justthestupidparts asked:

When you became a doctor, did you not swear an oath to, among other things, try to prevent disease as much as treat it? Refusing to advocate weight loss to obese patients breaks that oath; how do you justify continuing to practice medicine? Serious question.

agreekdoctor answered:

First of all, I apologize for taking so long to answer your post. When I received it I was still out of town. Second, I wanted to write something thoughtful and I needed time to not write something out of anger. Anger that you would accuse me of doing harm by not mindlessly insisting on weight loss as the ultimate solution to a fat person’s health problems.

To start with I would like to state that I do not refuse to advocate weight loss, where it is appropriate to do so. I assume that you are operating on the false assumption that being fat automatically makes a person unhealthy. I can assure you that it does not.

"But, what about the obesity epidemic? What about the diabetes epidemic? But what about…?" I hear you ask.

There are lots of illnesses that have been statistically correlated with being fat. But the thing to understand is that correlation does not equal causation.

Lets use Type 2 diabetes and fatness as an example. Diabetes type 2 is an illness of insulin resistance. That means the body requires more insulin to produce the same sugar lowering effect than a nondiabetic body would need. Insulin is produced by cells in the pancreas called beta cells.

Contrary to popular belief, people don’t just go from being nondiabetic to diabetic overnight. Rather there is a process that occurs. We have found that there are differences in a person’s beta cells that happen long before a person even begins to show signs of insulin resistance. Many people who go on to become type 2 diabetics will have higher levels of insulin circulating in their bodies for years before they even become prediabetic. One of the other functions of insulin in the body is to promote the storage of excess energy as fat. So, insulin makes people fat, and keeps people fat (makes it harder to lose weight).

Can you see where I’m going with this? The question now becomes, are people diabetic because they are fat? Or are they fat because they are diabetic? This is an extremely important distinction to make.

When I see a diabetic person, fat or not, I tell them to make sure they get plenty of exercise and to watch what they eat to control their carbohydrate intake. What does this sound like? “Diet and exercise.” The difference is that I don’t tell people to lose weight. Many of my patients who follow this advice do in fact lose weight, and that is fine. Many of my patients do not. That is also fine. They all have better control of their sugars, and in most cases, to similar degrees. I fail to see how not insisting on losing weight is “doing harm.”

There are times when a person’s weight turns out to be a factor in their illness and where weight loss may help in treating it. In those cases, I do suggest some weight loss. But in NO case is it ever necessary for someone to get to their “ideal body weight” to help their condition.

Finally, let’s look at the idea of “doing harm.” Did you know that studies (link and link) have shown that the medical profession as a whole is biased against fat people? That there are countless stories about people having serious illnesses going undiagnosed because they are fat and doctors refuse to look beyond that? That fat patients stop going to their doctors after being repeatedly made to feel ashamed for being fat by their doctors? For trying so hard to lose weight but not being “successful?” That, to me is the real harm that is done. The psychological harm. The physical harm that results from not going to the doctor for a serious problem because the doctor will either ignore it or just embarrass them again.

Are you aware that the vast majority of people who lose weight are not able to maintain that weight loss over the long term? And that people can end up far fatter than they would have become otherwise due to the lose-gain cycle. That that cycle can also cause serious harm to a person?

I care about each and every one of my patients whether they are fat or not. Whether they are healthy or not. Fat patients get the same consideration given to their concerns as thin people. I don’t simply dismiss things because a person is fat or tell them that losing weight is the ultimate answer. If my medical work up indicates that losing a small amount of weight may help, then I suggest it. Otherwise, it is not necessary.

Finally, before you try to tell me about all the research that shows being fat is unhealthy, I have a few of links to lots of evidence-based medical research that shows that being fat does not necessarily make one unhealthy.


Link with lots of individual links to various studies.

And finally,

Another link to lots of individual studies.

Serious question? Serious answer.