Wednesday, May 14, 2014

Docs! Please Stop Telling Patients How Many Pounds They Need to Lose!

I don't think a week goes by without a patient in my office recounting how at their last physical their doctor told them how many pounds they ought to try to lose. Sometimes those MDs will be going by BMI tables and aiming patients at a BMI less than 27. Othertimes those MDs will be pulling those numbers right out of their proverbial butts with random guesses of how much would be "good" or "healthy".

No doubt too, in the majority of cases, the recommendation to lose a particular amount of weight didn't come with any useful advice on how exactly those pounds were supposed to get lost.

So fellow MDs, if you're reading this, if you think weight is having a negative impact on one of your patient's health or quality of life I do think a respectful discussion of the issue is warranted. But before you go down that road you need to know a few things. Firstly you need to know that despite what society teaches, we don't have direct control over our weights. Sure, indirectly behavioural choices can influence weight, and yes, we can likely suffer ourselves down to whatever weight we choose, but suffering doesn't last, and consequently the direct control of losing "x" pounds - that's nonsense - if desire, guilt or shame were sufficient to lead to specific amounts of loss the world would be quite slim. Secondly you need to understand that if you have no useful weight management advice to offer beyond the less than useful, "try to eat less and move more", all you're really doing is undermining your doctor-patient relationship as the likelihood of your patients not wanting to lose if their weights are truly affecting their health or quality of life, is likely close to zero, and yet here you are, their doctor, telling them something they already know, inferring quite clearly that you think that if they just put their minds to it they could make it happen, while simultaneously offering them no actionable help or support whatsoever.

Docs, if you're concerned about one of your patients' weights, make sure you have a realistically actionable plan to help them with. If you yourselves are providing lifestyle advice, please make sure you have personally lived by that advice for at least a two month stretch to ensure it's remotely realistic and to help you to understand what your patients might face as challenges with it. If you don't plan on providing any advice yourself, please explore your community's options and find an organization or an individual that you personally research in regard to their program's safety, efficacy and ethics. And lastly, don't ever target numbers on scales as there's simply no way to ensure your patients will get there, nor is there necessarily any need that they do given that markedly subtotal losses, when combined with lifestyle changes (or even lifestyle changes alone without weight loss), are likely more powerful medically than any drug you have ever prescribed.

Putting this another way, as my friend Dr. Jamie Beckerman is liable to say, the goal must be the journey itself, not the destination.

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