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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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