The inexorable increase in obesity together with the futility of intervening in that epidemic leads to schizophrenia in the practice of medicine. (1)
According to a survey of 1500 health care practitioners, 97% responded that they have a responsibility to counsel their patients about obesity. Despite this belief, studies show that talking and giving advice about obesity just doesn’t happen in doctors’ offices.
The pundits keep saying that evidence-based guidelines and practical resources are available. In 2018, the United States Preventive Services Task Force (USPSTF) reaffirmed its 2003 and 2012 guidance on the effectiveness of, and imperative for, behavioral counseling for obesity.
There is lot of wind about what we “can” or “should” be doing. But it still boils down to admitting to patients that the advice to “just eat less and exercise more,” is unhelpful and that losing even just a few percent of whatever you weigh can bring important benefits and don’t forget about drugs and obesity surgery for those who’s excess weight is complicated by other health risks when they can’t or don’t lose enough weight with counseling alone. However the right advice about drugs and surgery is still a quagmire.
Calls for more training also abound. (2) And it’s not like everybody isn’t paying attention – a Google search for “weight loss” spits out 894 million entries. Finally we need to do some cost effectiveness analysis of this whole issue. (3) We have an axiom in medicine – primum non nocere – first do no harm. Then there’s my corollary to first do no harm and that is first do nothing. Just like in the case of illegal immigration across our southern border, for now until we come up with a new idea, I think we should continue to do what we have already been doing for a long time – nothing.
1. Kahan S, Manson JE. Obesity treatment, beyond the guidelines. JAMA 2019;321:1349-50.
2. Devries S, Willett W, Bonow RO. Nutrition education in medical school, residency training, and practice. JAMA 2019;321:1351-2.
3. Sanders GD, Maciejewski, Basu A. Overview of cost-effectiveness analysis. JAMA 2019;321:1400-1.