Dr. Arya M. Sharma has a thought-provoking article on KevinMD today in which he asserts that it’s unethical for doctors to tell you to lose weight.
Yes, he’s a doctor.
He distills his reasons down to several points we’re already familiar with. Namely:
- Doctors are often insensitive, and present their recommendation in such a way as to drive patients away.
- Doctors are relatively clueless in the advice they give. Instead of taking an evidence-based approach, they repeat the calories-in, calories out and move more, eat less nostrums.
- When the doctors advice doesn’t produce results, patients begin to distrust their doctors.
Again, this is hardly new to any of us. But he continues with an assertion that took me aback:
Believers in “evidence-based” medicine should listen carefully: there is to date no evidence whatsoever that intentional weight loss (short of bariatric surgery) will lead to a reduction in “hard” outcomes (heart attack, stroke, death). Any evidence on health benefits is limited to improvements in surrogate measures and risk factors or to “soft” outcomes like quality of life. While these are certainly important, we need to realize that any promise of a longer life with weight loss is premature and not based on any hard outcome trials.
I’m certainly intrigued by this assertion, as it is antithetical to everything I’ve been told: losing weight will prolong life in the (formerly) obese. I have a hard time accepting this, yet I’m also aware of various paradoxes that suggest overweight people fare better with some diseases than their thinner counterparts. Examples of this include the Diabetes Paradox, the Heart Paradox and the Kidney Paradox. Could these paradoxes be the flip side of Sharma’s assertion that there’s no evidence that weight loss leads to longer life? If so, is it unethical for your doctor to tell you to lose weight?
Resources:
- Why weight loss advice may be unethical, Arya Sharma, MD. Sept. 4, 2012. KevinMD.com
- Who Says Americans Are Too Fat?, Daniel Heimpel. August 26, 2009. Newsweek.
- There May Be An Obesity Paradox In Diabetes. August 9, 2012. Reuters.
