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Treating Obesity Is More Than Just Telling Patients They Have a Problem with Their Weight
LETTER
Treating Obesity Is More Than Just Telling Patients They Have a Problem with Their Weight To the Editor: In the March 2015 commentary by Robert Doroghazi, MD,1 factual errors overwhelm a few true observations. His primary point has been proven false repeatedly: that simply telling people “Sir or Madam, it’s not okay to be obese” is an effective way to solve the problem of obesity. He advocates telling people “it is their personal responsibility to eat less.” This is false for 2 reasons. In multiple clinical trials, simple admonitions to eat less have been shown to have minimal effect on the weight of people with obesity.2 To have a meaningful impact on a person’s weight requires intensive behavioral therapy, considerably more than the simplistic advice Doroghazi is recommending. It is also false because blaming and shaming people with obesity have been shown to cause obesity to worsen, not improve.3,4 In response to stigma and shame, people also avoid needed preventive care, become less likely to seek a primary care provider, and engage in less healthy lifestyle behaviors.5 Finally, it is worth noting that Doroghazi’s advice is violating his own principle, namely, “if something you are doing isn’t working, do something different.” People with obesity are already hearing “you eat too much” and “your health and your weight are your responsibility.” They hear it almost constantly from an early age.6 Advice to eat less is often the only treatment that physicians offer to people with obesity, and it is not helping. Funding: None. Conflict of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript.
0002-9343/$ -see front matter Ó 2015 Elsevier Inc. All rights reserved.
What can help people with obesity is skilled care from health professionals who provide evidence-based treatment for obesity, including intensive behavioral therapy, obesity medicines approved by the Food and Drug Administration, and bariatric surgery. Doroghazi’s superficial advice and stigmatizing assumptions are well documented to be harmful, not helpful. Obesity is one of the last acceptable forms of discrimination. We must make an effort to understand obesity as a disease and encourage physicians to provide their patients with useful tools and resources to help them improve their health and quality of life rather than instill shame and stigma. Theodore Kyle, RPh, MBAa,b Joseph Nadglowksi Jr., BSb Rebecca Puhl, PhDc a
ConscienHealth Pittsburgh, Pa b Obesity Action Coalition Tampa, Fla c Rudd Center for Food Policy & Obesity University of Connecticut Hartford
http://dx.doi.org/10.1016/j.amjmed.2015.04.015
References 1. Doroghazi R. A Candid Discussion of Obesity. Am J Med. 2015;128: 213-214. 2. Moyer VA. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:373-378. 3. Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS One. 2013;8:70048. 4. Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Perceived judgment about weight can negatively influence weight loss: a cross-sectional study of overweight and obese patients. Prev Med. 2014;62:103-107. 5. Puhl RM, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep. 2015;4:182-190. 6. Puhl RM, Latner JD. Stigma, obesity, and the health of the nation’s children. Psychol Bull. 2007;133:557-580.
Treating Obesity Is More Than Just Telling Patients They Have a Problem with Their Weight To the Editor: In the March 2015 commentary by Robert Doroghazi, MD,1 factual errors overwhelm a few true observations. His primary point has been proven false repeatedly: that simply telling people “Sir or Madam, it’s not okay to be obese” is an effective way to solve the problem of obesity. He advocates telling people “it is their personal responsibility to eat less.” This is false for 2 reasons. In multiple clinical trials, simple admonitions to eat less have been shown to have minimal effect on the weight of people with obesity.2 To have a meaningful impact on a person’s weight requires intensive behavioral therapy, considerably more than the simplistic advice Doroghazi is recommending. It is also false because blaming and shaming people with obesity have been shown to cause obesity to worsen, not improve.3,4 In response to stigma and shame, people also avoid needed preventive care, become less likely to seek a primary care provider, and engage in less healthy lifestyle behaviors.5 Finally, it is worth noting that Doroghazi’s advice is violating his own principle, namely, “if something you are doing isn’t working, do something different.” People with obesity are already hearing “you eat too much” and “your health and your weight are your responsibility.” They hear it almost constantly from an early age.6 Advice to eat less is often the only treatment that physicians offer to people with obesity, and it is not helping. Funding: None. Conflict of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript.
0002-9343/$ -see front matter Ó 2015 Elsevier Inc. All rights reserved.
What can help people with obesity is skilled care from health professionals who provide evidence-based treatment for obesity, including intensive behavioral therapy, obesity medicines approved by the Food and Drug Administration, and bariatric surgery. Doroghazi’s superficial advice and stigmatizing assumptions are well documented to be harmful, not helpful. Obesity is one of the last acceptable forms of discrimination. We must make an effort to understand obesity as a disease and encourage physicians to provide their patients with useful tools and resources to help them improve their health and quality of life rather than instill shame and stigma. Theodore Kyle, RPh, MBAa,b Joseph Nadglowksi Jr., BSb Rebecca Puhl, PhDc a
ConscienHealth Pittsburgh, Pa b Obesity Action Coalition Tampa, Fla c Rudd Center for Food Policy & Obesity University of Connecticut Hartford
http://dx.doi.org/10.1016/j.amjmed.2015.04.015
References 1. Doroghazi R. A Candid Discussion of Obesity. Am J Med. 2015;128: 213-214. 2. Moyer VA. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:373-378. 3. Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS One. 2013;8:70048. 4. Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Perceived judgment about weight can negatively influence weight loss: a cross-sectional study of overweight and obese patients. Prev Med. 2014;62:103-107. 5. Puhl RM, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep. 2015;4:182-190. 6. Puhl RM, Latner JD. Stigma, obesity, and the health of the nation’s children. Psychol Bull. 2007;133:557-580.