Why do doctors put so much focus on weight?

cuterbee

Doctors get two weeks nutrition in med school and don't feel qualified.

I think the ones at my teaching hospital get a little more, but really, it's not enough for them to feel comfortable teaching a patient. And they have enough to do as it is, and most people will blow them off anyway if the MD/DO says "Lose the weight."

It is not asking people too much to have them do their own research and find and then OWN their own solution. While it takes time to sort through the crap that's out there...a lot of people start this journey trying quick fixes first. Most people won't hear you when you tell them there are none, it's something they have to discover for themselves (and just look at these boards -- even here, people promote cleanses and fads!).

141by2016

I am in med school right now, so I feel the need to weigh in on this. The future of healthcare is changing and these conversations are going to be part of that change.

First, I go to DO school, which makes my perspective different from most Allopaths (MDs) you are likely to encounter. Basically we are the other type of fully licensed physicians in the United States. Doctors of Osteopathy work in a holistic framework, including the mind, body, and spiritual/social component of the individual. We believe that the body has the tools to be healthy and our job is to support health (through lifestyle, somatic adjustment, or medication). When you see a DO for back pain, they may give you pain killers, but they are more likely to ask about your work environment, your exercises regime and may apply OMT (like chiropractic manipulation, but with science!). Most MDs have not been trained on how to even bring up the obesity issue, let alone counsel on it.

Second, with the new guidelines, the AMA is considering making obesity a disease, so we CAN do nutritional counseling and refer to PT for exercise counseling. In the next 3 years we will be able to prescribe exercise! And when Obama Care goes into full effect, we will be able to bill for obesity and lifestyle counseling, so I think you will see more Docs getting re-certified with diabetes and obesity educator credentials. With the increased use of the medical home model we will see more coordinated care for obesity.

At my school, we believe that EVERYONE should be getting 30min+ of strenuous activity per day. I attend extra workshops in nutrition so when I graduate I will have an added dietetics endorsement, and we learn a lot about sports physiology. Part of my reason for starting this journey is that I don't want to be the fat Dr. telling people to lose weight and be healthy. I am far from perfect, but by the time I start seeing patients I will be able to support their efforts through both knowledge and experience, and I hope I can help change peoples' lives by showing them it is possible and helping them navigate the confusing health landscape.

That is my point of view, and I know it is different, but I can hope that in the near future people will be able to find appropriate support for living healthy (not just disease-free) lives.

concordancia

Remember that women have a much higher acceptable body fat range than men. 33% is the top of the healthy range for women. 'Cos boobs.

Huge fan of boobs...

But where are you getting this 33% number from? I'm admittedly just googleing, but body fat or BMI, 33% is listed as obese for a female too.

I have the same question. I did find one chart that claimed to be based on WHO and NIH, but was on a low carb site. Everywhere else put 33 firmly into overweight in all cases, and usually obese. After all, BMI is just a guesstimate of body fat percentage based on wide sampling. So yes, it is possible or the guesstimate to be off if you are particularly muscular, but the numbers that define the categories don't change.

dhakiyya

Whenever I go in to my annual exam, they take out the height/weight chart and give me a lecture- because based on my height/weight, I come in at like 36% BMI, if they took the time to actually test me, I'm at 33% BF...the high end of the normal spectrum (right now). I wouldn't have to go through that "you're obese" lecture every year if they took the time to listen to me/test me instead of depending on the chart.

What scale are you using? Any reference I can find, male or female, has > 30% = obese.

And 25-30% as "Overweight" (which also seems like something to address).

Add 5 or so to those numbers for women. Men and women don't store fat the same way,, and women have more essential fat than men. Essential fat for men is about 3-5%, for women it's about 8-12%. So a man at 10% body fat is equivalent to a woman at 15-18%.

Also age makes a difference, as you get older the way the body stores fat changes. Two women with the same skinfold measurement at different ages will not have the same body fat percentage. My skinfold (with accumeasure calipers) puts me at 23% body fat, yet the same skinfold measurement in a 20 year old would be about 20%

For young women (late teens, 20s) 18-25% is the normal/healthy range, for older women 40s+ it's more like 21-28% - overweight is a few percent above this, then obese would be significantly above this range. The usual figure I've seen quoted for women is 35%+ is obese.

For men all these figures would be lower, as men have less essential fat. 25% for men would be too fat, but for women this would be in the healthy range.

stumblinthrulife

Huge fan of boobs...

But where are you getting this 33% number from? I'm admittedly just googleing, but body fat or BMI, 33% is listed as obese for a female too.

I have the same question. I did find one chart that claimed to be based on WHO and NIH, but was on a low carb site. Everywhere else put 33 firmly into overweight in all cases, and usually obese. After all, BMI is just a guesstimate of body fat percentage based on wide sampling. So yes, it is possible or the guesstimate to be off if you are particularly muscular, but the numbers that define the categories don't change.

But we aren't talking BMI. We are talking body fat. The lady in question is saying that although her BMI puts her in the obese category, her Body Fat %age puts her in the acceptable range. Even an olympic athlete could be considered obese when considering BMI alone, because of their greater weight due to muscle mass.

Jackson and Pollock body fat percentage table -

http://cdn.builtlean.com/wp-content/uploads/2010/08/Ideal-Body-Fat-Percentage-Chart3.jpg

You'll see that from age 36 onwards, 33% is in the average range for women, if not ideal.

JNick77

The amount of weight you carry whether you're 10% BF or 30% BF is still poundage that your body has to carry and your heart has to support.

stumblinthrulife

I am in med school right now, so I feel the need to weigh in on this. The future of healthcare is changing and these conversations are going to be part of that change.

First, I go to DO school, which makes my perspective different from most Allopaths (MDs) you are likely to encounter. Basically we are the other type of fully licensed physicians in the United States. Doctors of Osteopathy work in a holistic framework, including the mind, body, and spiritual/social component of the individual. We believe that the body has the tools to be healthy and our job is to support health (through lifestyle, somatic adjustment, or medication). When you see a DO for back pain, they may give you pain killers, but they are more likely to ask about your work environment, your exercises regime and may apply OMT (like chiropractic manipulation, but with science!). Most MDs have not been trained on how to even bring up the obesity issue, let alone counsel on it.

Second, with the new guidelines, the AMA is considering making obesity a disease, so we CAN do nutritional counseling and refer to PT for exercise counseling. In the next 3 years we will be able to prescribe exercise! And when Obama Care goes into full effect, we will be able to bill for obesity and lifestyle counseling, so I think you will see more Docs getting re-certified with diabetes and obesity educator credentials. With the increased use of the medical home model we will see more coordinated care for obesity.

At my school, we believe that EVERYONE should be getting 30min+ of strenuous activity per day. I attend extra workshops in nutrition so when I graduate I will have an added dietetics endorsement, and we learn a lot about sports physiology. Part of my reason for starting this journey is that I don't want to be the fat Dr. telling people to lose weight and be healthy. I am far from perfect, but by the time I start seeing patients I will be able to support their efforts through both knowledge and experience, and I hope I can help change peoples' lives by showing them it is possible and helping them navigate the confusing health landscape.

That is my point of view, and I know it is different, but I can hope that in the near future people will be able to find appropriate support for living healthy (not just disease-free) lives.

Nice to hear from a future medical professional. And heartening to hear that obesity discussions are happening.

People are simply so overwhelmed by the BS they see on TV, and are sold by marketers of both junk food and faux 'health foods' that they need more support from their GP. Most people simply aren't going to to seek out nutritionists or do their own research. For that matter, many will just assuming that all their doc says is 'lose weight' then that's all there is to it. I'm a pretty educated chap, and I will admit that I'd never even thought about differentiating lean body mass and body fat when losing weight.

Further to the personal responsibility issue raised by another poster - if obesity were just impacting them, that would be one thing. Personal responsibility and all, yada yada. But the Western world has a massive problem with healthcare costs spiraling out of control mostly due to completely dietary issues. So assuming you don't like your health insurance and taxes going up and up, it's everyone's issue, whether you are obese or not.

JUDDDing

But we aren't talking BMI. We are talking body fat.

No, I got that. It's just I can't find any source that says that 33% body fat (or BMI for that matter) is ok.

You'll see that from age 36 onwards, 33% is in the average range for women, if not ideal.

The poster is 26. So, above average right? (Whatever average really means in a fattening population).

Nobody seems to use body fat for a measure any more. But... Here's a couple examples.

"Women should have 14-20% essential body fat weight and males should have 6-13% essential body fat weight. The “acceptable” range is 25-31% for females and 18-25% for males. 32% or more for females is considered obese and 25% or more is considered obese for males."

http://www.fitday.com/fitness-articles/fitness/weight-loss/percentage-body-fat-weight---whats-normal.html#b

Obesity is defined as an excess amount of body fat. The normal amount of body fat (expressed as a percentage of body weight) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

http://www.medicinenet.com/script/main/art.asp?articlekey=46582

This is the closest, if she were 40 then 33% would be ok: http://www.shapeup.org/bfl/basics1.html

Up to age 40, here 33% is "Well below average" (Top 10% highest body fat for white college educated women): http://tpm.scgov.net/ssDocuments/1140/Wellness program/H & F Screening/All screening results.pdf

Not that any of these are awesome sources or anything....

Nor does it matter... It just doesn't seem like an injustice that she'd get the obese lecture.

stumblinthrulife

Here is a Mayo Clinic article about "normal weight obesity" -

http://www.mayoclinic.com/health/normal-weight-obesity/AN02007

Seems I wasn't far off the mark when I said about being concerned about going from being a big guy with too much body fat to being a not-so-big guy with too much body fat.

ninerbuff

Because weight is the NUMBER ONE predictor of health related issues. You can still be overfat without being overweight.

A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 28+ years and have studied kinesiology and nutrition

A fair comment, from someone obviously much more qualified than me. But surely the underlying sentiment remains valid - doctors will always say 'lose weight', but will rarely provide or suggest the best ways to lose weight, or tools to aid in it.

This isn't a 'down on the establishment, doctors know nothing' kind of thread, by the way. I have massive respect for my doctor, and most doctors in general, and I follow the advice given closely. I just noticed that weight loss is an area where doctor's advice has been sorely lacking in my experience.

That's usually because most doctors only engage in nutrition for a couple of weeks or so. They will tell you to eat less fat and exercise. Very basic nutritional information.

A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 28+ years and have studied kinesiology and nutrition

Sycoholic

I went for my physical for my job. I got the results of all the tests and it shows me at a 32% bodyfat. It's only based off height and weight. Just like Wii shows me as a fat guy. Well the doctor was nice enough to include stuff about me losing weight and how detrimental to my health my body fat percentage is. I didn't realize he had his eyes closed when he examined me.

numsquat

Easy calculation and tracking. You can track weight easily with an inexpensive scale at home. Easy conversion to a BMI chart (which as a whole is very accurate but breaks down as you move to the individual level). The BMI is the still the standard for the medical field and insurance companies.

Luckily my doctor is more about BF% than weight and works with me on this. My medical insurance uses a separate company to track and promote wellness. My bloodwork is all good, my BF% is in a healthy range (15.5%) but my BMI is still "overweight" and I get dinged on the BMI every year. Sucks but even with my doctor telling them my weight is healthy the BMI still reduces the discount I can get on my insurance.

I do have to wonder how you're measuring your body fat mass.

InBody 230 http://www.bvtack.com/2012/10/03/new-body-composition-machine-available-to-students/