Bile Beans Keep You Slim

Is Weight Management Obsolete? Should It Be?

The trend among some dietitians is unmistakable. A number of dietitians today are very vocal in their doubts about the value of weight management. They certainly don’t believe in pursuing a goal of weight loss. They may or may not align themselves 100 percent with a social movement trademarked as Health At Every Size. But clearly, they have doubts about old ways of thinking about diet and weight.

So earlier this week, Arya Sharma – a remarkable expert in obesity care – asked a provocative question. Is there a role for dietitians in obesity management?

Poking the Bear

Naturally, this provoked some intense reactions. Online especially, people these days have sharp skills for expressing outrage. “I am appalled that another healthcare professional would slander our profession,” responded one irate dietitian. Another called Sharma “negative and elitist.”

It’s hard to listen to people with different points of view. In truth, though, Sharma was simply observing that some dietitians are uncomfortable in dealing with obesity as a chronic disease:

At times, in recent conversations, I was surprised (and concerned) that more than a few (younger?) dietitians are not only uncomfortable with addressing obesity in their clients. They are in fact ambivalent (if not frankly hostile) to the very idea that obesity is a disease. Or that dietary interventions to support weight loss have a role to play in obesity management.

Patient-Centered Care Grounded in Evidence

In thinking about these issues, dietitian Nina Crowley tells us they should not be so hard to resolve:

While I doubt any profession has 100% agreement on any topic, I am proud to see dietitians unite on two subjects. Against weight stigma and bias. In favor of patient-centered care.

Dietitians‘ training in evidence-based practice is consistent and strong. But we must remember that EBP includes provider experience and patient values. If we keep the patient at the center and utilize informed consent to relay the evidence about their options, use our own professional experience to guide our counseling to help patients meet their own freely chosen goals, then there absolutely is room for all RDs in working with patients in larger bodies.

An Excessive Focus on Weight?

To the extent that some dietitians have a concern about focusing on weight, they have a point. The focus can be excessive and cause great harm. Obesity is a chronic disease of excess adiposity. It’s the pathophysiology of adipose tissue that’s the core problem. Untreated, it can lead to diabetes, heart disease, liver disease, certain cancers, and many other health problems.

Excess weight is a byproduct. But that weight itself can cause some quite serious problems, too. Joint disease and limited mobility are two obvious examples.

Sharma wisely framed his question about managing obesity, not managing weight. Nonetheless, to manage obesity, one cannot ignore or exclude any consideration of weight. It’s part of an objective clinical assessment. It’s a concern for many patients.

Sharma is correct. If a provider can’t help a patient with weight management, perhaps they’re not prepared to care for patients with obesity.

Click here for Sharma’s commentary and be sure to read the diverse comments he received.

Bile Beans Keep You Slim, photograph © vgm8383 / flickr

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November 16, 2019