The Family Doctor János Plesch

AAFP, Weight Bias, and Misinformation About Obesity

AAFP LogoThis story is profoundly sad. We were reading about a recent decision by the USPSTF to affirm a broad recommendation for intensive lifestyle programs for obesity. The decision is a good one. Reporting on it by the American Academy of Family Practice (AAFP) unfortunately is not so good. AAFP presents the views of someone they label as an expert on the subject.

But that “expert” commentary presents serious bias and misinformation about obesity instead of facts.

Losing Weight Is Impossible

Family physician Robert Sallis says “it’s overwhelming to tell a patient they need to lose 60 pounds – it’s not going to happen.”

On one hand, wanting to avoid overwhelming a patient is perfectly reasonable. But on the other hand, assuming that significant weight loss would be impossible is false. One size does not fit all. Different people need different goals. Some patients really do need to lose 60 pounds or more. And with good obesity care, many people succeed.

Futility is never a good assumption.

Just Eat Healthy Foods

Sallis goes on to say that patients need to really focus on eating healthy foods. He recommends a high fat, low carb diet as the most sustainable, but says “any diet works.”

Of course, eating healthy foods is good advice. However, diets – defined as restrictive eating plans – usually don’t work well for the long term. Traci Mann explains this in detail with her 2015 book, Secrets from the Eating Lab.

A sound plan for healthy eating is a good thing. But by itself, it’s often not enough to protect a person’s health from the harm of obesity.

Medications Don’t Work

Sallis says anti-obesity medications “don’t make any logical sense” because when people stop taking them, they gain weight. By his logic, blood pressure and lipid lowering agents would make no sense either.

When you stop taking an effective medication for a chronic disease, the disease gets worse. Duh. Endocrine Society guidelines explain that anti-obesity medications help to maintain a lower, healthier weight.

Surgery Doesn’t Work and Too Many People Die

Sallis says he recommends against bariatric surgery because:

So many patients who have this surgery gain their weight back or have complications. In fact, I’ve had two patients die related to complications from bariatric surgery.

But objective data tell a different story. Bariatric surgery reduces the risk of death for people with obesity. And a large VA study shows most patients (97%) retained significant weight loss even after 10 years.

The Bias of an Exercise Enthusiast

Sallis concludes by setting up a tired, false dichotomy. “Regular exercise has a much more powerful effect on health than merely losing weight,” he says. Sallis is a professional expert on sports medicine and fitness.

Physical activity does indeed have important benefits. So does evidence-based weight management. These two concepts are complementary and not mutually exclusive.

Weight bias is not helpful in promoting physical activity and fitness. Unfortunately, fitness professionals tend to harbor strong bias against people with obesity. It’s tough to help people if you assume that they are bad and lazy.

We are deeply disappointed that AAFP packed so much misinformation and bias about obesity care into its reporting on new USPSTF recommendations for referring people to intensive lifestyle support programs. The USPSTF report is mostly a very positive document.

Click here for the AAFP report and here for the USPSTF draft recommendations.

The Family Doctor János Plesch, painting by Max Slevogt / WikiArt

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February 24, 2018

5 Responses to “AAFP, Weight Bias, and Misinformation About Obesity”

  1. February 24, 2018 at 8:57 am, John DiTraglia said:

    The USPSTF report is mostly a very positive document.

    • February 24, 2018 at 3:19 pm, Ted said:

      Yes it is, John. Thanks!

  2. February 26, 2018 at 2:34 pm, Walter Lindstrom said:

    Thank you for pointing out the flawed analysis of this so-called “expert” BUT you need to make a Comment on the AAFP site with a link to this detail – otherwise you risk preaching more to us choir members than to the AAFP docs and integrated health professionals who will be reading Sallis’ drivel.

    • February 26, 2018 at 3:47 pm, Ted said:

      Thanks, Walter. You’re right.

  3. February 28, 2018 at 1:14 pm, Ellen Jean Harman said:

    Walter is soooooo correct — how to get back to Robert Sallis? Woefully misguided – can you send him a copy of the studies you cite? thanks!