[cm2012]

Doctors telling patients they're fat doesn't help them get skinnier. The literature is pretty clear that in every double blind study, the category of medical advice or helping make nutrition and exercise plans leads to 0lbs average weight loss over 5 years.

[everforward]

No, but some people do need to be informed of how dangerous it is, and doctors can either prescribe weight loss medications or give a referral to a doctor specializing in medical and surgical weight loss.

Regardless, it’s something I would expect doctors to nag patients about, the same way my dentist nags me to floss.

[FeepingCreature]

Why, if there's proven to be no benefit?

[everforward]

The person I responded to said that there's no benefit to advice to diet and exercise. Presuming that's true (I doubt that there's 0 effect, and e.g. [1] would disagree), there are still benefits. As I mentioned, advice on dieting and exercising is far from the only tool doctors can reach for here.

There are medical options that doctors can prescribe (or refer to another doctor for a prescription). WeGovy/semaglutide, Adipex, HCG, good old adderall, etc. I haven't followed the space in about a decade so I don't know what's in and what's banned, but I'm aware there are a range of options there. I believe there are some outpatient programs as well, semantically similar to outpatient rehabs.

There are also surgical options that doctors can refer patients to a surgeon for. Laparoscopic bands, gastric bypasses, I think there's a third that I can't recall.

The incredibly sad issue is that doctors are sometimes forced to fall back on advice to diet and exercise because many of these treatments are contra-indicated with common comorbidities of obesity. Anesthesia can be very risky for patients with a BMI of 45 or 50, so they may need to lose weight the old fashioned way until they're at a weight where they can be safely anesthetized. Stimulants (adipex and adderall) are very effective at curbing hunger, but are contra-indicated by high blood pressure which is incredibly common.

I also believe there's a large segment of primary care physicians who aren't up to date on weight loss procedures, because they change fairly frequently relative to something like treating strep throat.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169796/#:~:tex... (

[kyleee]

It’s the right thing to do at the individual level. The doctor should be honest with each patient and every individual should be given the chance to act on that honest information, even if studies show that many people have difficulty overcoming weight issues on their own.

[lupusreal]

"Proven to have no benefit" in this case only means that most people won't lose weight after being told to. A minority will though, so doctors refusing to tell fat people to lose weight is a disservice to the few who stand a chance of making it. The rest should either be signed up for surgery, drugs, or written off as lost causes.