I’m starting to see this trend of podcasts and articles that seem to be raising the white flag against childhood obesity. We should all agree with physicians that these conversations should be approached carefully and thoughtfully. We should agree that there are clear reasons to promote regular exercise and a healthy diet. We should agree with the clear health benefits of maintaining a healthy weight. There are clear mental health benefits as well. I didn’t think I would see a day where these points would be debated.
Suddenly I see an argument that we should “give in to what we want,” which sends the message that any diet and, therefore, weight is acceptable. There’s concern about the risk of long-term disordered eating and mental health issues even for those who succeed with weight loss. Recently, a guest on the Michael Smerconish podcast went as far as to say doctors are to blame for poor outcomes in obese patients because we treat them differently and poorly. After all, we make assumptions based on their body habitus.
What about the stigma that doctors don’t have their best interests in mind? That’s a battle we fight daily; we don’t care, lack empathy, and want to make money. Those who try to help our pediatric patients lose weight are doing it because we want our patients to be healthy. We battle every day to fight the chronic conditions created by obesity, knowing that weight loss isn’t realistic for most patients due to the complications of their conditions, orthopedic issues, and so on. I almost have to ignore their obesity because there are so many other issues to address: So to say I’m focusing on that is outrageous.
I worry this is another example of doctors giving in to what patients want to hear. They don’t want to be told what they can do better. There is not enough personal responsibility in every corner of society. Our job is to honestly – yet thoughtfully – coach patients toward goals that will improve their quality of life. If we’re going to quit helping them eat better and exercise, we might as well quit our profession completely.
Personally, I see both sides to the mental health issues here. As a child, I was overweight and grew up lacking self-esteem. I remember constantly pulling my shirt out so my belly would stick out less. It was impossible to talk to the opposite sex. My entire life made a pivot when I got to college and succeeded academically, but I also lost about 40 pounds. I had confidence I never imagined.
Fast forward to 2020, when the pandemic hit. Like most of us, I had a lot of anxiety to deal with and, surprisingly, extra time as our appointments were canceled to keep everybody home. I started running – a lot. The resulting 50-pound weight loss and the marathons I’ve finished are things to be proud of, but I realized I didn’t know when to quit. Seeing the number come down on the scale was one of the few things in my life I could control, and it gave me a sense of satisfaction in a chaotic world.
Did my dieting in college put me at risk for disordered eating as an adult? Possibly. Did my obesity as a child lead to anxiety and potential depression that has been lurking somewhere ever since? That’s possible too. I actually consider myself lucky that my anxiety manifested in exercise rather than a controlled substance like alcohol, gambling, or even physically harming my family. I came out of the deal healthier than ever, and I have many running medals in my basement.
Most of my anxiety came from all my work to become a doctor being flat-out ignored during the pandemic. When things go right, it’s because somebody without the qualifications has “done their research.” When times are tough, the doctor is mean and doesn’t know what he or she is doing. My anecdotal story above should mean nothing to most people since it’s not a randomized study with thousands of people. Sadly, anecdotes mean more these days than evidence-based medicine. That feeling of inadequacy and helplessness in my profession probably got to me more than anything else.
I’ll have to be mindful of how I react to this new war – or list of excuses – against childhood obesity.
Nathan J. Hemerly is a family physician.
