FNCE: A Disorienting New Landscape in Obesity Care

For dietitians who have long been seeing people who want help with issues related to diet, weight, and obesity, the last few years in obesity care have been disorienting. The source of discomfort is simple. New medicines that offer tremendous help with the physiology of obesity have changed the landscape for the nutrition guidance dietitians offer. In multiple sessions at FNCE this week we see dietitians working hard to adapt.

In the old landscape, behavior change related to diet and exercise was everything. Surgery, though it is highly effective, was something that better than 90% of patients avoided like the plague. “I shouldn’t need that” and “You can do this yourself” were common and frustrating refrains from patients and too many clinicians.

But with better medical options, a lot of that thinking has turned upside down and many dietitians are not quite sure what to think.

Nutrition First!

Some dietitians seem a bit dazed by the rapid change in the landscape. This surfaced in questions for experts presenting at FNCE on clinical care that is complementary to medical obesity care. For example:

“With the normalization of weight-reducing pharmaceuticals, do you think we are setting unrealistic expectation of a healthy weight without addressing root causes of obesity?”

The common presumption is that the “root causes” of obesity are bad diets and inactive lifestyles. In the old, familiar landscape, the answer was always behavior change. But scientists will tell you it’s not that simple. In the new landscape, many people are finding that medical care makes behavior change – in both diets and physical activity – more possible.

For dietitians more familiar with the old landscape, the dramatic rise in use of obesity medicines seems abnormal. Data on medical outcomes with these medicines is new and unsettling. The false dichotomy of diet versus medicine is at work.

People First!

If there is a point of consensus about the disorienting new landscape of obesity, it is that the patient should be at the center of decision-making. “One size fits none” said exercise physiologist Renee Rogers in an excellent session yesterday. Her point is that clinicians should be person-centered, not method-centered, in their approach to obesity care.

This echoed in conversations with dietitians who once rejected all medical and surgical obesity treatment. Some of those same dietitians are now describing a more patient-centered approach. “I have clients for whom these medicines have been life-changing. I have others for whom they were useless. So I try to meet my clients where they are.” From someone who once treated the word ob*sity as an epithet, those words were surprising to hear.

So if this is evidence that new and better options for obesity care are bringing a change in old, hardened attitudes, then we are all for it.

Click here for the perspective of the Academy of Nutrition and Dietetics on the role of RDNs in obesity care and here for the Academy’s position on medical nutrition therapy for adult obesity.

Navigating Obesity Care at FNCE, photograph by Coleen Dawkins, FNP-C, RDN, CSOWM

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October 8, 2024