Is it the doctor’s fault if an obese patient cannot lose weight?

I need help.  In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient’s BMI.

If a student does poorly on an achievement test, is it the student’s or the teacher’s fault? If the obese patient does not lose weight, is it the doctor’s or the patient’s fault?

Recently in the NEJM, I read about Arena pharmaceutical’s attempt at creating the new “wonder pill” for obesity.  Lorcaserin is a novel serotonin re-uptake inhibitor which acts primarily in the brain centers that control hunger and satiety.  Theoretically, it provides a patient with the good sense not to eat too often, and as the skinny farmer advises, leave the table before you are stuffed.

Although, Locarserin had no major adverse effects, the weight loss was modest, up to 5-10% of body weight.  Thirty pounds is only the prologue for the 300 pound patient.

So, now we may have another pill for fatness.  Like we do for tiredness, and the low sex drive of male middle-agedness.

The study conclusion is worded with scientific precision.  The researchers say, in conjunction with behavioral modification, the drug was effective in weight loss  What people hear, though, and the drug manufacturer are really saying is: take this pill and be thin.

Cynicism is knocking at my door, and I am trying to ignore it.

It is clearly true that obesity is one of the developed world’s most important medical problems.  Paradoxically, while the fury of modern medicine has lowered death rates from heart disease and cancer, the obesity epidemic continues unabated.  The more sophisticated we become as a society, the fatter we get.

As a doctor of the heart, it is crystal clear that lifestyle choices lie at the heart of health. No disease is more preventable by lifestyle choices than heart disease.  And these same lifestyle choices work on obesity as well.  Call it being on “the program.”  Not a diet, the program is a simple concept: finding the groove of enough exercise, wise food choices and adequate rest.

I own only one belt.  It is thick leather.  At times, as I am human, the white-chocolate-chip brownies in the doctor’s lounge get the best of me.  If this behavior persists with any regularity the belt feels tighter.  Thick leather belts do not stretch. The tighter belt says, pedal a little longer and cut smaller pieces of brownie. Doing so restores equilibrium.  But if I deny too much the result is grumpiness. The pattern is repetitive.

This simple formula is the problem.

However, the notion that obesity is simply an imbalance of the equation, calories-in, calories-burned, is not in vogue.  It seems, by saying to the patient, eat less (really, it is sadly amazing how few calories a sedentary middle-aged human needs) and move more, you are at risk of being perceived as judgmental, incurious and even aloof.

If on the other hand you talk about enhanced receptor sensitivities in hunger centers that may be inhibited by sophisticated chemicals, you are smart, and a sensitive doctor.  The obese patient may conclude that poor lifestyle choices are not their fault, rather a chemical imbalance in the brain.  (And maybe this will be proven so.)

I don’t think we should persecute the obese. Malfeasance is bad for the heart.  Nor am I against novel pharmaceuticals or innovative surgery.  But taking a pill or having surgery (that someone else pays for) will always be easier than saying no to white-chocolate-chip brownies.

As we advance in medical technology, the simplicity of making a series of good choices should not be overshadowed by the science of receptor inhibition in the brain.

Surely, doctors should emphasize the program more.

John Mandrola is a cardiologist who blogs at Dr John M.

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  • doc99

    You can lead a horse to water but you can’t make him drink.

    • SmartDoc

      Obesity is an incurable illness.

      Treatable but not curable.

      Do you blame oneself for the malignant cancer patient who dies?

  • http://www.aneurysmsupport.com/ Mike

    There is no easy solution to the problem and, I agree it is a real problem. There is also no one cause for the epidemic of obesity in our society and thus no one solution. As the previous posted pointed out, you can lead a horse to water but you can’t make him drink. That there is a market for a get thin pill illustrates the biggest issue-lack of Self-Discipline.

    As a former overweight person, who paid the price for it with high blood pressure and a ruptured cerebral aneurysm, I know that this was the issue with me. Fast food was convenient and potential health issues never crossed my mind. It took brain surgery to wake me up.

  • http://www.epicclarityreporting.com plin

    Personally I was trained to eat everything on my plate when I was growing up. Throughout the years the amount of food increased with time. As a result my weight started marching up a few pounds a year. Before I know it I have gained quite a bit of weight.

    While obesity is not a curable disease, additional public awareness campaign such as http://www.letsmove.gov can really help. I started watch what I eat after seeing these public awareness campaign.

  • http://www.nourishourselves.blogspot.com Marie

    Well OF COURSE it is not the doctor’s fault when their patient cannot lose weight. But sometimes it is not entirely the patient’s fault either.

    I eat ‘normally’, averaging 1500 to 1800 calories daily. Certainly not a glutton by anyone’s standard. A brownie, white chocolate chip or otherwise, would not be a temptation for me. I don’t snack. I never had a weight problem for the majority of my life.

    But be a very short person. Take a diagnosis of MS and the add the drugs that often go with the symptoms (steroids, Neurontin), compound that with the accompanying immobility, throw in a non-healing, chronically painful fractured shoulder for grins and giggles and you have someone who becomes dangerously overweight – me.

    I don’t need brain surgery to wake me up, Mike. I am wide freaking awake. And absolutely despairing of ever returning to my normal, healthy size. I don’t even like to leave the house, I am so mortified. People who haven’t seen me in a few years do ill-disguised double takes.

    I don’t have an overwhelming appetite, so pills or surgery are not going to help me. I am attempting to keep to 1200 calories or less daily, but without exercise it is glacially slow. I am hanging in there, though, because I want to live as long as I can for my grandchildren. Whose fault is it that I cannot lose weight?

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    The evidence strongly suggests that physicians are “enablers” a obesity and probably a variety fo of there chronic condition as well. According to recent poll data, most people who are obese or overweight, see themselves a smaller than they actually are. In other words they don’t have a weight problem. Add to that the fact that 66% of these people reportedly have never been told by their physician that they have a weight problem. I guess physicians think patient know that they have a problems and don’t need the physician to “pile on.”

    I can’t help but believe that this same phenomenon goes ons with respect to having just a touch of sugar vs diabetes, high BP vs stress, and so on.

    Coincidentally I addressed this very issue in my current blog post at http://www.healthecommunications.wordpress.com.

    Steve Wilkins, MPH

    • nycdoc

      Steve,
      Physicians are more than enablers of obesity. In many situations, they iatrogenically cause obesity. Almost all central nervous system drugs [mood modifiers, antipsychotics, anticonvulsants, antispasmodics] cause very substantial weight gain. So do steroids and many of the antidiabetic medications. Insulin is one of the best anabolic chemicals known.
      So, let’s admit what MD’s are doing that worsens an already near critical situation and stop blaming the patients.

      • Bohdan A Oryshkevich, MD, MPH

        Doctors need not be enablers of obesity.

        Doctors need to be aware of what they prescribe. We spend too much time prescribing.

        I have dealt with inner city half way house patients on CNS agents. Yes, they are obese; yes, they are obese because of CNS agents. But should CNS agents be given out so readily? When I get agitated, I take a walk or swim. It works. I think that many of the patients would be calmer and would take fewer and lower doses of CNS agents if their therapy was more diversified. Different countries vary in their use of CNS agents. They use occupational therapy and activities. We warehouse people in half way houses and they have nothing to do but eat. One halfway house I worked with poured cooking oil into soups to make them more filling.

        We need to diversify our treatment.

        In terms of diabetic patients, we need to provide dosed physical activity to patients as part of care. This activity must be convenient and quantifiable. We could lower the use of a variety of diabetic medicines with exercise.

        There are now so many insulins that the internist has trouble keeping track. Some undoubtedly are worse than others. Why cannot we just stick with regular insulin and take it with meals. Convenience has trumped care here.

        Bohdan A Oryshkevich, MD, MPH

  • Ralph

    Marie it’s no one fault. But the current health system is thinking of tying Dr’s payments to goal results. Imagine if you Dr did not get paid for all the work he does because your wait is above the BMI for you. That is not fair but is a plan in the works. Many Dr’s will
    end up dropping pts who cost them money.

  • http://www.walkmore.us Bohdan A Oryshkevich, MD, MPH

    I worked in a community health center in NYC with all the sidewalks in the world and as the prevalence of obesity continued to rise some five or six years ago I decided to ask every patient on statins, anti-hypertensives, anti-diabetics, etc. and those who were simply overweight or obese, if they knew what their maximum healthy weight was (BMI=25). Virtually none did. So doctors were remiss here since in the vast majority of cases there was no documentation that the patient had been told. I made it then a principle to treat weight as a vital sign and as a casual nonjudgmental, occasionally humorous comment before asking the chief complaint. Simply making men (I am male) aware of their weight made about ten percent or fewer of them become very serious about losing weight. I had no impact on women. One man lost eighty pounds just on that one prompt. Besides giving a five by five by five point outline of a nutrition strategy that I had written up, I did nothing else.

    After this initial visit, I reminded every patient of their proper weight at every visit.

    I also began giving out a Finnish prescription for walking.

    There are three factors here.

    The environment: cheap food and an aphysical lifestyle with no physical activity built into modern existence.

    Patient responsibility: food intake and inactivity;

    Physician responsibility and limitations. The physician has the responsibility to make the patient aware of his weight and the consequences thereof. The physician is not out there to compete with McDonald’s for the attention of the patient. The physician is also not a cook, nutritionist, lifestyle coach, or parent. I would venture to state from personal experience that obesity is one of the elements destroying primary care.

    We need to enable physicians to be able to do more with obesity. Physicians need to be enabled to be able to measure the physical activity of their patients. (Food is too complex to control.) That is the patient should be able to prove to the prescribing doctor that he has walked, run, swam, cycled etc. a certain amount over a day, week, month, year, etc. The technologies for this exist. Supervision of objectively measured physical activity by primary care physicians should be a reimbursable service.

    Every person who is overweight or obese costs the system an extra $500 per year in costs. A primary physician practice of a 1000 patients thus has a $500,000 obesity burden. It would make sense to create a budget ($10,000 to $25,000 per 1000 patients) for every primary care physician towards preventing obesity. In my community health center, it was common to see poor immigrant early diabetics who could not afford walking shoes. Flip flops are not made for walking. A pool of money to enable patients to earn money for walking shoes by actually walking should be in place.

    I am thinking up a variety of strategies to deal with the obesity epidemic and I have developed an information technology tool (not GPS) to measure objectively ambulatory physical activity.

    Given the short time allotted for patient visits, the physician should be able to do a history and a physical without having to address the obesity issue directly. We must find a way that the patient knows that he is obese before the physician enters the room. That preventive money could also go to patient education by a nutritionist or exercise specialist. Given the current practice climate, a mandate to deal with obesity is unfunded and would be counterproductive.

    Obesity is a social problem with serious medical consequences.

    The website is not up yet.

    Bohdan A Oryshkevich, MD MPH
    baotwothree(at)columbia(dot).edu

  • http://shadygrovefarm.wordpress.com Nancy

    Neither Dr nor Patient’s fault, but a culture and commerce that insist food should be cheap and make it higher-status to make a living sitting still: encourage passive entertainment like “commercial” sports as good for the economy: tell everyone they have to get a college education or they’ll wind up digging ditches or serving burgers: subsidize maximum-consumption, zero-production suburban land use through the highway system and the mortgage interest deduction.

  • Annie Stith

    Hey, Dr. Mandrola!

    I’m with Marie. Only I’m not short, the Dx’s can be switched to fibromyalgia, chronic myofascial pain complex, degenerative disk disease, and osteoarthritis, and the “problem” meds switched with those for mood disorders and — ta da! — there I am.

    I disagree with some of the comments. I don’t think it’s “OF COURSE” not the doc’s fault, because mine missed my being hypothyroid, which added to the mix. The docs also assumed right off the bat (WITH attitude) that the OA and bad disks were because of the obesity rather than the other way around (and so blamed me and my “self-discipline” problem for my damaged joints and bad disks).

    I have tried low calorie, lowfat, low simple carb, high fiber, high veggie, low red meat, Mediterranean, big-breakfast-medium-lunch-small-dinner-with-snacks-in-between diets (all at the same time) with as much exercise as I can bear, and had just as much luck with eating whatever I want, when I want. I can lose weight (up to 10#) one month doing nothing “right” and gain as much a different month doing nothing “wrong.”

    How about we stop BLAMING and instead look at each patient as a UNIQUE individuals who may have their own issues around obesity instead of being part of a PERCENTAGE? I know I’d certainly appreciate it. In return, I won’t expect doctors to read my mind about what those issues are. Deal?

    Annie

  • solo dr

    I sent my diabetics and obese patients to dietitians. A1Cs drop by 1 point on avg. I have about a dozen severely uncontrolled diabetics with A1Cs in the double digits. Amazingly when they are on an 1800 calorie diet their average hospital blood sugars are in the low hundreds, with a few hitting FBS in the 60s with insulin and/or med dosing decreased in the hospital. The minute they go home, they start hitting 300-400 blood sugar averages again.

  • jsmith

    Human beings evolved in a calorie-poor environment and now many live in a calorie-rich one. But we still have appetite centers that scream eat when you can. Don’t blame the doc, blame… Well, I’m not really sure who to blame.

  • Amanda

    I have seen a few patients who “only eat” so many calories and yet are still obese. I have talked to a few in more detail, and many,not all, miscalculate their intake. Generally, because they assume portion sizes incorrectly.

    We have been so conditioned to huge portions a “normal” one just doesn’t seem right. The bowl of cereal some think is a portion is actually 1.5 or two so their 1800 calories is actually 2700 or 3600, yet they cannot figure out how the l s keep slipping on.

  • WhatPaleBlueDot

    I was recently diagnosed with PCOS with ir and put on metformin. I lost 7lbs in the first month with minimal reduction in my starch intake (my husband has Celiac, so there’s less starch in my life altogether), and most importantly, increasing the frequency of meals. The problem I’ve always had is that I tend to put on significant weight in short periods of time usually associated with significant stressors. I can literally write a list of the multiple times I’ve put on 20lbs in two weeks and what happened surrounding it. The most recent was an ankle fracture. Is it my doctor’s fault I’m fat? No. But there’s definitely more going on here than being lazy and camping out at McDonalds (neither, actually). Note, I had years and years of hormonal symptoms belied by pristine blood work.

    Of course, when I went to the nutritionist, he told me to eat wheat toast. Thanks for listening.

  • http://paynehertz.blogspot.com Payne Hertz

    HEALTHY weight loss is something that requires preparation, knowledge and a sophisticated understanding of various foods and the effects they have on your body. There is no one size fits all approach that works for everybody, and most people who lose weight and keep it off find that it is a painful matter of trial and error, sometimes taking years, to find out which approach works for you and adjusting that approach on a daily basis to the ever-changing needs of your body. It is an immensely difficult challenge and you are guaranteed to fail often, overdo it often, underdo it often and cause yourself a lot of suffering before you get it right. Simplistic mantras like “eat less, move more” and “calories in, calories out” make it sound easy in theory and in execution, when it most certainly is not. You may have the luxury of ignoring the complexity of the problem, your patients do not.

    Failing to examine the extensive literature on dieting as well as the multiple scientific criticisms of our “low fat, high carb” craze before advancing an opinion on weight loss certainly demonstrates incuriosity at best. To ignore the complexity of the problem and insist that weight loss is really as simple as your mantra suggests, one would have to believe that 67 percent of Americans are too stupid, lazy and indolent to do something as simple as eating less and exercising more, and that’s why they are fat. I don’t see how anyone could describe such an attitude as anything but judgmental.

    What’s more the mantra isn’t even accurate as an oversimplification. You can in fact eat more and move less if you eat the right foods, such as green leafy vegetables that have very little caloric value. It is much easier to follow a diet that allows you to eat more than one that requires you to eat less.

    I don’t believe that doctors are responsible for obesity, but they are responsible for the information they convey to the patient, which is often based on questionable science. Patients don’t need mantras and put-downs to get them to lose weight, they need accurate knowledge, understanding and encouragement. We also need to recognize that the American food supply, heavily laden with high fructose corn syrup and other refined carbohydrates, is the primary cause of our obesity problem and get past the idea promoted in this country that a high carbohydrate diet is healthy. The French eat 3 times more fat and 1/3 as much carbohydrate as us, yet their rate of obesity is 1/6 what ours is, and they have lower rates of heart disease. This is not a “paradox” but evidence that the theory underlying nutrition in the US is wrong. The French don’t “eat less and move more” than us, they just don’t eat a high carb diet like we are encouraged to do.

    “Fat Head” is an excellent documentary revealing just how flimsy much of the evidence underlying our national diet paradigm really is, and how reliance on this broken paradigm feeds the obesity “epidemic.”

    http://www.fathead-movie.com/

    • Anonymous

      The French eat 3 times more fat and 1/3 as much carbohydrate as us

      That would mean more fat calories than the typical American eats total calories, which makes that claim rather doubtful. The typical American diet is high carbohydrate and high fat, and mostly junky carbohydrates and junky fats.

  • William Rose

    Yes, it is the doctor’s fault to the extent MDs pretend to know about nutrition, exercise and, most importantly, behavior change. A team of a behaviorist and a trainer is worth 100 or more MDs. MDs are often enablers by giving people drugs (e.g. Lipitor, etc.) so they are persist in unhealthy behavior with the assurance that they are ok. We are still learning the unheathy effects of many of these drugs. MDs are nothing more than “body mechanics” who try to fix a broken part or system –not the root cause. We could save billions and improve our health by providing incentives to and empowering individuals to take charge of their own lives and health. The medical model for true health never really existed and needs to be abandoned.

  • ralph

    It is no ones fault unless you are being forced to eat. Unfortunatly the way food is available makes it almost impossible to eat small portions. Everything is available in huge portions. I also agree that the system shoul let pt’s see a nutrionist. You can of course but it may cost you more than you want to afford. (remember the insurance company only states they won’t pay for that consult, not that you can’t go). I don’t think there is any answer to weight loss as a general rule, only individual suggestions that most people already know.

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    So if physicians are not responsible for telling patients they have a problem with weight, ie., obesity, do they have a responsibilty for telling patinets they have diabetes, high cholesterol or hypertension (when supported by testing)? What about telling patients about abnormal lab results? Is there an obligation to tell the patient about the 9cm growth in their mediastinum?

    What can patient’s realistically expect from their physician in the way of health care? I think I know the answer and it is really scary!

    I have asked physician this question before on this blog and not one evidently felt comfortable responding. Anyone care to answer?

    Maybe it’s because physicians aren’t paid to respond or don’t have the time. Just kidding.

  • Anonymous

    Should weight or BMI be used as the only measure of progress (or lack thereof) against an individual’s obesity? Seems that some people simultaneously start exercising while cleaning up their diet, but the exercise causes muscle gain which masks the fat loss if they only look at the number on the scale. Then they get frustrated and give up, even though they are actually making real progress (which might be noticed by measuring waistline).

  • Ralph

    I tell all my patients to lose weight & stop smoking. Do many do? No. Is it my fault that they don’t? Absolutely not. How can I make them do something they already know to do.

  • Bohdan A Oryshkevich, MD, MPH

    I strongly feel that the patient must know what his proper weight is and what the consequences are of obesity modified by other risk factors and family history. The doctor in charge should know that it has been done and he should make certain that it is done. I am not certain that it is the direct responsibility of the doctor to inform the patient himself. Perhaps someone else should read the riot act to the patient. How about the insurance company whose executives get paid hundreds of thousands or millions of dollars? There needs to be a good cop bad cop routine. That sounds psychologically sound to me.

    Second, under current circumstances it is very difficult for the doctor to do so. In a fifteen minute or even half hour conversation there is not enough time to do the chief complaint and deal with obesity. Obese and diabetic patients have more complaints. Doctors need the cooperation and attention of the patient. They need to work at the margins. Obesity is chronic and the patient usually comes in for a relatively acute complaint.

    Realistically speaking patients walk away from doctors who tell them that they are obese. I cannot remember a patient who came complaining to me that he wanted to lose weight except for that one patient mentioned above. Eighty percent of doctors at the Mayo Clinic primary care section do not mention obesity to their patients or list it in the chart until the patient has serious complications thereof. And where can patients go in rural Minnesota? The Mayo is the best anywhere.

    Doctors are taught to diagnose, classify, triage, maintain, perhaps educate but not motivate patients. Perhaps, it should be in the curriculum. Someone should do it. In the future it should be part of medicine since more and more morbidity seems lifestyle based.

    Very few doctors want to be primary care physicians because such physicians do not get respect for their work, they do not have the time to connect with patients, they have huge loans, the salaries for primary care is relatively low, and the bureaucracy is atrocious. Primary care doctors get as much hassle per visit as an imaging specialist gets for something that pays ten times as much. Obesity is a primary care concern. Cardiologists like to dissolve clots and arrest arrhythmias.

    In addition it is very tedious to see one patient after another complaining of something relating to obesity and in total denial that it could be related to obesity. It is like playing the same record over and over.

    I reached my limit when a woman came in for bilateral carpal tunnel syndrome (when bilateral usually obesity and diabetes related or other hormonal illness) surgery clearance. She denied that weight was a problem even though she had gestational diabetes in her last five pregnancies and had a clinic wide temper tantrum since I would not give her clearance until she would have a fasting blood sugar and a two hour postprandial sugar. That was some years ago. Do you think that the clinic supported me? Of course not. I made a customer unhappy.

    In addition the track record for weight loss programs in adults are abysmal. Personally speaking for myself and for my fellow internists, I do not want to compete with McDonald’s. I do not have the power to measure the patient’s eating or walking at this time. Doctors like controlled situations. We are not marketers.

    AND I AM a physician who is working on obesity in the context of the whole interaction of the patient with the medical doctor. The doctor, the quarterback, needs a guard or a linesman to deal with obesity. That is one has to restructure the character of the doctor patient encounter. It has to be different, probably not one on one so that the doctor can elicit the history without prejudice. Someone else should deal with weight.

    Yes, this is going to be expensive. If we cannot educate our children to eat properly and to exercise enough, then you will have to pay for the consequences. There used to be an advertisement in the NYC subways: If you think education is expensive, then try ignorance.

    That is where we are. We are failing our children. That is the tragedy of the obesity problem.

    Bohdan A Oryshkevich, MD, MPH

  • J.T. Wenting

    “However, the notion that obesity is simply an imbalance of the equation, calories-in, calories-burned, is not in vogue. It seems, by saying to the patient, eat less (really, it is sadly amazing how few calories a sedentary middle-aged human needs) and move more, you are at risk of being perceived as judgmental, incurious and even aloof.”

    And rightly so!
    You’re glossing over any medical reasons for their weight gain (or failure to loose weight), rather resorting to the old “stop eating, you lazy fatso” line.
    You’re not helping at all, rather making the problem worse by alienating yourself from your patient.
    Maybe they need to eat less, or different. Maybe they could use some more exercise, or different exercise.
    But you never bother to find out, do you? You’ve made up your mind that your patient is a lazy fatso who should just stop eating those hamburgers and start attending the gym for 5 hours a day and he’ll soon be a healthy anorexic.

    Instead, you’ve lost their trust, probably lost them as a patient when you could have helped them had you put in a little real effort.

    Doctors tell me I need to eat less and I’ll soon be thin again without ever even inquiring about what and how much I eat, why should I trust them?
    If they asked, they’d learn I don’t eat excessively at all, in fact I eat less (and less fatty and high carb foods specifically) than many people who aren’t overweight at all.
    But noone ever asks, nor do they offer any real advice that could be useful because they’re so convinced that “eat less” is the magic formula for all weight problems.
    And the eternal “exercise more” is easier said than done when you’re dealing with chronic back injuries and other problems that prevent much of a normal exercise plan.
    I used to swim a lot, but a knee injury put an abrupt stop to that for example. It also prevents me from running any serious distance.
    Glossing over that with a blanket statement to “exercise more” again does more harm than good (a statement made also to my mother, who’s a wheelchair bound diabetic…).

    • Taylor

      Well they tell you to eat less, move more b/c that’s all they have time to tell you and 90% of the time eating less will usually help with weight loss. There is no time to go into what you eat, when you eat, exercise regimen, etc. You seem so hostile, yet you offer no alternative. You can’t exercise and you say you eat a healthy diet, but you’re obese. So now what? Do you eat much sugar? You say you used to swim a lot but a knee injury stopped that. I’m sorry, but swimming is one of the best exercises for joints b/c it is so low impact. What about simply walking a mile every morning? Water aerobics? As far as I can see you’re looking at the situation as black and white as your doctors.

    • Anonymous

      Glossing over that with a blanket statement to “exercise more” again does more harm than good (a statement made also to my mother, who’s a wheelchair bound diabetic…).

      Some of the leanest people I have seen are in wheelchairs. Manual wheelchairs.

  • guest

    Its squarely on the patient. Man up with personal responsibility.

  • Carolyn Smith

    I think every obese person is fully aware of the fact that they are overweight and this makes them socially unacceptable.
    I am fully aware of my own failing in this regard. It is not the MD’s fault that there are so many obese people in the US. However, there are many things (just like Haddon’s Matrix in Public Health Injury Prevention) that impact obesity that are amenable to change that are outside of individual control

    For instance, computers have taken over as sources of work and information and do not require much if any energy. Email is much easier than walking down the hall to share info. People are funneled into escalators and stairs are discouraged due to liability concerns.

    If obesity and health concerns were paramount to our leaders in business and government, there would be dramatic changes. A person would be given 3 months off for weight loss camp instead of an insurer waiting until a BMI has reached crisis stage and then ok’ing a lap band.

  • Bohdan A Oryshkevich, MD, MPH

    According to an OECD report just published, obese individuals die sooner. They thus incur lower health care costs over the span of a lifetime. They also collect less Social Security. The economical losses may be worse. It is the patient and the family that suffers. This may also depend upon the country. In the USA, health care costs may be much higher since we are much more aggressive in our approaches. The results may not be any better.

    If the direct costs to employers were higher, then there would be much higher.
    http://www.oecd.org/health/fitnotfat

  • http://dinosaurmusings.wordpress.com/ #1 Dinosaur

    HEALTHY weight loss is something that requires preparation, knowledge and a sophisticated understanding of various foods and the effects they have on your body.

    Heavens, no. All you need to do is eat less. Simple, even if not easy.

    For what it’s worth, losing 50 lbs myself over the last year seems to have inspired my patients. Sharing the nuts and bolts of how I did it (eating less) has really excited several of them, who are now determined to emulate me. Truly, if I can do it, anyone can.

    • Annie Stith

      Hey, Dinosaur!

      Saying “if I can do it, anyone can” has got to be the oldest (and least productive) guilt trip ever laid on someone who obviously struggles with being overweight. It’s right up there with “push yourself away from the table” or your other classic, “[just] eat less.

      I think it’s great if eating less has worked for you and it inspires some of your patients. I would hazard a guess, tho, that those who’ve spoken up here as having problems losing weight have more complex challenges and need more than the old platitudes.

      Annie