Advice
People like giving advice. People like helping others solve their problems. It’s human nature. We do this to some degree when it comes to all medical problems. We get diagnosed with pneumonia and the people around us give us their advice. Things like; “when my mom had pneumonia last year, her doctor gave her xyz antibiotic and it worked”, “my doctor gave me an inhaler last time I got bronchitis – you should ask about one of those”. Sometimes there is even someone with off-the-wall advice like, “eating chocolate donuts will help you heal up faster”.
We listen to these well-intentioned pearls of wisdom and we may google the diagnosis out of curiosity, but most of the time, the way we treat our disease is by meeting with our doctor and making a treatment plan – based on our individual presentation. However, when it comes to treating the disease of obesity, most of us have a very different approach. We rarely talk to our doctor about treatment. Instead, we comb through social media posts and blogs. We talk to our friends and family members – looking for the perfect advice.
We want good advice. We crave it. And nowadays, it seems like everyone has an opinion to give. People who are currently struggling with obesity have advice. People who have never struggled with excess weight have advice. People have an opinion about how obesity should be treated – whether or not they have actually seen the treatment work. Why do we do this? I believe there are two major reasons that we do this:
First, although the medical community has been saying it for years, most people don’t really believe that obesity is a disease. We have been so thoroughly brainwashed by this idea that weight is simply a balance between calories in and calories out that deep down inside, we view weight as a personal responsibility. Sloth and gluttony. We believe it about ourselves. We believe it about other people. And if we view excess weight as simply being a consequence of a lack of willpower, we aren’t going to ask our doctor about how to treat it.
Second (and this makes me sad), most doctors don’t have know how to successfully treat obesity. Hopefully, things in medical education are changing, but when I was in medical school, not a single lecture was devoted to the treatment of excess weight. For the first thirteen years in practice, I rarely brought up weight with my patients. Not because I didn’t think it was important – but because I didn’t know how to help them. I had no good scientific advice to give. And since I was also struggling with weight, it seemed hypocritical to start lecturing about something that I clearly couldn’t conquer either. And this is common among doctors – we typically don’t bring up weight with patients unless their BMI exceeds ours. We don’t want to be labeled as hypocrites. Back in the day, when patients bravely asked me for my advice, I would suggest something like Weight Watchers or a gym membership – essentially perpetuating the calories-in, calories-out hypothesis. Although patients would love to have sound medical advice about how to treat their excess weight, the reality is that most doctors today don’t know what to do – so we focus on the things we can treat – the health complications that often accompany obesity.
The science of weight management is pretty new. It took the medical community far too long to look beyond the calorie balance hypothesis and actually dive into the biochemistry and physiology of weight regulation. Thankfully, some amazingly talented researchers have been hard at work and a lot of data has been published over the past fifteen years. Data shows that obesity is a result of a lot of complex processes. These studies are slowly making their way into the day-to-day world of medicine. The information is gradually trickling into conversations on social media.
Years ago, when I first became aware of the field of Obesity Medicine, I was intrigued. Not only because I wanted to have something real to offer my patients, but also because I needed help myself. The fact that I was constantly battling weight bothered me more than I wanted to admit to other people. I have always considered myself a disciplined person and my inability to control this aspect of my life really contradicted my view of myself and made me uncomfortable.
I dove into the world of Obesity Medicine, finding an entire field full of people dedicated to combating excess weight. I attended conferences and webinars. The books and journal articles piled up on my desk. I relearned some of the basic biochemistry that I had thrown out of my brain after medical school. I eventually became board-certified in the field and have continued seeking out information. It took a while to translate the book knowledge into practical ways to help patients with their weight. In the process, I found the best way to treat my excess weight – although there was a lot of trial and error involved in the process.
My bookcases are now overflowing with journal articles and books as I keep accumulating information. I listen to researchers explaining their data on podcasts while I’m driving my kids to and from hockey practice. I spent last Saturday morning painting trim in my kitchen while listening to and participating in a four-hour webinar conference about food addiction. My kids have officially labeled me a nerd. I continue to go to Obesity Medicine conferences each year. It’s inspiring to be around other physicians like myself – who are part of this rapidly-growing field of medicine. There are now over 3300 physicians in the US and Canada who are board-certified by the American Board of Obesity Medicine. We are working hard to change the dialogue about excess weight. With the scientific evidence that obesity is a complex, multifactorial disease, we are trying to move obesity treatment into the doctor’s office – where evidence-based therapies can be explored. It’s not easy. For many years, patients got the same advice from their doctor that they got from their friends – so it’s no wonder most of us look online for advice rather than making an appointment.
Even those people who are starting to view obesity as a disease have a hard time looking at the treatment as actual medicine. Patients who call my office to schedule an appointment often ask my receptionist what their program will be and how long it will take. She’s learned to respond with something like, “I have no idea. Dr. Younglove will have to take a medical history from you. She will look at your labs. She will assess your dietary habits and preferences and the two of you will come up with a treatment plan together. It will take as long as it takes”. She doesn’t do this to be evasive, but because it’s the truth. If you developed knee pain and decided to call your primary care doctor’s office for an appointment, the receptionist probably wouldn’t be able to tell you what the doctor is going to during your exam, which imaging tests she is going to order and who she is going to refer you to for surgery!
It’s time to re-frame the disease of obesity as well as the treatment. Just like other diseases, there isn’t one program that is going to work for everyone. Some people will respond well to one treatment while others will not. Anti-obesity medications may work for some people and not for others. Some people will be very resistant to treatment and may take longer to figure out than others. That’s OK. That’s the human body. That’s medicine.
If you struggle with obesity, talk to your doctor. Talk to your friends and colleagues who have successfully treated their obesity, but don’t assume that what worked for them will necessarily work for you. It might – but it might not. Because obesity is a complicated disease and the treatment isn’t the same for everyone. Be careful who you take advice from. This is good advice in general but definitely applies to the treatment of obesity. If you were looking for advice about how to invest your money, you certainly wouldn’t take advice from someone who had just declared bankruptcy. You probably wouldn’t take advice from a teenager who had never saved more than $50 at a time either. In a perfect world, you would ask a financial adviser for advice – someone with advanced training in the complexities of money management – someone who could take your unique situation, understand your goals for investing and come up with the best possible solution.
Until then…
be strong – be healthy – be happy
Courtney Younglove, M.D.
