Heavy subject

Harping on people ad nauseam to lose weight is rather "sadistic," there's little evidence treating obesity works and even the benefits of weight loss are debatable.

In arguments such as these, being played out in the official journal of the College of Family Physicians of Canada, doctors are debating whether it's futile to try to treat obesity.

"The few patients who manage to lose weight and keep it off achieve something truly remarkable. From a public-health standpoint, however, the treatment of obesity is a failure," writes Dr. Jana Havrankova, of Clinique familial Saint-Lambert in Quebec, in the current edition of Canadian Family Physician.

One weight-loss drug after another has been pulled off the market over serious harms, and the long-term effects of existing treatments remain controversial, adds associate scientific editor Dr. Roger Ladouceur in an accompanying editorial.

"Why, then, do we tell our patients to lose weight?" he asks.

"Why do we repeat, 'You should lose weight'? What's with that? Somewhat sadistic, don't you think? Do we do this as a way of shifting the guilt and transferring the responsibility of the therapeutic failure?"

The statements, observers say, reflect a remarkable and possibly significant shift away from the prevailing medical dogma that everyone who is obese needs to lose weight.

No one is claiming obesity is harmless. Havrankova said the evidence of obesity's health-damaging effects is "irrefutable" and the costs to society and individuals "astronomical."

Yet, "there is very little evidence that the treatment of obesity works," Havrankova said. Of the studies done, most are of mediocre quality and, for the small percentage of patients who succeed, the weight loss is modest and gradually regained over time.

"For every individual who wants to lose weight, I maintain hope," Havrankova stressed. But prevention, starting in early childhood, "offers the best hope in the fight against obesity," she said.

In his editorial -- Should we stop telling obese patients to lose weight? --Ladouceur said the genetic, environmental and societal factors linked to obesity are "deeply rooted" within us. "It is very difficult for us to change."

Given that, he asked, "Shouldn't we put a stop to this preoccupation with our patient's weight" and simply encourage healthy lifestyle habits, including a balanced diet and exercise, "even if it is simply walking?"

The debate reflects a "clear departure" from the message patients typically hear, said Dr. Arya Sharma, professor of medicine and chair in obesity research and management at the University of Alberta, and scientific director of the Canadian Obesity Network.

"It's moving to a point where we are becoming much more realistic -- simply telling people to lose weight and leaving them pretty much up to their own resources is not the way to go," he said. "We have to be much more reflective: For whom is there really likely to be a benefit?"

Sharma's group says any discussion about weight must begin with the doctor first asking the patient's permission. It's one of the cornerstones of a new road map for doctors the network is launching today. Called the "5 A's of obesity management" -- ask, assess, advise, agree, assist -- the checklist is designed to help doctors and other health-care workers broach the subject in a sensitive and non-judgmental manner.

Today in Canada, being overweight and obese are the new norm. There are more overweight Canadians than there are those of "normal" weight.

-- Postmedia News

Republished from the Winnipeg Free Press print edition May 22, 2012 B6