Obesity Treatment: One Size Fits All Is Rubbish

What would you think of a doctor who gave everyone with heart disease a stent for their coronary arteries? Or surgery for every cancer? But when it comes to obesity, possibly most doctors follow a similar strategy. The common refrain:

“You need to balance the calories you consume with the calories you burn. Let’s work on your diet and your exercise.”

This isn’t a bad start. It’s what you’ll get from the rare doctor who bothers to deal with the subject of obesity. The more common response is silence.

But that opening line becomes a corrosive platitude when it’s all that a physician has to offer.

Increasingly, obesity researchers and clinicians are coming to appreciate a wide ranges of different types of obesity that respond in distinct ways to different treatment strategies. One person might respond very well to an intensive dietary intervention. Another might not respond without an obesity medicine that fits his or her physiology. Sometimes drugs for other conditions — like diabetes — require adjustment. Some people respond brilliantly to bariatric surgery.

Scott Butsch made this point in an interview with the Boston Globe this week. He introduced the reporter three patients who were each successfully treated at Massachusetts General Hospital. Each of them required very different treatment to find their success. Butsch is an obesity medicine physician at the MGH Weigh Center and a key member of the Obesity Society’s Advocacy Committee.

Unfortunately, the experience of most patients doesn’t match that experience. When patients don’t respond to relatively superficial nutrition advice or self-help strategies, they often get more of the same. Or their physician drops the subject.

Research promises to identify better ways of matching people with treatment strategies that will address their particular form of obesity. But even today, patients who aren’t getting the help they need can seek out an obesity medicine physician.

You can find a directory with all 842 of them at http://abom.org/diplomate-search/. There’s no reason to settle for less.

Click here to read more in the Boston Globe and here to read more about different kinds of obesity.

One Size Fits All? Photograph © Christer / flickr

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