From a happier file in the Ottawa Citizen, some Canadian doctors are coming out swinging AGAINST weight loss as a health strategy. In an article that sounds basically like an argument for HAES, Sharon Kirkey highlights comments from the medical journal Canadian Family Physician by doctors Havrankova and Garrel. Dr. Havrankova thinks an ounce of prevention is worth a pound of cure, saying "Screening and monitoring excess weight from early childhood, ensuring that physical activity is part of the curriculum right up to university, creating neighbourhoods that encourage people to get out and walk, and teaching people how to prepare healthy meals are just a few suggestions." I say there are still going to be fat folks no matter what you do, but these are some solid ideas for improving everybody's health, so I wont complain too much. I worry, however, about screening and monitoring excess weight in kids. As seen in last week's post, and the rise in eating disorders and body disatisfaction in general in children, hounding them and their families about their weight from an early age is just setting them up for some really scary problems.
Dr. Garrel, on the other hand, honestly thinks that "Today, many physicians are tempted not to intervene with their obese patients. They are not weighed and the subject of body weight is never raised with them." He also thinks "the treatment of obesity is simple and need not be time-consuming." (Insert me laughing out loud at my computer screen here. What doctors has he been talking to?!) He recommends the Edmonton Obesity Staging System, designed by Dr. Sharma and Dr. Kushner, in determining what needs to be done for an obese patient, from simply maintaining their current weight to recommending bariatric surgery. The Staging system is vastly superior to simply using BMI for discussing health and weight with fat folks, as it looks at whether or not a person is actually healthy or not, not just what they weigh vs. how tall they are.
Associate scientific editor Dr. Roger Ladouceur asks, in an accompanying editorial to the debate in the CFP, "Why do we repeat, ‘You should lose weight’? What’s with that? Somewhat sadistic, don’t you think? Do we do this as a way of shifting the guilt and transferring the responsibility of the therapeutic failure?" I think that's likely part of it. It must be very frustrating for doctors to have an obese patient who, despite both their best efforts, can't lose weight. It *must* be something the patient is or isn't doing, right? Wrong. If it *was* as simple as 'calories in, calories out' and long-term lifestyle changes, things like Weight Watchers and Jenny Craig WOULD be effective in 'treating' obesity (It's laughable to me that Dr. Garrel actually suggests that people who can't afford a multidisciplinary team of doctor, nutritionist and kinesiologist simply be referred to those kinds of programs!). But we don't know how to make a fat person thin anymore than we know how to make a thin person fat, so the continued focus on weight instead of health really needs to go. It's heartening to see that there are some doctors out there who are ready to make that mental leap.