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Lord I hope not.
Last week I attended a talk at the Family Medicine Forum in Toronto (the largest Canadian family medicine conference of the year). The talk was entitled,
"Childhood obesity in 2008: A growing challenge for family physicians"and according to the conference program the learning objectives for this talk included,
"1. to increase awareness of the importance of childhood obesity,To help frame their talk the speakers used a hypothetical case of a 16 year old, obese, socially withdrawn, depressed female and then highlighted what they thought treatment should include.
2. to improve participants’ clinical skills towards children and adolescents,
3. to introduce a multimodal, integrative treatment strategy including practical instruction on exercise, nutrition, family
recruitment, medications, and more invasive options, and
4. to work to improve advocacy and prevention strategies at the patient as well as community levels."
Want to know their proposed treatment plan?
What was not included? Any strategy to reduce hunger (ie. eating every 2-3 hours, including protein with every meal and snack, having sufficient numbers of calories per meal and snack, improving the quality of her carbohydrates by switching to whole grain versions, fueling properly for her hour of exercise etc), any discussion regarding calories and tracking food with a food diary (despite the recent study showing those who keep them lose twice as much as those who don't), any discussion regarding her depression (important given that an active depression is a contraindication to initiating an effort of intentional weight loss).
Basically they took this socially withdrawn, depressed obese teen and told her that all the things she actually enjoys doing in her life she can't do, that she's got to go from not enjoying exercise to plodding through an hour of it a day (without ascertaining whether or not she's got time), that she's simply going to have to learn to eat less calories than before without any adjustments to how she uses food to minimize hunger and that she's now no longer able to access the only social venue she's got where she doesn't have to be the obese girl (the anonymous internet). There was also no mention of family counselling to determine family habits and lifestyles, no mention of exploring her social history to look for things like physical or sexual abuse, no mention of teaching her how to read a nutrition facts panel, etc.
This girl needs guidance, not guilt. There was no mention of treating her like a living, breathing, complicated human being and instead the message being given to her was the classic and useless - eat less and exercise more.
Perhaps the only thing worse than the messages these physicians were providing was the room full of family doctors nodding their heads in agreement.
If this is the future of childhood obesity treatment in Canada we're all in big trouble.
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Bravo Yoni! You have brought up very valid points!
ReplyDeleteThank you. Wise compassion is needed, and I so appreciate your voice!
ReplyDeleteWhy did their plan not include a referral to a Registered Dietitian who is a qualified health professional to address the food / nutrition issues you outlined in your post? Family physicians have virtually no training in the art and science of nutrition and meal planning - why do they pretend to be qualified instead of simply referring to someone who IS qualified?
ReplyDeleteThat is a shortsighted plan of action that I can only see leading to more problems. Redesigning consumption patterns requires a whole family approach and should never be focused on the child only.
ReplyDeleteI agree with JT, this teen would benefit from the skills of a multidisciplinary health team. One who included qualified professionals who could properly address all of the determinants of this teens health (nutrition education, depression, exercise). Most overweight individuals know eating less and exercising more will achieve weight loss, if this "advice" was the missing key obesity would not be the epidemic it is today.
ReplyDeleteWow, how disconnected are these physicians from the community of obesity practitioners/researchers?! They need to be re-educated!!
ReplyDeleteFantastic overview on what's wrong with docs and their treatment of obese children. I have an obese stepdaughter and it's so hard for me to try to advocate for her when she doesn't live with us. Only 1 doc (and she's sick all the time with colds, etc) has said anything about her weight or had the guts to do something about it. Unfortunately her family didn't follow thru and she's pounds and pounds heavier than before. It's so frustrating. The whole family needs to treat this like the crisis it is. She's 9 now and I'm scared to death to what her teenage years are going to be if we don't get this squared away now.
ReplyDeleteInteresting that those doctors came up with that plan ... see study synopsis below from the Robert Wood Johnson Foundation:
ReplyDeleteStudy Calls on Parents to Promote Healthy Habits, Not Diets, Among Overweight Teens
Jun 5, 2008
A study in the June issue of Pediatrics suggests that parents should emphasize healthy eating and fitness habits, instead of dieting, to help their children who are overweight, Reuters reports. To evaluate the impact of parental behaviors on overweight teens, researchers at the University of Minnesota analyzed data from 170 pairs of adolescents and their parents who participated in Project Eating Among Teens in 1999 and 2004. Researchers found that parents who correctly saw their child as overweight were similar to and different from those parents who inaccurately saw their child as not overweight. The parents with correct perceptions were no more likely to engage in healthy family behaviors such as eating family dinners; limiting soft drinks, unhealthy snacks and television; and encouraging children to make healthy food choices and exercise. However, they were more likely to encourage dieting‚guidance associated with poorer weight outcomes for teenagers across five years, particularly among girls. Teenagers who were encouraged to diet were three times as likely to still be overweight five years later. The study's lead author, Dr. Dianne Neumark-Sztainer of the University of Minnesota, Minneapolis, cites previous research suggesting that children who diet are more likely to binge-eat, skip breakfast and turn to less-healthy weight control strategies. In addition, she suggests that anti-obesity strategies should support parents in making their home environment "more conducive to healthier weight management" (Harding, Reuters/Yahoo! News, 6/4/08; Neumark-Sztainer et al., Pediatrics, June 2008 [subscription required]).
RWJF source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=7957&c=EMC-ND138
I love this blog.
ReplyDeleteBeing a formerly obese teen...that "treatment" plan would have been the opposite of productive for me. Thank you for your voice of reason, compassion and understanding. Wow...I can't believe that health professionals really think that way.
ReplyDeleteThat sounds terrible! What evidence did they present to backup this plan? Was there a Q&A session so that you could say something?
ReplyDeleteTo be honest Vincci I'm sad to say I was too angry at what was being said to trust myself with the microphone. I think had I grabbed it I might have come off as just some raving loony and consequently diluted my message. I chose instead to blog about it and next year will offer my own version of the talk if they'll have me.
ReplyDeleteI have heard all of their advice ad nauseum all my life. If it were really that easy I wouldn't be obese today. There have got to be efforts made to deal with the psychosocial aspects of obesity to come close to getting it under control. For those of us who "eat our feelings" it just isn't enough to take away the things that comfort us without providing healthy alternatives.
ReplyDeleteThank you for standing up for those of us who struggle constantly with this.
Great post.
ReplyDeleteProbably my favorite post of yours ever.
If you could teach this to pediatricians and family practice docs everywhere, that would do a world of good. Recognizing the depression, investigating family dynamics, teaching how to eat to avoid hunger and fuel exercise -- responding as a human being not only following a protocol -- these would all go such a long way.
I don't always agree with what you say, but you hit a homerun on this post. Have you considered following up with the presenter? Sometimes these talks are presented many time over, and it would be great to offer up your viewpoint before the presenter gets a chance and his/her next audience.
ReplyDeleteI highly agree with your statement ,protein with every meal , active daily with a proper balanced caloric diet and obviously one of the biggest mis- conceptions is the people supplying these foods , ( the parents ) , no lucky charms for breakfast , eggs and veggies would be a better choice, after all , you are what you eat !
ReplyDeleteI am a family practitioner who is obese and has been obese all my life. I am currently planning a talk on treating family obesity and that's how I came across your blog. Actually I can see the validity in both points of view. As a patient I was always told that I should lose weight, but never really given any actually help. Over the last 9 months I have lost about 50lbs because I finally became motivated to try to work on my weight regardless of what was going on around me or what stressors came my way. I try to take time to counsel my overweight/obese patients, but it only helps when they are at a point where they see their weight as a problem that they ware willing to face long term. Most times patients want a miracle pill or special 30-day diet and do not really want to change habits that the have had for years.
ReplyDeleteAn additional problem is that obesity treatment takes time to discern the problem and what the pt has tried in the past and what options are available-all in an environment where insurance companies do not want to reimburse for Obesity visits.
I have found that as an obese physician who has had some success in losing weight I have been a sensitive ear for my patients and a good motivator. I do not pretend to be perfect, but sometimes it especially angers me when I se obese children (like the 54lb 2-year old-totally different subject). Usually I don't respond to bogs, but I just felt compelled to add my 2 cents to this one.
Plus Sized MD
Jeez! Why not just lock her in a cell with gruel and water? That's the worst advice I've ever seen. No wonder things just keep getting worse, the harder they try.
ReplyDelete