I’m not a diet doctor or a weight loss doctor. I focus on understanding who people are, why they tend to gain (or re-gain) weight, and what we might be able to do about it. I work together with patients to understand and address the specific drivers of their weight gain; build skills, knowledge, and perspective; and find a reasonable and sustainable path forward for long-term management of weight and health (and happiness, though I know that sounds a bit “new age-y”).
In my view, there’s several problems with typical “diet doctors”:
- Diet doctors tend to to have a “magic bullet” that they aim at every patient who steps into their office. Magic bullets include special diets, surgery, pills, potions, hormones, fasts, supplements, and the like. While any of these can be useful tools, none of these are magic bullets that will solve the obesity epidemic – if they were, we’d have solved it by now. And none of these work on their own for very long. Any of these potential “tools” should be used as part of a strategic, scientific, and humane approach to addressing the patient as a whole person.
- Diet doctors tend to focus exclusively on weight loss. At best, this is a short term goal. Nearly all of us have lost weight, only to re-gain it over time. Of course, weight loss is important at times, but it’s only a small piece of the “big picture.” Long-term weight management is a “marathon,” yet diet doctors, the weight loss industry, and the media tend to focus only on the “sprints” – the diets, the pills, the before/after pictures, etc. The rest of the marathon, however, is far more important in managing and maintaining weight and health.
- Diet doctors tend to focus on huge amounts of weight loss, probably because that’s what garners big headlines and brings people in the door. But large amounts of weight loss are relatively rare – and rarely necessary to improve health. Studies show that fairly small amounts of weight loss can be enough to significantly improve health and prevent disease. Of course, larger weight losses are possible, and sometimes preferable, but any large weight loss must necessarily start with a smaller first step. When huge weight loss is sold as the sole goal and expectation, far too often we will be let down.
- Diet doctors tend to focus exclusively on weight. But weight is usually a symptom of an underlying cause. Simply treating weight may only mask the problem temporarily, and ultimately result in weight regain. In fact, concentrating on weight itself is a misguided goal that suggests to patients that we simply need to work harder – ie, have more “willpower” – in order to succeed at weight management. Most of the patients I work with have more than enough “willpower,” and yet still have had trouble managing their weight. Addressing the underlying drivers of weight gain must be a central piece of the puzzle.
- Diet doctors tend to put the onus entirely on the patient. While we all – the patient, the doctor, the dietitian, the family, the society, etc – have a place in the prevention and treatment of obesity and weight disorders, any discussion of treatment must start with the unhealthy food and activity environments that surround us. We live in a society that virtually guarantees weight gain over time. We should anchor any discussion or treatment of weight problems with this understanding.
- Finally, and most unfortunately, many diet doctors are fraudulent and dangerous. Some aren’t even doctors. The obesity and diet industry today is still a sort of “Wild West” in which all sorts of peddlers and practitioners prey on people’s hopes. It’s sad.
Diet doctors can be incredibly counter-productive, even dangerous. They often concentrate on the wrong things. We need more doctors who specialize in an appropriate, evidence-based, and humane practice of weight management, not more diet doctors.