Doctors and Weight Loss

So, what is an overweight or obese person to do before they start a diet?

On the one hand, the public is told repeatedly to see their doctor before starting a diet to lose weight; on the other, they're cautioned that their doctor's advice and treatment might be dangerous.

Last month I tackled the subject of "Medical Weight Management" programs run by doctors and clinics that claim to have proven programs that you can lose weight with only if you are their patient. Many of these programs are counting on the fact that most people trust doctors; thus if a doctor is overseeing the diet, it is somehow better for them and their health.

An article today at WCCO-TV highlights the fact that there is no board certification for doctors wishing to claim expertise in diet and weight loss.

However, special training is not a requirement for the 2,500 doctors now in the field of medical weight loss. There is no residency program or recognized board certification.

The article continues that "experience and training are vital because diet doctors commonly dole out appetite suppressants and other medications that can have serious side effects."

The main criticisms in the article include:

• Doctors in non-practice fields hanging out the shingle to open a diet centered practice
• Doctors doling out appetite suppressants and other medications like candy
• Focus on short-term weight loss rather than diet and lifestyle change for the long-term
• Doctors pushing products, like supplements and nutrition bars, on patients

While these are valid criticisms, the very same I myself wrote about in my previous article, they do not, in my opinion, represent the vast majority of doctors out there who are working with their patients to help them lose weight - general practitioners and family doctors. And, let's not forget those doctors who are "specialized," who work daily with patients who have specific medical issues and are overweight or obese - cardiologists, bariatric surgeons, endocrinologists, OB/GYNs, pediatricians...heck, every last specialty out there has doctors with patients who need to lose weight!

We do need change though.

The medical establishment does not need to specialize - again - "weight loss" or "bariatrics" into a board certified specialty - there already does exist an organization that DOES certify physicians specialized in medical weight management - The American Board of Bariatric Medicine (ASBP), that has a seat in the American Medical Association's (AMA) House of Delegates.

Granted, they are not recognized by the American Board of Medical Specialties - but do we really need this, or do we need all doctors to be educated about dietary approaches for weight loss?

There already exist enough specialties, in addition to those already board certified by the ASBP, where weight loss is a "good fit" - endocrinology is one obvious example, since many who are overweight also have underlying metabolic/hormonal issues causing or contributing to their weight and endocrinologists are specifically trained to manage these metabolic/hormonal complications while working with other specialists a patient may be seeing too, like a cardiologist who may also be treating the same patient for a heart condition.

In my opinion, we don't need another layer of "specialist" in the treatment picture - we already have enough specialties, already have an organizations "board certifying" for bariatric medicine, and even have plenty general practitioners who are highly qualified to help patients lose weight.

What we really need is to have them all educated about all the available evidence-based approaches in their "toolboxes" of options to consider for an individual patient.

There is no "one-size-fits-all" approach that will work for everyone. We know this. Yet, we continue to hammer away at educating physicians and the general public that it is as simple as "eating less and exercising more," reduce fat intake, increase whole grains, eat a varied diet and everything in moderation will work for everyone.

Doctors from all specialities need to know about and understand how the various, scientifically-supported, dietary approaches work, whom they are appropriate for, how to monitor effectiveness and when to try something different. These various approaches include calorie restriction - portion control, low-fat, low-carb, controlled-carb, glycemic index/load, and yes, even vegetarian approaches.

Until we address the fact that no one diet will work for everyone we will not reverse the obesity epidemic anytime soon. It is high time we set aside the "politically correct" dietary dogma and got down to business to address the real issue here - the use of evidence as the foundation to help a patient lose weight, instead of our current "consensus opinion," industry-influenced based recommendations that fail for so many.

A number of organizations are trying to do just that.

The Nutrition & Metabolism Society is hosting a conference in Janaury to explore the evidence we have for carbohydrate restriction; the American Society of Bariatric Physicians includes various treatment approaches within the guidelines, from low-fat diets to low-carb diets; the Weston A. Price Foundation is hosting Wise Traditions this month to present evidence about traditional diets; and the North American Association for the Study of Obesity (NAASO) just wrapped up a conference that presented data from various studies across the spectrum of dietary approaches for weight loss.

What we need now isn't more "specialists," but someone to bring it all together to create a useful clinical practice guideline package for physicians to use!

In the meantime, consumers - the general public - should find a doctor they trust, one who treats them as an individual and considers their medical history and dietary needs and isn't just hawking their own "program" that requires a patient to buy their products to realize success in their weight loss effort.