Thursday, February 11, 2016

Fat chance on that one

Dr. Yoni Freedhoff, noted blogger and practitioner around obesity, weighs in on a question deserving of heavy consideration.

Should MDs Measure Things That Shouldn't Change Treatment?

I'm not going to step on Dr. Freedhoff's toes too much here, since I'm not in the business of treating obesity (I'm not in the business of treating anything right now), but I am going to play Devil's Advocate.

Dr. Freedhoff is arguing that doctors need to reexamine the usefulness of measuring weight, BMI, and so on, and instead focus on the patient's lifestyle. We're in the business of trying to get people to live healthier lives, right?

There are serious problems with this line of thought. If we aren't trying to diagnose a patient's condition using some form of verifiable, objective, and (hopefully) treatable measure, what exactly are we doing?

I suppose providing general "healthy lifestyle" advice falls under the purview of medicine. But if we abandon objective yardsticks, at what point are we no different than priests, lecturing people on how to live their lives in the pursuit of a completely nebulous outcome (whether it's "better health" or "finding salvation")? If that's indeed the goal, what business does anyone, much less a doctor, have in taking on the role of "health priest"?

Setting aside the hypocrisy in that proposition (a box of donuts in a hospital staff room empties much faster than a vegetable tray), it's a slippery slope when doctors move away from the objective towards the subjective. It undermines the role of research evidence in clinical decisions, and makes other specialties of medicine as vague and hazardous as psychiatry.

Personally, I don't know where the obsession with obesity in medicine comes from, but it's systemic and out of proportion to the broader societal distaste for fat people. It's also something of a stain on the profession, because it's not like we have any remotely effective treatments for obesity as we do for other conditions. Ultimately, obesity by itself isn't as important as its effects on other diseases and other body systems. But, if we're going to label obesity a disease, it needs to be treated as such, and that means measuring, target-setting, and tracking. Otherwise, we might as well trade med school for a seminary.

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