Everything I have ever learned about nutrition, healthy living or lifestyle changes has come from self-directed learning outside of medicine. Everything I've ever learned about why obesity can be - but not in every case - so toxic to the body, I learned in medical school.
I learned about the solution in one place and the biophysiology of the problem in a completely different place.
This doesn't make any sense. But this is how it is.
When I was a student at the Institute for Integrative Nutrition, we mostly learned about coaching practices and self-care. When I was a medical student, and now also as a resident, my learning sits squarely in the disease model. I felt like the basic premise of my training was: Obesity is a disease and we treat the consequences with pills. Exercise and eating well are awesome but we don't really know how to get people to do that. We realize the problem is much bigger than any one person, but that's how medicine works.
Sound cynical? It is.
Patients need help with weight loss. General practitioners are where people go for help.
In most cases, because GPs aren't trained for this work, people head into the free market and purchase diet plans and weight loss products.
None of which really work - though there is some decent evidence for Weight Watchers in some groups of people - so they get disappointed. And nothing changes. Certainly not our society.
And I do my best because I have a lot of extra training and personal experience. I can handle a lot of this work because I really love it. I have been on both sides of the chair.
So I was interested when I came across this thesis research from Elaine Banerjee at Thomas Jefferson University. She identified - correctly - that in America, poor black women are at the highest risk of obesity. She then took a close look at the interaction between women from this group and their doctors around weight loss.
She specifically looked at the group of women who were able to lose over 5% of their body weight and who were part of a family practice affiliated with the university. She interviewed 20 of these women to figure out what the interaction between their doctors and these women actually looked like.
If your GP isn't doing these five things, all of which were framed as core themes in Banerjee's research, then it may explain why you, or the people in your life who struggle with this issue, aren't getting anywhere:
Framing the problem of obesity in the context of other health problems provided motivation.
Connecting obesity to disease (i.e. high blood pressure) helped make the problem real for the patients. This helps them fully suss out their motivation for change.
Having a discussion around weight management was important.
Often doctors totally ignore the issue of weight. It is a hard subject to bring up - especially with teenagers and kids - because you want desperately to avoid shaming your patients. You want to come across as supportive and sometimes that it so, so hard. So many choose to say nothing until patients are actually quite sick. Patients sometimes want to bring it up on their own time, so then it's important to follow their pace. But not bringing it up at all is not really a plausible option.
Celebrating small successes was helpful.
This is very tricky. In our culture, when someone loses weight, everyone showers them with compliments. This has the effect of equating the person's value with their weight loss, even if this isn't intended. If the weight is regained, as is often the case, people say nothing. Nothing. They are silent and they avoid eye contact. I've gained and lost so much weight that I can basically predict how people are going to interact with me if they've not seen me for sometime. This kind of cycle totally screws with your self-esteem. So, as a doctor, my goal is to positively reinforce the weight loss by congratulating the patient on their commitment, their blood pressure and blood sugar and on how they feel in their bodies. The focus must not be on their appearance because their appearance may change. I never want a patient to feel as though they've disappointed me by gaining weight.
An ongoing conversation and relationship was helpful.
Weight management is a life-long effort, and so too should the clinical care experience be between doctor and patient.
Advice is helpful but only to a point.
For patients who don't want to think about their weight, aren't ready to consider change or lack the emotional stability to have a safe, warm and compassionate conversation about weight, it is important to not push the issue. Talking about weight at the wrong time can serve as a setback to patients who aren't interested in change. We call these patients pre-contemplative in the Stages of Change theory. They may or may not be ready at the next visit but that's the journey we are all on.
Counselling people on weight loss feels like a mysterious dance at times, almost as much so as trying to lose weight itself. But people should be able to expect the time of the day from their GPs on this issue.
If you're not getting what you need from your GP, it may be time to just ask and see where it goes.
I am keen to know if anyone has ever had a really positive interaction with their GP around weight loss? What did they do to support you? How did they talk about the journey?