The Role of Doctors in Weight Loss

Vetticus_3

http://www.sciencetimes.com/articles/7155/20150824/study-reveals-the-key-to-success-in-weight-loss.htm

Hi,
I'm just linking an article which mentions the importance of having a supportive doctor in weight loss.

This sort of hit home for me. This happened to me a couple of months ago.

I'm usually not sick. I don't visit the doctors that often (maybe once a year, if that). I do have a herniated back, which I manage with physio and pilates. Anyway, I recently moved, my back gave me some problems, and needed to get a new physio (a referral from a friend with a similar problem). To make a long story short, he was terrible, and made my back worse. From that, I decided to get a referral from the GP.

At the same as my back issues happened, my BMI crept up to 30 (the heaviest I've ever been - and this was on my really dodgy scales). The thing is, I wasn't really over eating. I don't indulge in chocolate or take out. I don't buy prepackaged food. I'm a vegetable and protein person. I thought it might be a health issue. (It turned out it's big-portion issue... )

I had never been to this GP before - and it was a week long wait. I figured, I've never talked to a doctor about weight loss before, and thought she could help. I was expecting her to record my weight and measurements, and a blood test to check thyroid levels - maybe see the nurse or something.

What I got was a big bunch of nothing.

Not only did she not help with my back (no referral, just a suggestion that I should do pilates... which I've been doing for years)... but her advice on weight loss was that she has no problem keeping her weight down. And I was too thin to get any nutritional advice from the dietician.

I'm serious. This was all she said: She has no problem keeping her weight within a healthy BMI. How is that supposed to help me? And I was on the threshold of being obese.
No measurements.
No scales.
No advice.

I got so mad. And when I asked if this was usual (on another weight loss forum)... it happens all the time. How are people supposed to get medical help when the GPs don't do anything?

I've noticed that there is the flow chart that pops up when people don't lose weight - and after exhausting all the possibilities it suggests seeing a doctor to check for health issues. Has anyone gotten a good response when talking to their GP about these health checks?

Anyway, I got so mad I went back to CICO and then I joined this website a couple of weeks later. 6kgs down, and other 8kgs to go (on good reliable scales).

Just thought I'd share. Maybe someone has some information regarding supportive GPs when it comes to weight loss.

juggernaut1974

Meh...

Quite a few MD's know little to nothing about proper nutrition, as demonstrated by some of the posts on this forum.

I'm trying to find the actual study - so far, everything linked in the article just links to other articles.

My n=1: I get an annual physical from my MD, but other than that, I don't get weight loss advice, or discuss anything of the sort with her.

I would have thought the number 1 key would be eating less than you burn. I wonder if anyone's ever done a study on that?

Hornsby

Last time I was at my GP, he told me to go on a 1200 calorie diet...

He isn't my GP any more.

LeanButNotMean44

Here's an interesting read for you, which basically reinforces what you said in your post (from the American Medical Association):

What's at stake in nutrition education during med school

While physicians encourage patients to make healthy food choices, only 27 percent of U.S. medical schools actually offer students the recommended 25 hours of nutritional training, according to a recent perspective piece in Academic Medicine. Hear why experts say improving health outcomes may require physicians in training to move from the classroom to the kitchen.

“In an era when rates of obesity, diabetes and other lifestyle-related disease challenge medical educators and governments worldwide, it is necessary to consider novel educational strategies, both didactic and experiential, whereby current and future health professionals can be prepared to proactively advise and teach patients enhanced self-care skills,” the authors of the perspective wrote.

A recent study from Diabetes Care revealed that more than 86 million American adults have prediabetes, the precursor to type 2 diabetes—and these increased burdens on the health care system break down to a national cost of roughly $322 billion.

Still, many chronic illnesses, such as type 2 diabetes, are preventable, the authors wrote. They cited instances when simple lifestyle changes—such as not smoking, limiting alcohol use, being physically active and maintaining a healthy diet—reduced patients’ chances for coronary heart disease by 82 percent.

So while the country’s rate of chronic illness may be daunting, medical educators are looking at how they can change these trends on what they are calling a “societal scale.”

That’s where creating courses in medical schools on self-care, nutrition, cooking and life skills can make a difference. If medical schools teach students how to adapt healthy lifestyle and self-care skills in training, the authors argue, they’ll know how to impart this information to their patients.

The current state of nutrition in medical education

Modern medicine maintains the importance of proper nutrition, yet on average, U.S. medical schools only offer 19.6 hours of nutrition education across four years of medical education, according to the perspective authors. “This corresponds to less than 1 percent of estimated total lecture hours,” they wrote. “Moreover, the majority of this educational content relates to biochemistry, not diets or practical, food-related decision making.”

A lack of external incentives that support schools teaching nutrition also deepens this educational void, the authors note. Current United States Medical Licensing Examination tests evaluate “biochemical knowledge and information relating to nutritional deficiencies, but no standardized patient examination tests the knowledge or skills of medical trainees to advise a patient seeking guidance with regard to evidence-based diet and lifestyle modification,” they wrote.

Training at the postgraduate level has followed suit, they said. They pointed to how the word “nutrition” isn’t included in board examination requirements for internal medicine certification, and cardiology fellows don’t need to complete a single requirement in nutrition counseling.

What this means for educators: How to innovate nutrition education

Despite the low rate of nutrition education in medical schools, the authors of the perspective offer a hopeful consideration for educators: Most students in the beginning of training actually value nutritional knowledge.

In fact, among entering medical students, “71 percent think nutrition is clinically important. Upon graduation, however, fewer than half believe that nutrition is clinically relevant. Once in practice, fewer than 14 percent of physicians believe they were adequately trained in nutritional counselling,” the authors wrote.

Improving this outcome and maintaining students’ interest in nutrition will require schools to think “outside of the box” about creative integrations between core curriculums and nutritional content.

Some schools already are addressing this need through interactive courses that explore the impact of social determinants on access to whole and nutritious foods. For instance, the New York University School of Medicine, a member of the consortium of schools in the AMA’s Accelerating Change in Medical Education initiative, recently conducted a neighborhood food project in which students canvassed 30 neighborhoods across Manhattan to investigate the availability and cost of basic foods in local grocery stores and restaurants.

Armed with neighborhood maps that they created as part of their research, students recorded characteristics and costs of local food sources in each neighborhood, noting advertising for foods and beverages. This information has been compiled in a database that faculty will use to further analyze the impact of food environments on childhood disability.

Other schools, such as the Pritzker School of Medicine at the University of Chicago, have taken a more direct skills-building approach to national education. This school is simulating “teaching kitchens,” where medical students study the value of food in a culinary setting.

juggernaut1974

Well on the third clicked through article I found this:

At the end of the trial, patients filled out surveys that asked, in part, about their relationships with their primary care physician, including questions about how often their providers explained things clearly, listened carefully and showed respect, as well as how helpful their physicians' involvement was in the trial. Of the 347 patients who filled out surveys, about 63 percent were female, about 40 percent were African-American and all were obese, with body mass indices of 36.3 on average. Each participant also had one of three cardiovascular disease risk factors: high blood pressure, high cholesterol or diabetes.

Results of a review showed that nearly all of the 347 patient surveys reviewed for the Johns Hopkins study reported high-quality relationships with their physicians, with the overall relationship showing little effect on weight loss. However, those patients who gave their physicians the highest ratings on "helpfulness" during the trial lost an average of 11 pounds, compared to just over 5 pounds for those who gave their physicians the lowest "helpfulness" ratings.

So those who lost more weight gave their doctor better ratings? Color me shocked! I'm not sure how that leads to the conclusion in the first article that having a doctor relationship is the key to weight loss.

jemhh

I see my OB/GYN for an annual exam but when I am sick, I usually go to the Minute Clinic instead of a PCP. (I went to my GP/PCP a month ago for the first time in 3 years and they had me do the paperwork that new patients do because mine had been sent to storage.)

ANYWAY, I've never had a doctor say/do anything about my weight. I went in for my annual GYN exam in April 2014. The doctor asked if anything had changed and I said that I had lost about 30 pounds since the year before. He said "you have!?!" and that was pretty much it. Then this year when I went in, I didn't say anything because I was wondering if he would and when he didn't, I just didn't bring it up.

Francl27

Depends. Most GPs don't have a clue about nutrition.

I've had 4 different GPs in my 13 years in the US. The first two never even mentioned my weight. The third did, and went on to give me horrible advice (he told me to switch to whole grains and have granola bars as snacks) and guilt trip me about being fat because I had high blood pressure at that appointment (first and last time ever, because I was a SAHM, it was just before Thanksgiving, and I was just really stressed out).

But that's where I kinda agree with the article, in the sense that my 4th doctor is the one that actually made it happen. But she didn't even comment on my weight more than 'ok so you know you're obese right?' but more in the matter-of-fact way, then she went on ordering a ton of tests (EKG, extra bloodwork etc) and explained that it was because of my weight and that I was at high risk for heart issues. Basically, she scared the **** out of me. Although I'm not sure it's the kind of 'support' the article mentions, but that's how I decided to do something about it (my appointment was in December, and I told myself I'd enjoy the Holidays first, got myself sick of food then, and started MFP mid-January).

choppie70

My former GP wanted to send me right to weight loss surgery. She did not ask any questions, or even really talk to me about my habits. Her answer to anything I asked was "Yeah, some people are like that." or she would search on her phone for answers!

My current GP is more understanding. She gave me nutritional information. She suggested I look into a fitness tracker and start looking at what I ate. She was encouraging and offered to make an appointment with a nutritionist for me if I did not see a difference with what she suggested.

TuffChixRule

My GP's extremely obese nurse usually hands me a paper with weight loss tips every time I go for a checkup. It's the same generic stuff you can find almost anywhere - less processed foods, more fruits and veggies, exercise more. Nothing earth shattering or new. Then when I tell her I lost weight with CICO and walking more, she looks at me like I have three heads. My GP is also a pill pusher which is another thing I don't like. He really wanted to put me on cholesterol meds (which I would have refused to take anyway) but my numbers went down due to my weight loss. He actually looked a little upset that I finally heeded his advice and am changing my lifestyle. So OP you are correct in assuming that GP's know very little about nutrition and weight loss.

ki4eld

Most GPs have no clue about nutrition or at least not more than the basics. The same goes for gynecology or orthopedics or any other specialty. There are specialists for a reason. My GP worked with me for 3 years. We tracked food and weight and meds, but that's really all he could do for me and he was very upfront about that. "I'm not a specialist, but let's start with the basics." Basics meaning simple examination and application of dietary and exercise principles and routine testing. When it became obvious that the basics weren't going to work with my medical profile, he referred me to a specialist. Crazy me, but I thought that's what GPs do... keep an eye on things, fix the simple stuff, refer to specialists when it's not simple anymore. At least that's what I expect of my GP. There's a reason why I've been with my GP for 10+ years!

Vetticus_3

The original study if anyone wants it: http://www.ncbi.nlm.nih.gov/pubmed/26026649

kshama2001

Other than the doctor who prescribed phen/fen for me in the 90s, my doctors (and there have been quite a few as I move around a lot) have not been involved in my weight loss.

CurlyCockney

My GP is fantastic. Not because she thinks she knows everything, but because she knows she doesn't. She refers me to the relevant specialist, and I have an appointment with her every month (at her request), just to make sure everything's going ticketyboo. I haven't spoken to her about weight loss yet as there is a lot of other medical stuff going on, but I will at my next visit and get a referral to a dietician.

Azexas

Depends on the doctor. My first primary care doctor told me to lose weight just cut out wheat. That was it, that was all the advice he gave me. Wheat was the magic cure to weight loss.

I ended up moving and going to a new PCP who was the one who introduced me to this site.

It depends on the doctor. Most med schools require little to no nutrition lectures as part of the curriculum.

lemurcat12

Most doctors aren't experts on weight loss, but also most weight issues aren't caused by health issues (being obese may cause health issues, obviously). IMO, eating correctly is a basic human skill and all of us really know what to do, people just don't, for whatever reason. I mean think about it -- it's hardly rocket science or complicated medical knowledge that should tell you that you shouldn't eat too many calories, that you should moderate consumption of high cal, low nutrient foods, that getting enough protein is good, that you should eat vegetables (and fruit too, if you like it), and that it's probably good to have some fiber.

Personally, I was irresponsible and avoided seeing my doctor at times when I was obese, as I knew she'd want to warn me about it and suggest I do something about it and I wasn't ready and didn't want to feel bad (and I knew the conversation would make me feel bad). NOT recommending that--it was stupid. When I did see her when obese she did say something and I said I knew and was working on it and roughly told her how and she said "let me know if you need help." When I later saw her the next year and had lost all the weight she asked me what I'd done to confirm I hadn't been doing anything unhealthy and then said great job.

More recently I saw her when I was maybe BMI 26 and she commented that I was technically overweight but seemed to be really fit and in great health, so she didn't think it was a concern. She asked about my exercise. I told her, she was pleased, and also told her I was working on losing more weight -- she asked how much, seemed fine with my answer (which was not crazy low), and asked generally what I was eating/how I was doing it. As usual, she seemed to think my eating was fine (it's pretty healthy, I think, due to the application of common sense) and when we talked about counting calories she asked if I was using any particular way to do it and when I mentioned MFP she got all excited and said she liked the app.

I assume she would have referred me to a dietitian if I'd wanted it for some reason, but she didn't seem to think there was any reason for it, and nor do I.

My mother, however, has had health issues that require a special diet, and I've never been happy with how clearly (or not clearly, that being the problem) the dietitian she worked with has conveyed advice, although part of this is likely my mother -- I wish I could go with her and help her ask questions.

SLLRunner

When I was complaining about losing weight to my GP some years back, I told her I knew I needed to lose weight and maybe I just needed to stop eating all the burritos I love so much. She said, "losing weight isn't about not having the burrito, it's about having half and saving the rest for another day." She offered no other diet advice.

My current doctor has never tried to give me diet advice, but if I asked he would refer me to the proper people who could help me.

The thing about general practitioners is that they generally have little knowledge when it comes to nutrition and diet, therefore they should not be giving advice. A good doctor will refer you to a dietitian, who has the degree and experience to advise you.

zyxst

Before my current GP, doctors said, "Lose weight". No advice on how to achieve that, just to do it. Current GP said, "Lose weight and go on the DASH diet". When she asks about my weight (which is rare and she's never weighed me at the office), I tell her what it is and that leads to how much I've lost. When I say I keep a food diary and try to eat less than I burn, she looks at me like I have an ED. Other than HBP, I don't have any medical issues that weight loss will "cure" or, at least, mitigate, so nothing more gets said. My GP is more concerned that I don't use birth control than my weight.

airbent

This is why so many overweight people don't go to the doctor as much as they should. It's so often discouraging and unproductive. So many doctors will look at you and automatically chalk every symptom up to your weight, give nonconstructive and impersonal advice about losing, then call it a day. Conditions go undiagnosed or untreated because of it.

cwolfman13

most GPs aren't well versed in nutrition...it's simply not what they do. what they can do is send you for blood work and review that blood work to see if there's anything medically wrong with you that would be preventing you from losing weight...that's why people say to go see a Dr...blood work...not nutritional advice. From there, a good Dr. will refer you elsewhere for specific care...the "G" in GP stands for General...as in not specialized.

stealthq

I'm pretty sure the role of most doctors in weight loss is to let you know "hey, you need to lose weight - your health is at risk".

The pity of it is that some don't even do that.

tomatoey

i have a lot of complaints about my doc but this issue wouldn't be one of them.

stealthq wrote: »

I'm pretty sure the role of most doctors in weight loss is to let you know "hey, you need to lose weight - your health is at risk".

right exactly, they're not behavioural management specialists. what should happen, ideally, is that patients get referred to people who are behavioural management specialists, routinely.

Alyssa_Is_LosingIt

stealthq wrote: »

I'm pretty sure the role of most doctors in weight loss is to let you know "hey, you need to lose weight - your health is at risk".

The pity of it is that some don't even do that.

The ones that do get complained about on tumblr.

Alyssa_Is_LosingIt

cwolfman13 wrote: »

most GPs aren't well versed in nutrition...it's simply not what they do. what they can do is send you for blood work and review that blood work to see if there's anything medically wrong with you that would be preventing you from losing weight...that's why people say to go see a Dr...blood work...not nutritional advice. From there, a good Dr. will refer you elsewhere for specific care...the "G" in GP stands for General...as in not specialized.

I completely agree with this.

Doctors also tend to want you to lose weight as quickly as possible, so they are usually more likely to prescribe some kind of pill or a low-calorie diet to achieve quick results. They don't think in terms of long-term sustainability; they think in terms of a cure for your fatness.

PeachyCarol

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

SLLRunner

PeachyCarol wrote: »

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

Yep. Common sense doctors rock.

tomatoey

SLLRunner wrote: »

PeachyCarol wrote: »

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

Yep. Common sense doctors rock.

Where are they

jgnatca

The GP who referred me to my path to weight loss and health is a small town doctor who does address weight with all of his patients. He has insulted and offended townspeople by doing this. It's a small town. Word gets around. But he's right.

http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/

PeachyCarol

tomatoey wrote: »

SLLRunner wrote: »

PeachyCarol wrote: »

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

Yep. Common sense doctors rock.

Where are they

Apparently in New Jersey/Philadelphia? I've had terrible doctors in the past, but the four I see now (GP, neurologist/migraine specialist, rheumatologist, and endocrinologist) are all fantastic.

lemurcat12

SLLRunner wrote: »

PeachyCarol wrote: »

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

Yep. Common sense doctors rock.

Agreed! I also approve of not being treated like a child.

tomatoey

PeachyCarol wrote: »

tomatoey wrote: »

SLLRunner wrote: »

PeachyCarol wrote: »

My doctor encouraged me to start exercising and gave me a recommended caloric range. She didn't really give me any tips on how to eat within that range or anything, but I'm not exactly a spring chicken and don't need to be treated like a child to figure things out. She told me only calories mattered after I told her that I was eating well and not losing weight.

I really like my doctor.

Yep. Common sense doctors rock.

Where are they

Apparently in New Jersey/Philadelphia? I've had terrible doctors in the past, but the four I see now (GP, neurologist/migraine specialist, rheumatologist, and endocrinologist) are all fantastic.

Aha yeah makes sense, spitting distance from NYC but not so nutty to actually be based there

Glad you have competent docs

mccindy72

Being a general practice medical doctor is pretty difficult. They get to see patients for 20-30 minutes each, and most patients have a number of particular issues they want addressed in that amount of time. Not to mention a physical exam is performed in that time, as well. The doctor needs to remember information about the entire visit so that he or she can effectively chart what happened during that time to meet legal requirements and have information to refer back to the next time the patient comes in.
Also, a GP has to have general knowledge of the entire body. They don't specialize in anything, so they have a little bit of information about the entire thing. Not all the indepth information that a specialist has. Yet every patient expects the doctor to know everything about the body and all medical issues, and still remember each patient who walks in the door. That's not really possible. GPs do learn as much as possible to get their licenses, and do have to take continuing education to keep up with new advances, but they don't know everything there is to know.
When a patient has a specific need or complaint that requires more attention and time than the GP can address, he or she refers that patient to a specialist. That's not always another doctor. Sometimes it's a cardiac nurse or physician's assistant. Sometimes it's a behavorial health therapist. And if the patient has an issue with obesity and doesn't know how to eat correctly to lose weight, the referral can be to a dietician, and sometimes a physical therapist to address exercise options.
Good GPs will do this.