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Harping on people to lose weight "sadistic"; little evidence obesity treatment works; benefits of weight loss debatable.
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Sweet Zombie Jesus
May 25, 2012, 12:42:47 PM5/25/12
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Battle of the bulge: Does treating obesity as a disease help?
By Sharon Kirkey, Postmedia News May 22, 2012
"The few patients who manage to lose weight and keep it off achieve
something truly remarkable. From a public health standpoint, however,
the treatment of obesity is a failure," writes Dr. Jana Havrankova, of
Clinique familiale Saint-Lambert in Quebec, in the current edition of
Canadian Family Physician.
Harping on people ad nauseam to lose weight is rather "sadistic",
there's little evidence the treatment of obesity works and even the
benefits of weight loss are debatable.
In arguments like these, being played out in the official journal of
the College of Family Physicians of Canada, doctors are debating
whether it's futile to try to treat obesity.
"The few patients who manage to lose weight and keep it off achieve
something truly remarkable. From a public health standpoint, however,
the treatment of obesity is a failure," writes Dr. Jana Havrankova, of
Clinique familiale Saint-Lambert in Quebec, in the current edition of
Canadian Family Physician.
One weight-loss drug after another has been pulled off the market over
serious harms and the long-term effects of existing treatments remain
controversial, adds associate scientific editor Dr. Roger Ladouceur in
an accompanying editorial.
"Why, then, do we tell our patients to lose weight?" he asks.
"Why do we repeat, 'You should lose weight'? What's with that?
Somewhat sadistic, don't you think? Do we do this as a way of shifting
the guilt and transferring the responsibility of the therapeutic
failure?"
The statements, observers say, reflect a remarkable and possibly
significant shift away from the prevailing medical dogma that everyone
who is obese needs to lose weight.
No one is claiming that obesity is harmless. Havrankova says the
evidence of obesity's health-damaging effects is "irrefutable" and the
costs to society and individuals "astronomical."
Yet, "there is very little evidence that the treatment of obesity
works," Havrankova said. Of the studies done, most are of mediocre
quality and, for the small percentage of patients who succeed, the
weight loss is modest, and gradually regained over time.
"For every individual who wants to lose weight, I maintain hope,"
Havrankova stressed.
But prevention, starting in early childhood, "offers the best hope in
the fight against obesity," she said.
In his editorial — "Should we stop telling obese patients to lose
weight?" — Ladouceur says the genetic, environmental and societal
factors linked to obesity are "deeply rooted" within us. "It is very
difficult for us to change."
Given that, he asks, "Shouldn't we put a stop to this preoccupation
with our patient's weight" and simply encourage healthy lifestyle
habits, including a balanced diet and exercise, "even if it is simply
walking?"
The debate reflects a "clear departure" from the message patients
typically hear, said Dr. Arya Sharma, professor of medicine and chair
in obesity research and management at the University of Alberta, and
scientific director of the Canadian Obesity Network.
"It's moving to a point where we are becoming much more realistic —
simply telling people to lose weight and leaving them pretty much up
to their own resources is not the way to go," he said. "We have to be
much more reflective: For whom is there really likely to be a
benefit?"
Sharma's group says that any discussion about weight must begin with
the doctor first asking the patient's permission. It's one of the
cornerstones of a new roadmap for doctors the network is launching
Tuesday. Called the "5 A's of obesity management" — ask, assess,
advise, agree, assist — the checklist is designed to help doctors and
other health care workers broach the subject in a sensitive and non-
judgmental manner.
Today in Canada, overweight and obesity are the new norm. There are
more overweight Canadians than there are those of "normal" weight.
Currently, 59 per cent of adult Canadians are either overweight or
obese. Unless trends change, by 2026 the proportion will reach 70 per
cent, according to estimates presented in March at a federal-
provincial summit on the issue.
At any given time, 36 per cent of the population is trying to lose
weight.
But, according to a review article published in the same edition of
the journal, people in the "high-normal" or overweight range have the
lowest mortality, or risk of dying.
"In terms of your chances of dying related to your weight, your best
bet is to be slightly overweight," said the study's author, Dr. John
Bosomworth, an honorary lecturer in the department of family medicine
at the University of B.C. in Vancouver and a retired family physician.
People whose weight remains stable at any level throughout adult life
also tend to have a lower risk of dying, he said.
He cautions that most of the studies are observational — meaning
researchers simply followed large populations over time, looking at
who gained weight, lost weight or stayed the same. They don't prove
cause and effect.
But evidence is mounting that a significant proportion of overweight
people are metabolically healthy and that the risks associated with
obesity require a more sophisticated approach.
"We don't seem to have to beat ourselves up about being overweight in
terms of our health unless we have a health-related problem, such as
diabetes or heart disease," Bosomworth said. Among the obese — meaning
those with a body mass index of 30 or more — about 80 per cent have a
weight-related health problem. In those cases, "you have an argument
that perhaps weight loss, if you could ever achieve it, might be a
good thing," Bosomworth said.
"But there's also the argument — why are you aiming for weight loss,
since nobody's succeeding anyway? What's important is physical and
metabolic fitness — and that can happen without weight loss.
"Maybe we should be giving them a pedometer and say, 'Why don't you
increase your number of steps by 2,000 over the next two weeks every
day, bring it back and show me what you've done,' and not worry about
the weight."
In a counter-argument, Dr. Dominique Garrel, of Universite de Montreal
in Quebec, argues that obesity "must be treated" given the
consequences of excess weight. People can improve their health
considerably, he said, by losing even five to 10 per cent of their
weight.
Garrel said surgery "is very popular and increasingly simple and safe"
and suggested patients be referred to specialized teams of
nutritionists, psychologists and kinesiologists.
He acknowledged that the $2,000 to $3,000 cost of such care might
represent an "insurmountable barrier" for some patients.
"If this is the case the patient can be referred to an organization in
the community such as Weight Watchers or Choisir de maigrir."
In her rebuttal, Havrankova asks "where are these teams" and, "most
important, what results do they achieve?"
"If there were 'simple' and effective ways to treat obese patients,"
she said, "we would know it."
ski...@postmedia.com
By Sharon Kirkey, Postmedia News May 22, 2012
"The few patients who manage to lose weight and keep it off achieve
something truly remarkable. From a public health standpoint, however,
the treatment of obesity is a failure," writes Dr. Jana Havrankova, of
Clinique familiale Saint-Lambert in Quebec, in the current edition of
Canadian Family Physician.
Harping on people ad nauseam to lose weight is rather "sadistic",
there's little evidence the treatment of obesity works and even the
benefits of weight loss are debatable.
In arguments like these, being played out in the official journal of
the College of Family Physicians of Canada, doctors are debating
whether it's futile to try to treat obesity.
"The few patients who manage to lose weight and keep it off achieve
something truly remarkable. From a public health standpoint, however,
the treatment of obesity is a failure," writes Dr. Jana Havrankova, of
Clinique familiale Saint-Lambert in Quebec, in the current edition of
Canadian Family Physician.
One weight-loss drug after another has been pulled off the market over
serious harms and the long-term effects of existing treatments remain
controversial, adds associate scientific editor Dr. Roger Ladouceur in
an accompanying editorial.
"Why, then, do we tell our patients to lose weight?" he asks.
"Why do we repeat, 'You should lose weight'? What's with that?
Somewhat sadistic, don't you think? Do we do this as a way of shifting
the guilt and transferring the responsibility of the therapeutic
failure?"
The statements, observers say, reflect a remarkable and possibly
significant shift away from the prevailing medical dogma that everyone
who is obese needs to lose weight.
No one is claiming that obesity is harmless. Havrankova says the
evidence of obesity's health-damaging effects is "irrefutable" and the
costs to society and individuals "astronomical."
Yet, "there is very little evidence that the treatment of obesity
works," Havrankova said. Of the studies done, most are of mediocre
quality and, for the small percentage of patients who succeed, the
weight loss is modest, and gradually regained over time.
"For every individual who wants to lose weight, I maintain hope,"
Havrankova stressed.
But prevention, starting in early childhood, "offers the best hope in
the fight against obesity," she said.
In his editorial — "Should we stop telling obese patients to lose
weight?" — Ladouceur says the genetic, environmental and societal
factors linked to obesity are "deeply rooted" within us. "It is very
difficult for us to change."
Given that, he asks, "Shouldn't we put a stop to this preoccupation
with our patient's weight" and simply encourage healthy lifestyle
habits, including a balanced diet and exercise, "even if it is simply
walking?"
The debate reflects a "clear departure" from the message patients
typically hear, said Dr. Arya Sharma, professor of medicine and chair
in obesity research and management at the University of Alberta, and
scientific director of the Canadian Obesity Network.
"It's moving to a point where we are becoming much more realistic —
simply telling people to lose weight and leaving them pretty much up
to their own resources is not the way to go," he said. "We have to be
much more reflective: For whom is there really likely to be a
benefit?"
Sharma's group says that any discussion about weight must begin with
the doctor first asking the patient's permission. It's one of the
cornerstones of a new roadmap for doctors the network is launching
Tuesday. Called the "5 A's of obesity management" — ask, assess,
advise, agree, assist — the checklist is designed to help doctors and
other health care workers broach the subject in a sensitive and non-
judgmental manner.
Today in Canada, overweight and obesity are the new norm. There are
more overweight Canadians than there are those of "normal" weight.
Currently, 59 per cent of adult Canadians are either overweight or
obese. Unless trends change, by 2026 the proportion will reach 70 per
cent, according to estimates presented in March at a federal-
provincial summit on the issue.
At any given time, 36 per cent of the population is trying to lose
weight.
But, according to a review article published in the same edition of
the journal, people in the "high-normal" or overweight range have the
lowest mortality, or risk of dying.
"In terms of your chances of dying related to your weight, your best
bet is to be slightly overweight," said the study's author, Dr. John
Bosomworth, an honorary lecturer in the department of family medicine
at the University of B.C. in Vancouver and a retired family physician.
People whose weight remains stable at any level throughout adult life
also tend to have a lower risk of dying, he said.
He cautions that most of the studies are observational — meaning
researchers simply followed large populations over time, looking at
who gained weight, lost weight or stayed the same. They don't prove
cause and effect.
But evidence is mounting that a significant proportion of overweight
people are metabolically healthy and that the risks associated with
obesity require a more sophisticated approach.
"We don't seem to have to beat ourselves up about being overweight in
terms of our health unless we have a health-related problem, such as
diabetes or heart disease," Bosomworth said. Among the obese — meaning
those with a body mass index of 30 or more — about 80 per cent have a
weight-related health problem. In those cases, "you have an argument
that perhaps weight loss, if you could ever achieve it, might be a
good thing," Bosomworth said.
"But there's also the argument — why are you aiming for weight loss,
since nobody's succeeding anyway? What's important is physical and
metabolic fitness — and that can happen without weight loss.
"Maybe we should be giving them a pedometer and say, 'Why don't you
increase your number of steps by 2,000 over the next two weeks every
day, bring it back and show me what you've done,' and not worry about
the weight."
In a counter-argument, Dr. Dominique Garrel, of Universite de Montreal
in Quebec, argues that obesity "must be treated" given the
consequences of excess weight. People can improve their health
considerably, he said, by losing even five to 10 per cent of their
weight.
Garrel said surgery "is very popular and increasingly simple and safe"
and suggested patients be referred to specialized teams of
nutritionists, psychologists and kinesiologists.
He acknowledged that the $2,000 to $3,000 cost of such care might
represent an "insurmountable barrier" for some patients.
"If this is the case the patient can be referred to an organization in
the community such as Weight Watchers or Choisir de maigrir."
In her rebuttal, Havrankova asks "where are these teams" and, "most
important, what results do they achieve?"
"If there were 'simple' and effective ways to treat obese patients,"
she said, "we would know it."
ski...@postmedia.com
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