In this MD Newsline exclusive interview with endocrinologist/obesity medicine specialist Dr. Rocio Salas-Whalen, we discuss what physicians should know about treating patients with obesity.
What should other physicians know about treating obesity?
Dr. Rocio Salas-Whalen:
“I think the first thing we need to do is educate healthcare professionals on obesity. Unfortunately, there’s still the thinking that obesity is a consequence of poor lifestyle choices. The concept of obesity has changed. We now consider obesity to be a chronic multifactorial disease, like diabetes, hypertension, and high cholesterol. We don’t blame the patient for developing these conditions.
We have to see obesity the same way. We cannot keep blaming the patient or putting all the responsibility on the patient to lose weight. We have to treat obesity as a disease. By doing that, we can offer real solutions to patients. There’s no more, ‘oh, eat healthy, exercise, come back in 6 months.’ That was not working, and we’ve been doing that for years. Right?
What would happen was the patient would get frustrated, the physician would get frustrated, and then we stopped talking about it. We moved on to treating the complications of obesity: diabetes, hypertension, osteoarthritis—so many complications from obesity. But now, we can treat the source of these complications.
Unfortunately, there’s still a lot of stigma surrounding obesity treatment. I have patients who tell me, ‘oh, I feel like I’m cheating by seeking medical treatment for obesity.’ We have to change our thinking about treating obesity, and we have to start with the healthcare professionals.”
What do you mean when you say patients feel like they’re cheating by seeking medical treatment for obesity?
Dr. Rocio Salas-Whalen:
“They feel like they’re taking the easy way out to lose weight and like they’re giving up on things within their control. But what’s interesting is 80% of my practice as an endocrinologist and obesity specialist is obesity and weight loss, and most of my patients have the same story. By the time they come to me, they’ve gone through so much.
I always like to ask my patients, ‘how old were you the first time you thought about your weight, that you had to watch what you ate, or that you wanted to lose weight?’ I have patients that remember being 7 years old, 9 years old, or going through puberty when they first had those experiences. So they’ve struggled their whole life. They’ve done diets, extreme exercise—everything under the sun—with no results.
That’s why patients feel like, ‘maybe I should keep trying harder. Maybe I should go on another diet. Maybe I should try some other form of exercise.’ Now, they’re accepting the medication, but they’re still having some trouble letting go of the idea that maybe they could have controlled their weight themselves.
Lifestyle choices will always be a part of weight loss and weight loss maintenance. But lifestyle choices on their own are not enough to achieve weight loss and weight loss maintenance. Other factors—genetic factors, environmental factors, food industry factors—heavily contribute to obesity, and these are factors that patients don’t have control over.
It can be very liberating for patients to hear about the contributing factors of obesity that are beyond their control [and the need for medical treatment for obesity].”
Responses have been condensed and lightly edited.