Medical practitioners asking people with obesity to lose weight often offer suggestions that are generic or vague, and sometimes not even supported by science. A report on consultations between obese patients and their doctors revealed that in many instances the advice given by doctors was “abstract or superficial or not very practical”.
The study, by researchers at the Primary Care Health Sciences at the University of Oxford in the United Kingdom, observed that doctors need clear guidelines on how to talk to patients living with obesity about weight loss, in a way that helps patients avoid amplifying stigmatizing stereotypes and provide effective and individualized guidance to lose weight.
As part of their study, researchers examined hundreds of audio recordings of consultations between people with obesity and general practitioners. They found that the advice given by doctors rarely included effective methods for weight loss and in the majority of cases involved telling patients just to eat less and exercise more.
The study pointed to existing shortcomings in medical education where it tends to focus on treating diseases rather than preventing them.For instance, nutrition, despite its importance to overall health, is often not even included in many medical school curriculum. Additionally, physicians very rarely have the time or inclination to advise patients in-depth on behavioral and lifestyle changes.
The researchers reported that superficial advice was common, with suggestions such as a person needing to “change their lifestyle”, but without specifying how or what changes to make. The study reported that only 20 percent of the consultations saw doctors give patients detailed advice on how to carry out weight loss programs.
The researchers found that when doctors did offer specific advice relating to weight loss, it was often not backed by science and was unlikely to result in real weight loss. Advice such as making small changes in behavior and taking the stairs more are not backed by research, the researchers said.
The researcher suggested that weight-loss advice needs to be practical and tailored to each individual patient. What works for one may not work for another. For example, you cannot get somebody who is not exercising to go from zero to exercising five times a week. Whereas if you tell them to start with once or twice a week and then gradually increase their pace, it is more likely to work.
Also, when it comes to specific recommendations, it is not about what is ideal, it is about what is practical and what is scientifically proven to be workable. Some physicians may ask the patient to go on a ketogenic diet or to cut out all carbs to lose weight. But there is no evidence to show this works, or that it is consistently applicable for all people. Studies have shown that a lot of carbohydrates are healthy and needed by the body; what needs to be avoided is some of the processed carbohydrates and added sugars.
The study recommends that patients and doctors should find the time to have a detailed conversation on weight loss management in order for it to be effective.
However, doctors report a number of barriers to having a conversation. They include being unsure of the best advice to give and a lack of knowledge about effective weight loss strategies.
Another common myth that the study found when it came to weight loss was that doctors often advised patients to have the ‘right mindset’ to lose weight. But this kind of language is problematic, noted the study. The idea that it is someone’s choice to have obesity or carry all that weight around is part of a biased narrative against obesity and obese individuals.
Obesity, like heart disease or cancer, is a disease and needs to be treated as such. You cannot expect people to just have the right mindset and treat their heart disease or cancer. Equally so we should use science and research and evidence-based treatments for obesity. Also, when it comes to practical advice for losing weight, an individualized approach that considers the circumstances of the person who has obesity, is required.
You do not become obese overnight and you cannot lose all the weight overnight either. Obesity is multifactorial and just following a restrictive diet alone is not very effective. To be successful, you have to identify the factors that contribute to weight gain and help the patient restructure the behaviors to achieve a healthy weight. That ideal scenario should combine nutritional counseling and education with behavior modification and lifestyle change.