“Obesity is a choice” is the biggest misconception we tell ourselves and our patients. Read any of the genetics or neuroscience of obesity literature, and you would quickly rid yourself of this concept. Ignorance remains an obstacle to progress.
Notably, personal responsibility still matters. It is the difference between learned helplessness and learned optimism. You do not have to be a victim. And we could do all this while appreciating that some aspects of our environment and biology are outside of our control.
Being lean is a privilege much like never suffering from cancer, Alzheimer's disease, etc. Congratulations to those who benefit from the ideal combo of genetics and environmental factors. Personally, it has never been hard for me to lose weight. For others, that is not the case.
A lot of people are struggling to understand the concept of obesity as anything other than a choice.
Why you should consider a career in Obesity Medicine:
Reason #1: Essentially No Call
Yes, I occasionally have to decrease insulin because a patient’s glycemic control is improving too rapidly. I know! It’s a terrible problem to have.
Reason #2: Medication Deprescribing
How many of you get to routinely stop BP, Diabetes, antidepressants, and pain meds? Deprescribing is the new prescribing.
Reason #3: Highly Rewarding
When a patient loses weight for the first time in years. When you stop their pain meds because their knee or back stops hurting. When you throw away their CPAP because they no longer have OSA. These shared moments are special.
Anecdotes are empowering and even intoxicating for most. If you lose 100+ lbs, change the trajectory of your health, and have increased vitality it may seem like a natural step to share your miraculous discovery with others. The reality is...
2/ biological systems are complex and individuals are unlikely to respond in the same way as YOU. How do we know? We have studied it. When you look at the variation in response across different wt loss interventions, it looks something like this...
3/ Some lose a small amount of weight
Some lose a LOT of weight (maybe like you)
Some lose NO weight
Some GAIN weight
This is why we study these things and perform the scientific method. Just like in TV disclaimer: INDIVIDUAL RESPONSES MAY VARY. (gotta love @ethanjweiss' plot)
There is a stronger evidence basis for calorie counting as a core behavioral strategy for reducing food intake than “eating to satiety.”
Eating foods that reduce the risk of overeating and promoting satiety and less hunger is impt but this is an unproven behavioral strategy.
The reality is appetite is complex; regulated by a number of factors acting on two neural circuits. Also, we know people can eat past satiety given higher level neural circuitry involved in the complex regulation of feeding. But, hey, people like oversimplifying things. 🤷🏼♂️
People struggle to be healthy in an OB environment, and w/o monitoring, typically overeat without knowing. Calorie counting serves as a way to self-monitor and should not be viewed as an "exact science." People pushing this narrative have no idea what they are talking about.
1/ In honor of #WorldDiabetesDay2020, and to directly address two significant public health threats of the 21st century, I want to discuss very-low-energy-diets and low-energy-diets as a potential treatment for obesity and T2DM. [thread]
2/ Total Diet Replacement (TDR) strategies have been extensively studied and found to be an effective dietary intervention to promote a Calorie deficit and reduced food intake.
3/ I originally became interested in TDR interventions reading the many works of Dr. Thomas Wadden, demonstrating clinically significant short-term weight loss with VLEDs. [Tsai & Wadden, 2006]