wanting to be smaller in a society where you are treated better if you are smaller, is a reasonable thing to desire under the circumstances, but that it is not something I can recommend ethically. I then reiterated that she is the boss of her body and whatever decision she makes, I will ultimately support her choice, Including prescribing meds if that’s what she wants, under the circumstances of an extensive discussion of the risks, benefits, and expected outcomes.
Gosh, I so applaud this conversation, Jessica! I'm sure all kinds of emotional residue came up with the patient. Being told that weight loss isn't the magic bullet for all that ails us in a hard pill to swallow (pun intended) but if a physician had ever told me that the cure is not weight-loss, it would have rocked my world! Kudos!
I'm curious, was there a discussion about weight-neutral, healthy habits to address the depression/anxiety, joint pain they're seeking relief from? I'd love to know how you shape the conversation if you did.
She does already have a plan in place with ortho for her hip pain and she’s on meds for depression and anxiety, but she had a low Vitamin D level so we are addressing that, and *after asking* if she gets regular movement and she said no, we discussed ways to add this that are enjoyable and accessible for her. So we’re going to revisit things in 8 weeks when we recheck her vitamin d etc.
Gosh, I've been where she is at. A big driver of my depression was my life-long belief that losing weight would make everything better, and because I couldn't keep weight off, I felt demoralized and broken. It wasn't until I realized that a diet isn't a cure and that weight isn't a curse that I was able to see a balanced way forward. Good luck!
What an extraordinarily powerful piece, Ragen. One thing that I think is worth considering is the " all or nothing" mentality that many patients might bring to their caregivers, as in I'm either on a diet or I'm absolutely out of control and bingeing on ultra-processed, manufactured foods. My research indicates that manufactured foods are a key driver of weight-gain (and not just from the caloric perspective) and create equally dangerous metabolic disruption and hormonal imbalance, i.e, negative health consequences.
For binge eaters like me, our weight-cycling is driven by the extremes of binging and restricting, and it would be helpful if more caregivers understood that any conversation around intentional weight loss can trigger patients in all kinds of ways. Obviously the psychology of binge eating disorder (BED) or any ED is complex, and I wish the healthcare community understood what they are dealing with when they are talking about intentional weight loss, pro or con. It would be great to have a caregiver be able to have a balanced, middle ground conversation about what it means to try to cure emotional distress through having a smaller body.
I had this exact situation this morning with a patient - the conversation was essentially “I think a lot of my problems wouldn’t be as bad (depression, anxiety, hip pain) if I was smaller.”
We talked extensively about the fact that we don’t have any good evidence for a method of weight loss that is more permanent or long lasting than one to maybe two years, and that wanting to be smaller in a society where you are treated better if you are smaller, is a reasonable thing to desire under the circumstances, but that it is not something I can recommend ethically. I then reiterated that she is the boss of her body and whatever decision she makes, I will ultimately support her choice, Including prescribing meds if that’s what she wants, under the circumstances of an extensive discussion of the risks, benefits, and expected outcomes.
It was hard. The whole thing.
Gosh, I so applaud this conversation, Jessica! I'm sure all kinds of emotional residue came up with the patient. Being told that weight loss isn't the magic bullet for all that ails us in a hard pill to swallow (pun intended) but if a physician had ever told me that the cure is not weight-loss, it would have rocked my world! Kudos!
I'm curious, was there a discussion about weight-neutral, healthy habits to address the depression/anxiety, joint pain they're seeking relief from? I'd love to know how you shape the conversation if you did.
She does already have a plan in place with ortho for her hip pain and she’s on meds for depression and anxiety, but she had a low Vitamin D level so we are addressing that, and *after asking* if she gets regular movement and she said no, we discussed ways to add this that are enjoyable and accessible for her. So we’re going to revisit things in 8 weeks when we recheck her vitamin d etc.
Gosh, I've been where she is at. A big driver of my depression was my life-long belief that losing weight would make everything better, and because I couldn't keep weight off, I felt demoralized and broken. It wasn't until I realized that a diet isn't a cure and that weight isn't a curse that I was able to see a balanced way forward. Good luck!
Where is your practice located?
Manitowoc WI - half an hour south of Green Bay on Lake Michigan, and an hour drive east of where I live in Appleton
What an extraordinarily powerful piece, Ragen. One thing that I think is worth considering is the " all or nothing" mentality that many patients might bring to their caregivers, as in I'm either on a diet or I'm absolutely out of control and bingeing on ultra-processed, manufactured foods. My research indicates that manufactured foods are a key driver of weight-gain (and not just from the caloric perspective) and create equally dangerous metabolic disruption and hormonal imbalance, i.e, negative health consequences.
For binge eaters like me, our weight-cycling is driven by the extremes of binging and restricting, and it would be helpful if more caregivers understood that any conversation around intentional weight loss can trigger patients in all kinds of ways. Obviously the psychology of binge eating disorder (BED) or any ED is complex, and I wish the healthcare community understood what they are dealing with when they are talking about intentional weight loss, pro or con. It would be great to have a caregiver be able to have a balanced, middle ground conversation about what it means to try to cure emotional distress through having a smaller body.
The New York Times had an article this morning that goes along with this question exactly: Can Dieting Actually Lead to Long-Term Weight Loss?
Thanks for your response as always