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DIY Obesity Care, Self Blame, and Quality of Life

Two new studies in Obesity point to a big opportunity lost for people living with obesity. Professional help with obesity can offer significant improvements in quality of life. And yet, 90% of the people who could benefit don’t get that help. DIY obesity care is the dominant strategy.

DIY Obesity Care

Stokes et al. Obesity Care Seeking BehaviorsAndrew Stokes and colleagues analyzed data from NHANES to get an idea of the choices people are making to do something about obesity. The dominant approach is self-help. More than half of all people with obesity (51%) try to lose weight on their own with no help from any health professional. Most of the rest either do nothing (30%) or see no problem (9%). Only ten percent seek help from any health profession and only four percent consult a doctor.

This research puts hard numbers on a familiar problem. Health professionals, for the most part, are simply not engaged in providing obesity care in any form. Part of the problem is financial. Health plans have been slow to pay for obesity care. Part of it is skills-based. Most health professionals lack the skills to provide the necessary care.

But the worst part of the problem is fat shaming. Anti-fat bias among health professionals remains strong. When the subject of obesity comes up, patients feel shamed and blamed. Helpful care is rare.

Missed Opportunity

DIY obesity care leaves people to try an endless parade of diets. It produces short-term weight loss, followed by regaining all of that weight in most cases. It leaves people feeling worse and worse about themselves.

But the second study, by Rebecca Pearl et al, shows that something as simple as intensive behavioral support can yield real improvements in the lives of people with obesity. People in this study lost, on average, a bit more than nine percent of their starting weight in a 14-week program. A year later they maintained most of that weight loss and enjoyed a significantly better quality of life.

People could function better physically. They felt better about themselves and experienced less depression. Interestingly, public distress (e.g., embarrassment related to weight) went down, but the effect was gradual. Unlike other measures of life quality, this dimension took time to improve.

Why this missed opportunity? As we’ve said, you can find many reasons. But what’s important is to realize that, even with simple measures, we can do better.

Click here for the study by Stokes and here for the study by Pearl.

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April 30, 2018

2 Responses to “DIY Obesity Care, Self Blame, and Quality of Life”

  1. April 30, 2018 at 8:18 am, John DiTraglia said:

    You can lament the dearth of medical treatment of obesity but the bottom line is admitting to our patients that you can’t lose more than 5-10% of your weight and expect to keep it off (without surgery). And while that is important metabolically, it is not something they want to hear or believe.
    Also no one should have to pay a lot for that “medical treatment.”

  2. April 30, 2018 at 8:35 am, Ted said:

    Of course, many people are conditioned to believe in miracles. “Maybe 23 and Me has the answer.”

    But I know plenty of people that whose lives and health have improved with modest weight loss and support for life-long health from professionals who understand obesity, as I know you do, John.

    The best we can do is help folks who want help, take away the barriers, stop telling people they “can’t,” and keep up the work on finding better answers. But first and foremost, we must stop the blame and shame.

    Thanks for thinking hard about this, John.