When To Recommend Weight Loss For Obesity

Onne of the things I hear frequently when education for T2’s is been provided is the famous statement about their need to lose weight. We all know that losing weight is not as simple as that, and more and more people feel they are failing because they can not lose the weight their doctor recommended. I liked the way this piece explains it, hopefully, more health care professionals use this approach.


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Perhaps I’m missing a point here, but it seems to me that being obese carries some added health risks. And even if an obese person has no health issues, they are at heightened risk for a number of medical problems. Just because a patient comes in with an unrelated health issue doesn’t mean the doctor shouldn’t discuss things like obesity, smoking, etc. And even though making changes is hard, patients should understand the risks. Diabetes is hard too!

Of course medical shaming is inappropriate and doctors shouldn’t try to create a cause and effect when none exists. But waiting until the doctor sees a symptom related to obesity could be too late. It’s a discussion worth having.

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It seems to me that the best time to do weight control is before you get very overweight. I have been about 40 pound overweight for 30 years. One time I posed for a picture with a pregnant woman in my office, belly to belly, and we looked about the same. I decided last year I was going to lose some weight, so I cut out snacks and cut my food intake in half, and lost 20 pounds over six months or so, but I am stuck at my present weight, and it goes up and down like a cork in a rough sea. It is hard to maintain that discipline, and I sympathize with truly obese people who have so much further to go. It seems to me that the solution to overweight is to eat fewer calories than your body uses, and to do some exercise, even walking. My nutrition researcher daughter tells me that there are medical reasons why some people cannot lose weight, and those people in this category who wish to lose weight should seek medical advice, but I remember a radio interview with a doctor who specialized in weight loss. When the interviewer asked what the most basic thing to do to lose weight might be, the doctor replied, “My friend, eat less!”

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The mantra that we get fat because we eat too much and exercise too little has been popular for many years. But some are starting to question it. Dr. Robert Lustig has been saying that a calorie is not a calorie for multiple years now and I find his thinking credible. He cites considerable research showing that what you eat is more important that how much you eat.

For me, weight loss is important no matter how many years you’ve been overweight. I lost about 30 lbs in the last nine months and seem to at least be maintaining that. I’ve been both overweight and diabetic for decades.

But I think we’re getting off track on the original post. @Mila was discussing whether doctors should talk to patients even when the symptoms don’t suggest a connection with overweight. I believe doctors should discuss overweight as a health hazard, even if the symptoms aren’t evident. Many of the increased risks associated with overweight may not be evident until they kill you.