Doctors urged to treat obesity like any other ailment

[bananas]

Source: USA Today

There's no ideal diet that's right for everyone, but that shouldn't stop the nation's doctors from helping their heavy patients battle weight issues as aggressively as things like blood pressure, according to new obesity treatment guidelines out Tuesday.

<snip>

The guidelines are designed to help health care providers aggressively tackle the obesity epidemic. "The overall objective is quite a tall order: to get primary care practitioners to own weight management as they own hypertension management," says obesity researcher Donna Ryan, co-chairwoman of the committee writing these guidelines for the Obesity Society, American Heart Association and American College of Cardiology.

<snip>

"The gold standard is an intervention delivered by trained interventionists (not just registered dietitians or doctors) for at least 14 sessions in the first six months and then continue therapy for a year," says Ryan, a professor emeritus at the Pennington Biomedical Research Center in Baton Rouge. If this kind of intensive therapy is not available, then other types of treatment, such as commercial weight-loss programs or telephone and Web-based programs, are good "second choices," she says. The new guidelines are based on the latest scientific evidence from 133 research studies.

<snip>

Medicare began covering behavioral counseling for obese patients last year, and under the Affordable Care Act, most private insurance companies are expected to cover behavioral counseling and other obesity treatments by next year.

<snip>

Read more: http://www.usatoday.com/story/news/nation/2013/11/12/obesity-treatment-guidelines-weight-loss/3499171/

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This is an epidemic, and it should be treated as epidemic.

[TheDebbieDee]

1. I think this is the first step in making "lap band" and "gastric by-pass"

elective surgeries that are covered by most health plans......

[bananas]

2. The guidelines are diet and behavioral counseling. nt

[TheDebbieDee]

4. Currently diet and counseling are the guidelines....but guidelines can be changed.

[MADem]

5. A friend of mine had that lap band thing.

I just can't imagine going under the knife like that--better to just push away from the table.

[AngryOldDem]

7. Agreed, but for some it isn't that easy.

Back in the '80s, when all these surgeries will still pretty much unknown territory, a coworker had stomach stapling. She had been morbidly obese (she was in her early 30s at the time), and had tried every diet and medication under the sun. Nothing worked. This surgery for her was the last resort, and luckily for her she came through okay. She was off work for a long time, though.

But, my ex knew someone who had the lap band, developed an infection, and died.

These surgeries should be presented as the **absolute** last measure to fight obesity. And I'm glad to see that counseling is to be given along with the physical treatment. I had another friend who literally ate herself to death because of abuse issues she had growing up. She could have used that.

[MADem]

24. I'm not going to get into the business of counseling others to eschew the procedure.

If they have the need and the guts (pardon the pun) to let someone else cut into them, they should go for it, if that is what they want.

It's just not for me.

[CountAllVotes]

8. Agree

I have a friend that had this surgery done when it first came out and she's so very very thin ... worrisome as hell really.

I have not seen/heard from her for quite awhile now and I'm seriously wondering if she is ok.

She said she weighed over 300 lbs. at one time. Now she weighs about 110 if that ...

[Arugula Latte]

16. It's easy to say "just don't eat so much" but

as I understand it, a large percentage of the very obese are truly food addicts. I mean addicts in the sense of their brains function the same way that the brains of other types addicts do. Fighting addiction is hard enough in itself (there is a fairly low success rate), and compound that with the the problem is, unlike an alcoholic or a drug-taker or what have you, food addicts can't stop eating for the rest of their lives. They have to fight the food battle every minute of every day.

[TheDebbieDee]

17. For some people food is an addiction and they can't simply push away from the table.

You did know that, didn't you?

[MADem]

23. Well, I wasn't talking about other people.

I was talking about me. I don't care for surgery, and if I have a choice, I'll avoid it.

If anyone else wants to go under the knife, more power to them. I don't tell others what to do with their bodies.

[TheDebbieDee]

29. Lol !

[MissMillie]

9. Many (if not most) insurance companies already do cover those surgeries

And in a lot of cases the hospitals only perform them as part of a comprehensive program that includes nutrition classes and counseling.

[ejpoeta]

26. and you have to meet certain guidelines.

I had a friend who had it, and she was only allowed to because she had health issues on top of the weight. She is very thin now. My sister in law had the surgery and she had to go through all this stuff.... i think it took about a year. Plus you have to prove you can lose weight.... I think that is more to prove that you are serious and WANT to do the work. The surgery isn't all that there is... there is a lot of things you have to do along with it.

[MissMillie]

28. All of those things were true in my case as well

I think it was that you had to have a BMI of 40 or more, or 35 or more if you had co-morbities (sleep apnea, high blood pressure, etc.).

I had to lose 10 lbs before my surgery. And my process was 11 months from the first informational meeting I went to until the date of my surgery.

This was all 9 years ago. My insurance covered it.

I lost 150 lbs.

[Akoto]

3. I am young and obese due to my medication.

As a disabled person with severe chronic pain issues, my medications make life somewhat livable. Unfortunately, one of the pills can't be swapped out and has proven itself to be a cause of weight gain for me. I'm up into the obese range now, and am doing my best to diet, but my diet was already quite healthy to begin with (it has to be on all of those meds for the sake of your gut).

So, do you go off of the medication and lose the obesity in exchange for daily torture, or do you accept the weight and have quality of life returned in terms of the pain? It's a vicious circle with no great answer. I *can* say that, when I finally stepped on the scale and saw my weight, I was humiliated and am still embarrassed today. I'm more conscious of how people may look at me, when I was already walking around with a cane and a limp at my young age. Some of us aren't obese because we need to diet and stop cramming down boxes of truffles.

On the bright side, I recently saw my doctor - and her cardiologist husband by extension - for other reasons. My blood pressure was perfect, bloodwork was all ideal (cholesterol was spot on), EKG and ECG showed no problems. I seem to be doing okay in those respects. I'm just lugging around a gut much bigger than I'd prefer to.

[MADem]

6. They need to fashion meds to help you, without those side effects. nt

[Nine]

10. This could backfire.

No one wants to go the doctor and get a lecture about their weight. People may avoid going to the doctor just so they don't have to hear about their weight.

[diabeticman]

11. It isn't JUST an AILMENT there are more factors than that. Most people who are overweight happen

to be part of the poorest economic tiers of our society.


My wife is overweight and a lot of her problem are not only genes and poor metabolism but ever since she was a girl she has had to deal with a dollar that was stretched to it's max. She grew up in a single parent home in which her mother's income was the only money coming in and of course we have a large problem that isn't being address in this country Those who make too much to qualify for food stamps or any other assistance and YET don't make enough to make ends meet. My wife's body stores because it has gone on for so long not knowing when it will have a healthy meal and when my wife had to live on sandwiches. My wife isn't lazy. In fact a lot of overweight people aren't lazy.


Not to mention some places in the united states those in poor economic tiers cannot get the proper foods and a good price like a farmer's market.

Diet pills and shaming people aren't going to fix the problem.

[L0oniX]

12. "behavioral counseling" ...don't make me laugh.

[AngryAmish]

13. The problem is many obese people deny that they have a problem.

Would people with thrush say that this is perfectly normal and not a problem? No they don't. But obese people say that they are perfectly healthy and it is society that is the problem.

Watch this video:

This woman insists that she has a low metabolism yet she ignores the evidence.

Bottom line: we believe what we want to believe the majority of the time. And getting people to eat less is very difficult.

[madville]

14. Many that claim to "eat healthy" are far from it

Carbs make me gain and hold weight: bread, rice, pasta, potatoes, fruits, sugar, etc.

I easily maintain and lose weight with moderate exercise and by sticking to a primarily meat and veggie diet. I start eating carbs like those listed above and I swear I can feel myself getting heavier and more sluggish.

I have a family member that is obese and swears she "eats healthy". She considers "low-fat" to be healthy, the problem with that is everything "low-fat" is typically loaded with carbs/sugars. Low-fat ice cream, crackers, chips, cookies, etc are still loaded with tons of calories and you can't eat the whole box in one sitting and call that healthy because it has "Heart-healthy" or something on the label.

[AngryAmish]

15. I could eat my weight in bread and potatoes daily

Yet I don't because I'd be 500 lbs

[PasadenaTrudy]

19. There are many factors

There was a study reported in the NYT last week linking gut bacteria to obesity. In the meantime, this...

http://www.fatnutritionist.com/index.php/the-third-option/#respond

[Nine]

20. I don't believe that.

I think most overweight people - especially overweight women - are painfully aware of it. Your posts in this thread seem very judgmental to me.

[laundry_queen]

25. +1 nt

[PasadenaTrudy]

18. I love this nutritionist's approach

Very sane and no fat shaming...

http://www.fatnutritionist.com/index.php/real-food/

[Elmergantry]

21. Epidemic my (fat) ass

The Plague was an "epidemic"

Shoveling too much food in your mouth is not something you contract.

I'm overweight. I also have slow metabolism and take a pill for it. but I'm not using it as an excuse.

I like food and I each too damn much of it.

So there!

[flvegan]

22. By teaching and promoting nutrition?

Oh, no. Sorry. Forgot we were talking about a demographic (doctors) that doesn't know shit about the topic.

[Nine]

27. Heartbreaking piece I just found through one of the upthread links:

http://kateharding.net/2007/07/12/fat-hatred-kills-part-one/

So when I was about 11 years old, and Mom went to see her doctor because of some problem she was having, and he scathingly told her that her problem was she was fat, and not to come back to him until she’d lost 50 pounds? Yeah. It hurt her. It hurt her bad. But she believed in the rules. And so she tried to ignore how hurt she was and focused on trying extra-hard to get back to following those rules.

...

So, having been unable to meet her doctor’s demand that she lose 50 pounds, she followed the only part of his stated rule that she could: she didn’t go back.

From that point on, whenever she got sick or injured and someone suggested she go see a doctor, she brushed them off. “Oh, they’re just going to tell me I’m too fat. Don’t worry, it’s just a cold/a sprain/a whatever. I’ll be fine.”

To be fair, that’s not to say she never went back again. She did. But only when she had to.

...

So Mom made the appointment and went, but she took all her fat-shame with her, and did her best to at least mitigate the awfulness of her sin — that she hadn’t lost 50 pounds, and in fact had gained some more besides — and she was going back to the doctor anyway. So she tried not to take too much of their time. Went in with a probable diagnosis at the ready, even, thanks to her daughters’ histories of asthma. She didn’t want to bother them too much, you see, even though by then it had been two decades since her last physical. She thanked the doctor when she got the prescription for the inhaler, and never called back when it sometimes didn’t work, because she didn’t want to take up their valuable time on a rule-breaker like her.

...

She spent her last two days in pain, having difficulty breathing, and not once did she call a doctor or try to get some help.

You see, she still hadn’t lost that 50 pounds.

I know people like this. I know someone diagnosed with high cholesterol years ago, which runs in her family. She's not on medication because her doctor said something like, "Let's try diet and exercise first before we put you on statins." She was never able to modify her habits to her level of satisfaction so she never went back. She didn't want to go back as a failure. After all this time she's still hoping that someday she'll have gotten herself into a good diet and exercise routine and then she'll be able to go back to a doctor and get those statins and be able to say that, yes, she tried diet and exercise, so that's not to blame for her cholesterol problems.

[avaistheone1]

30. k&r