Any social media platform can boast an abundance of practical health and weight loss recommendations, whether scientifically accurate or not. Many professional athletes and companies are eager to sell their plans for a premium price and advertise them to the public heavily. Unfortunately, U.S. medical education cannot boast the same dedication towards confronting the obesity epidemic. By the end of my first year of medical school, I had only two lectures that included a slide or two on obesity and weight loss. How can this be, knowing that obesity is an epidemic in the United States with high prevalence, morbidity, and mortality rates? As a first-year medical student, I could sooner diagnose many obscure genetic disorders than I could confidently address a patient, family, or friend about weight loss. Having finished 17 years of education, I expected to have heard some sound advice on this matter. Such was not the case, and it needs to change for future medical students.
Before medical school, I worked as a scribe for four fellowship-trained orthopedic surgeons in a private practice office. I admired each physician’s clinical acumen and mastery of their respective specialties. As time went on, I noticed that each doctor counseled patients on weight loss differently. One might have recommended a calorie deficit, another might have suggested a reduction in carbohydrate intake, and still, another may have recommended intermittent fasting, each insinuating their own interpretations of the science of weight loss. I admire them for at least addressing their patients’ weight and endeavoring to help them. However, I left this experience wondering why these expert clinicians all had a different understanding of the same medical problem.
If current trends persist, I predict that the advice patients in America receive on healthy eating habits and weight loss will become more discrepant before becoming more coherent. Changing curricula, expanding scopes of practice for mid-level providers, pseudoscientific Netflix documentaries, and the spread of faulty health advice social media will all contribute to growing confusion surrounding the question, “How do I lose weight?” More adults and kids are overweight or obese now than at any time in history, and it is not getting better. I believe that it falls within the responsibility of physicians to combat this plague of misinformation surrounding weight loss and advise on the matter with authority and knowledge, regardless of specialty. As leaders and future health care team leaders, we need to dial this in and get all medical professionals on the same page about weight loss. In short, we must medicalize weight management, displacing it from the discretion of nonprofessionals and pseudoscience. Furthermore, we must include diet, nutrition, and weight loss to a much greater degree in medical education. Failing to do so is to do harm.
Fatty liver, insulin resistance and Type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, stroke, sleep apnea, gallbladder disease, hyperuricemia and gout, osteoarthritis, and mental health issues are among the many comorbidities accompanying obesity. Any deviation from healthy weight status should be a red alert for clinicians at every level of practice because of the complications that will arise when a person reaches obese status and should be promptly addressed. When framed like this, the question becomes like any other diagnosis and treatment—how do I help this person return to a healthy weight? What is the official recommendation? At this time, though, there is no official recommendation that all clinicians are aware of and are ready to prescribe.
Just as important as losing weight is counseling a patient on how to avoid gaining weight in the first place. Because of the widespread discrepant health and nutrition information abundant in our society, my observation is that most people no longer trust or no longer follow the 2,000 calories per day recommendation from the food and drug administration. Few take it upon themselves to understand basal metabolic rate and take it into daily caloric considerations. Paramount to this discussion is that most people do not adhere to a diet for longer than seven days. We need specific scientifically proven recommendations for preventative nutrition and exhort strict, sustained dietary adherence of our patients. Perhaps this should be taught on day-1 of medical school, acknowledging that many medical students live a sedentary lifestyle and gain weight throughout their tenure.
In his article, “The Obesity Pandemic—Whose Responsibility? No Blame, No Shame, Not More of the Same,” Dr. Elliot Berry asserts that comprehensive programs dealing with obesity require coordinated actions at nine levels of involvement—national, food system, educational, medical, public health, municipal, societal, parental, and individual. I assert that to best fulfill our role as physicians or future physicians, we need to implement sound recommendations and integrate more nutrition education into medical curricula, thus standardizing a cohesive approach to addressing weight loss. Anything less will result in more of the same.
Kevin Seely is a medical student and can be reached on Instagram @Kevinseelymed.
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