Thursday, 22 January 2015

When "do no harm" can mean NOT talking about dieting

There has been much controversy in the nutrition and weight management world about the sometimes harmful role professionals can play when trying to help a client lose weight. Since doctors carry so much weight (so to speak) with their advice, it is extremely important that they give useful, easy to understand and sympathetic advice. By sympathetic I mean advice that takes into consideration their clients as people (not just bodies) who have limitations, feelings and are probably doing more for their health than they see. Obviously, it is also important to that doctors know their limitations in knowledge and make referrals. Knowing your limits can be harder than you think especially if you come from a background of an "all knowing" profession like medical doctors. This is where a lot of my frustration stems from- the "all important god" that is better known as your doctor who gives harmful and often wrong advice on weight loss. One big argument is the fact that the hippocratic oath may suggests that bad weight loss advice is unethical by actually doing harm to their clients.
Before I go further, I must state that not all doctors frustrate dietitians or give harmful advice to their clients. Unfortunately, I only hear the sad stories from my clients.

Recently I had a few clients who were (and I quote) "traumatized by what my doctor told me about the need to lose weight". I can only guess that the doc's goal was to motivate the client to lose weight (little did he know that she is already doing many things to try to lose weight...did he even ask her?). However, I wonder the usefulness of stating that "[she] would be better off as a drug addict than addicted to food". Yes- that is a direct quote from the client quoting her doc.

Firstly, being obese is vastly different than being addicted to food (which is not a well supported theory amongst eating disorder professionals) so he first assumed she was addicted to food (again, not a diagnosis as popular as say, binge eating) and secondly that being skinny while doing drugs is better. Is that really based on science? Will that advice really help her lose weight? All that encounter did was make that day the "worst day of [her] life" (another actual quote). Was that advice ethical considering she may turn to unhealthy ways to lose weight such as diet pills, fasting, or very low calorie diets? All of which may lead to binge eating, skewed relationship with food and body hate.

Not only do my clients already feel ashamed and hateful of their bodies, but they have to return to see their doctor for a follow up. It's no wonder that they are scared, anxious, preoccupied about the upcoming visit. I wonder if these feelings will help or get in the way of communication at their next appointment?? It was certainly something that got in the way in talking about nutrition at our session. I was more than happy to discuss the encounter since issues that influence eating is something we discuss (not just diet advice) at appointments. However, I can only imagine how frustrated my paying client felt after leaving our session with little spoken about the topics for which she sought advice.

Weight shaming and weight bias as well as misunderstanding the complexity of weight loss is something that is expected from the masses. NOT from educated health professionals.

My advice to my clients who bring these stories to our session is easier to give than to take- find another doctor. Not an easy task in this city or in Canada. If that's not possible, perhap a firm but polite acknowledgement that things are being taken care of in the weight loss area with the help of another professional, then asking the doctor to get back to what they specialize in practicing.

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