Nicholas Bakalar has a good article about physicians’ efforts to encourage patient weight loss in the New York Times “Science Times” section. Bakalar is one of the most careful writers at the Times when it comes to avoiding flashy medical findings that aren’t likely to hold up, as well in making a point of looking for and clearly reporting on the limitations of the studies he covers. You wouldn’t think those would be unusual traits in science journalists, and especially in Times reporters, but they are. (I should also mention I’ve met Bakalar a few times and consider him a friend, but my admiration for his work pre-dates my knowing him.)
Bakalar’s piece makes two important points: physicians normally have little luck in getting patients to lose weight, and physicians tend to have more impact when instead of trying to push a patient into losing weight they instead work with the patient to try to figure out together what to do about the problem. I’ve been researching both of these issues for my ongoing obesity projects, and Bakalar’s article is spot on with regard to both of them. I’ve asked dozens of physicians how many patients they’ve managed to convince to lose weight, and the answer is pretty much always just about zero. And the idea of working with patients to come up with an appropriate plan that focuses in part on helping patients to recognize and deal with their lack of motivation, and in part in figuring out what actions can be taken that are realistic for whatever level of motivation they have, is a critical part of a behavioral approach to weight loss. Something I’ll be saying a lot more about in this blog and elsewhere is the fact that the behavioral approach, while backed by a lot of evidence, made famous by Weight Watchers and pushed by many highly credible experts and public health officials, is largely ignored by most of the overweight public as well as by most physicians and obesity researchers–and I think it’s a big reason we keep getting bigger.
Separately, here’s a piece, this one in Canada’s Globe and Mail, that hits on a another point I’ve become very interested in: the terrible job that people and devices do in measuring calories burned when exercising. I’ll have more to say about this soon.
David H. Freedman 