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Top 10 Reasons NOT to prescribe weight loss: (and what to do instead)

1 It doesn’t work. Follow-up studies of 2-5 years show almost everyone regains at least the weight they lost if not more, regardless of treatment.

2 The patient tunes us out. "Blah, blah, blah, weight loss," - they’ve been there, done that, and we must not get it. If the patient stops listening, nothing else we say gets through either.

3 It repeats the trauma for the patient of being seen only in terms of body size ("I come in for a ear infection and get a weight loss lecture").

4 We make it more likely that the patient will avoid medical care in the future to avoid a) The Lecture and b) feeling like a failure about weight.

5 It encourages the patient to postpone life until after "the project" of reaching a certain weight, rather than integrating healthy behaviors now, for good.

6 It gives people the illusion that they can choose their body size, emphasizing the end result (x number of pounds to lose) rather than the process (the choices one has control over day-to-day). When they fail, they may resort to increasingly extreme behavior to "get results."

7 It’s hypocritical for us to prescribe behavior to fat patients (labeling food good/bad, restricting intake, relying on the number on the scale for feelings of success) which we would diagnose as eating disordered in thin patients.

8 It’s a mindset where we see patients as statistics (numbers on the height/weight charts) rather than as individuals, and risk exposing them to dangerous and sometimes deadly "interventions" which can be worse than the status quo for that particular person (cf. diet pill fiasco of 1997).

9 Some studies show even when people lose weight they die earlier. Weight loss itself may have hazards we do not understand. We don’t know enough about the different kinds of obesity and their associated health risks, or the different long-term risks of weight loss, to mindlessly prescribe it and still Do No Harm.

10 We miss the opportunity to support and validate the healthy behavior people are already engaging in (even if it is not making them thin).

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Top 10 Things to do INSTEAD of

recommending weight loss:

1 Do an individual assessment rather than reading anything into body size. Spend time getting to know your patient as a person, then trust what you know in your assessment.

2 Recommend the practices that lengthen life and raise the quality of life for anyone regardless of body size: Eating nutritious and whole foods, regularly and joyfully moving one's body, getting enough sleep, having friends to rely on, wearing your seatbelt, using sunscreen, etc.  Focus on collaboratively brainstorming realistic changes under the patient's direct control.

3 Teach the stages of change model to help patients appreciate that a) thinking about treating yourself better "counts," not just action; b) change is not linear; and c) permanent change takes a long time.

4 Refer the patient to supportive services. This could be any number of resources to address the quality of life issues.

5 Expect to follow up with the patient as part of your treatment plan. Remember change takes a long time.

6 Work on giving up a weight focus for yourself. If you are really struggling with a lot of body hatred, or if you have a strong "negative countertransference" about fat patients, get help, and consider not working with fat patients until it becomes more neutral for you.

7 Make your office a "body disparagement free" zone. Raise consciousness about the offhand "fat talk" remarks we are all trained to make. Encourage staff to acknowledge that the "normative discontent" we have with our bodies is not harmless, and brainstorm what they can do to combat it. Provide large-size chairs, gowns, and medical equipment.

8 Expect to be challenged by other professionals who still prescribe weight loss. Rely on the factual data from research showing that the health risks of obesity are not well understood and may be exaggerated.

9 Work to end discrimination based on body size, including access to medical insurance and good medical care. Stress from being denied equal opportunity kills.

10 Cultivate "weight neutrality": Put quality of life first, focusing on the practice of a healthy life, whether someone loses, doesn’t lose, or even gains, weight. Trust that there is a logic to the body’s processes and respect it.


For wonderful info on the "New Paradigm," see:

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Last updated: March 05, 2011.