Hey, MDs: LISTEN to the PhDs, please!

In Weight-Loss Maintenance on October 13, 2010 at 1:57 pm

There are many good-hearted doctors who recommend weight loss to their patients even though they know that long-term success is a long shot.  Empirical research says that ninety-seven percent of dieters will fail to maintain their losses for five years, and many will weigh more than before they lost weight.  Lest you think I’m making this up, here are some studies: 

While these studies are a bit old, they remain valid.  They’ve withstood the test of time and prove we’ve known this uncomfortable truth for a while.   

Survey research is a little more forgiving than empirical.  According to a recent study published by scientists at the National Weight Control Registry, 20 percent of maintainers are successful, if you define success as maintaining a 10 percent loss for one year.  That’s success?  I wouldn’t feel successful if I’d gained back all my weight, but waited till day 366 to begin the process.  Nor would I feel successful with a mere 10 percent loss all together.

My favorite Meta analysis of long-range dieting failure is a 2007 study by UCLA. Medicare asked the scientists to conduct an overview of diet research and come back with a recommendation on which programs should be eligible for reimbursement, if prescribed by a medical doctor.  The scientists’ conclusion?  None.  

And yet, doctors still prescribe weight loss thinking, what’s the harm in trying?  The harm is compromised immune function, gallstones and increased risk of coronary death.  There is another danger that is harder to study, and that is medical AWOL caused by shame and depression.  How many patients simply “go missing” from their doctors after losing a lot of weight followed by the humiliating process of regaining it all?  The UCLA study points out that attrition in diet studies is common and high, but not computed in any standard way.  Moreover, attrition is often marginalized to make dieting look more successful long-term. (p. 226)

If diet studies commonly have people go missing, how many doctors are also experiencing this kind of attrition and not recognizing it?  Anecdotal stories are widely available on First, Do No Harm and other size acceptance websites and blogs.  We also know that fat people who haven’t yo-yo dieted avoid doctors and participate in fewer health screenings and visits.  Many people have suggested that this is for fear of judgment and “the weight-loss lecture.”  So, returning to our original question:  what’s the harm?  Even if none of the other health risks were an issue, avoiding doctors, clearly, puts people’s health at risk. 

A doctor should never blithely suggest or prescribe weight loss.  If a patient is asking for help losing weight, the doctor should evaluate whether that patient has in place all the resources necessary to maintain losses.  Both the doctor and the patient need to understand that weight loss is easier than maintenance, which is a permanent part-time job with no vacations and an unfair boss.  Most patients would be better advised to improve their health – eat a wholesome, less toxic diet and exercise frequently – without the expectation of weight loss and the complications of maintenance that will follow.  If the patient insists on dieting, the doctor should make clear that he or she will be supportive regardless of the outcome.  Moreover, if the doctor does not have time to mentor the patient through loss and maintenance, then a careful referral is in order.  While there are bazillions of doctors who will help people lose weight, precious few understand the complexity of maintenance and continue to work with their patients in the years after the weight is lost.  I, personally, know of only one.  Her approach to maintenance is a little different from mine in the particulars, but we agree on its enormous challenge.  She assures me there are a few endocrinologists and other doctors who understand this too. 

If your doctor needs to consider these thoughts, please feel free to forward this link.

  1. Thank you from the bottom of my heart for writing this blog. (I refer to the entire blog, including this post.) As a new RN, I hear more ridicule of fat people, by so-called professionals, than I care to admit even to myself. Diseases such as diabetes are typically viewed as self-inflicted when the person is obese. The ignorance level about dieting for weight loss (and life after weight loss) borders on criminal. I sometimes wonder “How can they not know?” Then I remind myself that professionals are subject to the same cultural myths and pressures as everyone else.

  2. When I consulted my doctor during my last physical about losing weight, his response was “You already know how to do it. You just need to do it again.” (I lost 70 pounds and have maintained a 35 pound loss for about 6 yrs.)

    Uhm…yeah, right. Talk about frustrating and useless advice.

  3. Thank you, RNegade. You cannot know how good it makes me feel to provide support for someone who may be a changemaker in the medical field. There are all too few of you. Still Redheaded gives you additional reason to plug on with your efforts.

  4. Does anyone know how to go in after the fact and underline the links? I just realized that people who are red/green color blind cannot find them. I tried to simply go in under the edit feature and underline them. It didn’t work. Do I need to completely unlink and relink with new underlined copy?

  5. Debra,

    All I can say is WOW, you really rock! I think your blog is a must-read for anyone in the weight-o-sphere (losing, maintaining, HAES, etc.).

    Tomorrow, you’ll be seeing a short post on my blog devoted to you and your blog. I am blown away.

    Thank you so much. I’m hooked.

  6. THANK YOU, New me! I’ll look forward to it.

    For my Red/Green colorblind friends: I cannot get the Underline function on the links to work in the edit feature of this program. I’ve tried several ways. Therefore, I bolded them. There are seventeen, if you’re counting. I will, henceforth, try to bold all my links (I’m a link happy person). If I want to shout or emphasize, I’ll use CAPS or italics.

  7. “They’ve withstood the test of time and prove we’ve known this uncomfortable truth for a while.”

    After perhaps a bit too much consideration of the matter, I’ve come to the conclusion that, after imperialism, what Western “civilization” appears to be best at is emphatic and consistent refusal to acknowledge uncomfortable truths.

  8. @DebraSY: How links look is controlled by your theme’s CSS. For instance, changing the definition for anchor tags to a {text-decoration: underline; } will automatically make all the links underlined. However, with you need to purchase the custom CSS premium feature to be able to edit DePo Masthead’s CSS. I’m a web developer. Feel free to email me, or look me up on Twitter if you’d like some help, gratis, fine-tuning your site’s theme.

  9. Thank you, Leo. That is so generous of you. I’m now making my way through the Sams Teach Yourself WordPress in Ten Minutes (sic — what is it with apostrophes?) book. The chapters, needless to say, take me more than ten minutes each. It is becoming apparent that to do anything to make my blog attractive, I’m going to have to pay. I was really disappointed that on my Size Acceptance Day post I couldn’t have a picture-screen of the weather girls video leading to the link. I think I’m going to have to jump to the next step and get my own domain. I’m hesitating to pay for anything now, as it will only be wasted once I get my own domain. And I’m hesitating to get my own domain because I’m so ignorant about blog basics and think I should learn them first. I will take you up on your offer and contact you.

  10. […] loss, dieting, maintaining, and “backsliding” (regaining lost weight) lately, and this post by Debra SappYarwood clarified a lot of thoughts I’ve had for years (and reinforced them). […]

  11. Actually, Stunkard later acknowledged that his studies were probably not valid, and that more folks actually maintain than his study suggested. Remember that his “test” population was not a cross-section of overweight folks; rather, it was the “last chancers” who had come for “last chance” treatment. (I am probably remembering the exact wording imperfectly, but will go look it up, when I get a chance.)

    • Currently, Stunkard has moved on and is studying Night Eating Syndrome, but NYT reporter Gina Kolata interviewed him for her book, Rethinking Thin, published in 2007. She devotes the better part of chapter 4, “A Voice in the Wilderness,” to him and she quotes him in several other places in the book. I’m pressed for time and can’t quickly find the quote, but as I recall, he doesn’t defend the early study, but he also doesn’t retract the result or call it invalid. It was a small sample size, so the 2% may not be precise. The subjects were people who were given a Doctor’s plan to follow and wanted to lose weight. They were no different from people who show up on the doorstep of Weight Watchers or Jenny Craig every day, where they are given a plan to follow. Actually, since they had tried other things, they may have been MORE motivated to succeed this time around, and more experienced. At any rate, he still maintains that weight loss maintenance is rare, if not 2%. He tries to be optimistic, and there is a weight management program at Penn that has been named for him, but he clearly does not think that weight-loss maintenance is common.

  12. […] the absolutely golden post: Hey MDs, listen to the PhDs please by Just Maintaining. You should read the whole thing – it’s ok, I’ll […]

  13. […] you only read one article on the problems with the weight loss industry, please read “Hey, MDs, Listen to the PhDs please” which includes a rundown on a lot of relevant research and contains the following two gems: […]

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