Tuesday, 8 December 2020, CLEVELAND: The standard weight loss advice — “Eat less and move more” — is not aging well. Patients with overweight or obesity issues should seek a physician who understands their complex condition. Obese patients are too often stigmatized, even by healthcare professionals, as there is no one-size-fits-all cause or solution. Obesity treatment is complex and requires compassion.
Obesity has tripled worldwide
According to the World Health Organization, obesity has nearly tripled worldwide since 1975. In its most recent figures available, more than 1.9 billion adults, 18 years and older, were overweight in 2016. Of these, over 650 million had obesity.
But W. Scott Butsch, MD MSc FTOS, Director of Obesity Medicine at the Bariatric and Metabolic Institute at the Cleveland Clinic, says the good news is that researchers and doctors are continuing to learn more about the disease of obesity. Increasingly there are new pharmacological and endoscopic treatment options.
“We now know that many genetic, biological, developmental, behavioral and environmental factors contribute to weight gain and the development of obesity,” he says.
He points out, however, that there is still a widespread belief that obesity is a lifestyle choice. That people develop obesity because they choose to eat too much or exercise too little. As a result, people with obesity are stigmatized and stereotyped in many aspects of their lives. This even happens at the places they visit to seek help.
Weight bias in healthcare
“Studies find that weight bias is common in healthcare,” Dr. Butsch says. While medical professionals strive to provide the best possible care for their patients, studies have shown that some of them also carry negative attitudes toward patients who have obesity, or feel out of their element when it comes to treating it.”
Those attitudes affect patient care, Dr. Butsch said. “As a physician, telling someone to eat less and move more is like telling someone who has depression just to cheer up.”
“Doctors wouldn’t dream of saying this to someone with depression, but many have little reservations when making recommendations for weight loss. For whatever reason, some doctors continue to do this when they discuss obesity.”
Medical professionals, as a whole, need to be better educated about the biology of obesity, he asserts, as well as the factors that play into it, and their own biases — which they may or may not realize they have. The results of a recent study he published showed that among U.S. medical school deans, only 10% reported that their medical students were ‘very prepared’ to manage patients with obesity. He added that in more than one-quarter of medical schools, non-judgmental communication and use of respectful language with patients who have obesity was covered to a very small extent or not at all.
Having obesity heightens a person’s risk of developing diabetes, heart disease, hypertension, and cancer. Hence, a discussion on weight is an appropriate and important topic for doctors to have with their patients. However, he says, patients with obesity have likely already had many negative, biased encounters with providers. They deserve the conversation to be thorough and compassionate.
Understanding the causes of obesity
Dr. Butsch says it is also important for patients themselves to understand the complex nature of obesity. “There is a very tightly controlled physiologic system that regulates body weight, aiming to keep it at a certain set point, and this can hinder weight loss. Therefore, when someone is unable to lose weight, it is not their fault necessarily. They shouldn’t berate themselves, just as the medical establishment shouldn’t blame them.”
People do not understand the complex processes involved, they often think there are only two pathways to addressing obesity – exercising and dieting on the one hand, and surgery on the other.
No single treatment will work for everybody
“However, there are many types of obesity, and therefore many types of treatment and no single treatment will work for everybody,” he says. “Understanding where the patient is in their weight loss journey and to what extent their excess weight is not only affecting their health risk but also their quality of life can determine what treatment pathway we might choose.”
Dr. Butsch stresses the importance of a thorough review of each individual patient’s case. “When a patient comes to see us with a problem with their weight, we want to take a weight history. So, often, what’s not done in the medical establishment is to make the effort to understand the chronology of an individual’s weight. Identifying contributing factors to weight gain may not only lead us to more targeted and appropriate treatment options but may help comfort patients who commonly blame themselves for their excess weight.”
Finding the right pathway
Addressing obesity is an ongoing process. If one approach is not working after several months, the doctor and patient should consider changing course and trying a different therapy. Working with a physician who has a greater understanding and expertise in obesity is key to this process, says Dr. Butsch.
“If you feel that you’re being judged by your doctor, then you have the opportunity to seek another physician who is more knowledgeable in the field of obesity, who will provide more appropriate, non-judgmental care,” he says.
About Cleveland Clinic
Cleveland Clinic is a nonprofit multi-specialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians. They had a vision to provide outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. The U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.