Study Finds Doctors’ Weight Loss Advice Is Rarely Effective
Studying the studies
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In findings that will likely not surprise anyone who has been on the receiving end of it, a recent study (What advice do general practitioners give to people living with ob*sity to lose weight? A qualitative content analysis of recorded interactions) found that doctor’s weight loss advice is rarely effective
Examples of unhelpful general advice included
· Eat less and do more (which I wrote about in-depth here)
· Look at your diet
· Be careful what you eat
· Follow proper dietary advice
Some more specific advice included:
"I think, yeah, just try and reduce your carbohydrates next," and “reach for a banana instead of a Mars bar” (and I would be all the money in my pockets that the doctor had no knowledge of whether the patient ever ate Mars bars, or was allergic to bananas.) There was also “change your lifestyle a bit" and “make your own bread using gluten-free flour” which is…oddly specific for weight loss advice (as opposed to, for example, celiac disease.)
That’s where the study starts to break down. The study authors understand that this advice is ineffective, but seem to think that there is effective weight loss advice that could be given. They provide no evidence to suggest that any advice would lead to significant long-term weight loss (which is an issue as nearly one hundred years of research shows that it won’t.)
At any rate, I think it’s important to point out that much of this is not the fault of doctors, they get precious little education about food (or movement) and they are trained to make assumptions about fat patients behaviors based on how they look, and misinformed that becoming thin is a something that is achievable for everyone.
While some doctors are certainly operating out of extrinsic weight bias and fatphobia, in my experience most doctors who are doling out this advice either actually believe it is helpful, or know that it isn’t but feel immense pressure to provide “weight loss counseling” and don’t know what else to say.
Doctors can receive less than twenty hours of nutrition education in four years of medical school (compared to, for example, registered dietitians who have 4-5 years of school at a minimum, then a 1,200 hour internship, and a board certification exam), and doctor’s continuing education options are deeply impacted by the ways in which their Continuing Medical Education is heavily influenced by the weight loss industry.
Doctors are set up to fail here, which is unfair to them and, worse, dangerous to their patients’ lives and quality of life.
There is an easy solution. Doctors should just get out of the weight loss advice business altogether.
This can be accomplished by moving to a weight-neutral paradigm. When we stop considering body size manipulation to be a healthcare intervention, then doctors will not feel obligated to provide weight loss/nutrition/movement advice that is completely out of their area of expertise and almost always doomed to fail. Removing a focus on patients’ weight from doctors’ plates could clear space for them to be able to focus on the actual health of their patients.
This could help doctor-patient interactions in a number of ways. It would end the delays in care that happen because fat people avoid going to the doctor because they fear they will just get body shaming and a “prescription” to lose weight. It would end the delays in care that happen when fat patients are body shamed and sent away with a “prescription” to lose weight. It would help end practitioner weight distraction, during which they become so fixated on the patient’s size and their desire to manipulate it that they fail to listen to or treat the patient for their presenting complaint(s). It would increase trust of other practitioner recommendations among patients who are aware that their doctor’s weight loss advice is neither evidence-based nor effective. It would remove the pressure for doctors to give weight loss advice that is not evidence-based and would allow doctors the opportunity to refer to practitioners for whom food and movement are areas of expertise.
Asking doctors to dole out weight loss advice is unfair to doctors and harmful to patients, let’s move on from this failed paradigm and into a paradigm that focuses on health instead of body size.
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
"Reach for a banana" -- Of course, if you are diabetic and limiting carbohydrates, a banana is a VERY poor snack choice. A snack for a diabetic should be about 15 g of carbohydrates, and an average-sized banana has 27 grams. A Mars Bar, in contrast, has . . . 27 grams!!! So in fact, reach for a Mars Bar OR a banana -- in terms of carbohydrate intake, it makes no difference.
I had the pleasure of this nonsense recently, when a doctor phoned me, told me she didn't know why she was phoning but she had a note to do so, then asked what my weight was, and proceeded, out of nowhere to tell me to eat only plain brown bread, lettuce, and grilled chicken or salmon as a treat.