Weight loss: doctors provide ineffective advice

The Oxford researchers examined 159 audio recordings of consultations between obese people and general practitioners.

They found that during consultations, the advice given by doctors rarely included effective methods for losing weight and, in the majority of cases, involved telling patients to eat less and exercise more.

Lauri Wright, PhD, director of the Center for Nutrition and Dietetics at the University of North Florida and president-elect of the Academy of Nutrition and Dietetics, says the results are not surprising.

“Working in a hospital for over a decade, you understand that healthcare in our country is all about disease rather than prevention,” she told Healthline. “There’s so much to teach in medical school that many don’t even offer nutrition in the curriculum. Additionally, practicing physicians rarely have time to counsel patients on behavioral and lifestyle changes.

The researchers reported that superficial advice was common, with suggestions such as someone needing to “change their lifestyle a bit”. Only 20% of consultations saw doctors advising patients on how to achieve weight loss.

The researchers found that when doctors offered specific weight loss advice, it was often not backed by science and unlikely to result in actual weight loss. Advice such as making small behavioral changes and taking the stairs more is not supported by research, the researchers said.

Dr Kurt Hongan internal medicine expert specializing in obesity, metabolic diseases and other nutritional disorders at USC’s Keck Medicine in California, says the advice given to patients should be practical.

“You don’t make someone who doesn’t exercise go from zero to five times a week. Whereas if you tell them to start once or twice a week…when they feel like it’s under their control, they’re more likely to do it,” he told Healthline.

“When it comes to specific recommendations, it’s not about what’s ideal, but what’s practical. When it comes to diet, unfortunately, there is a lot of bad information,” Hong added. “Some doctors think the only way to lose weight is to follow a ketogenic diet or cut out all carbs. Today we know that’s absolutely not true. You can have plenty of healthy carbs, as long as you are able to be selective by making sure you avoid some of the processed carbs and added sugar.

Experts say even a brief chat with a doctor about weight management can be effective.

However, doctors report a number of barriers to conversation. They include uncertainty about the best advice to give and a lack of knowledge about effective weight loss strategies.

The researchers identified that a common weight loss myth was that patients needed the “right mindset” to lose weight.

Dr Michelle Hauserthe director of obesity medicine for the Medical Weight Loss Program at the Stanford Lifestyle and Weight Management Center in California says that kind of language is problematic.

“There’s a huge problem with the obesity bias, this idea that it’s someone’s choice to be overweight or obese, and that’s really classified as a disease. Like heart disease is a disease or cancer is a disease, obesity is a disease,” she told Healthline. “We wouldn’t expect people to just have the right mindset and treat their heart disease or cancer.Likewise, we should use science, research and evidence-based treatments for obesity, as we would for anything else.

When it comes to practical tips for losing weight, experts who spoke with Healthline say an individualized approach is needed that takes into account the obese person’s situation.

“You don’t become obese overnight, nor can you lose all the weight overnight. Obesity is multifactorial and just following a restrictive diet alone is not very effective,” Wright said.

“To be successful, you have to identify the factors that contribute to weight gain and help the patient restructure behaviors to achieve a healthy weight. This ideal scenario would combine nutritional counseling and education with behavior modification and lifestyle change,” added Wright.