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Some doctors have stopped recommending weight loss. Here's why


For years, weight has been used as a measure of health in doctors' offices. Higher BMIs are correlated with heart disease, diabetes and other conditions. But as more research has emerged about how hard it is to keep weight off without medications and how harmful weight stigma itself can be, some providers are moving away from focusing on the number on the scale. From member station KUOW in Seattle, reporter Eilis O'Neill has the story.

EILIS O'NEILL, BYLINE: About five years ago, Sarah Barak badly tore a ligament in her thumb and needed surgery to get it reattached. But when she went in for the operation, she got some unsolicited advice. The surgeon said she should lose weight, suggesting her size and her injured thumb were connected.

SARAH BARAK: He was making the argument that, like, my posture was affecting my arm pain and that my posture was made worse by my size, all of which could be true. But I still had a disconnected thumb. And even if I lost 100 pounds, the thumb would not have been reattached on its own.

O'NEILL: Patients with larger bodies often report that when they go to the doctor, their problems are ignored or written off as an inevitable result of their weight, and they're given suggestions for diets and lifestyle changes they've already tried. Research has found that some people avoid or delay health care because of that. Barak says she's assertive about advocating for the care she needs, but it's draining.

BARAK: It's freaking exhausting. And frankly, not everyone can do it.

O'NEILL: Experts also say providers sometimes miss diagnosing major health problems because they're so laser-focused on a patient's weight. These harms are a reason that a growing number of providers are shifting to a new approach, often called weight-inclusive or weight-neutral care. Dr. Tess Moore is a family medicine physician in Seattle.

TESS MOORE: These are our exam rooms.

O'NEILL: Moore's done her best to make her clinic feel comfortable for people of all sizes. Every exam room has an array of blood pressure cuffs for different-sized arms, and the chairs and exam tables fit all patients.

MOORE: We always have our gowns of various sizes, speculums of various sizes and...

O'NEILL: In June, the American Medical Association started recommending providers look beyond BMI when measuring a patient's health. The new policy says to consider factors like genetics, blood sugar levels and where there's fat on a patient's body. But Moore and other weight-neutral providers go much further than that.

MOORE: We don't recommend weight loss as a way of treating medical conditions.

O'NEILL: Doctors who take a more traditional approach often tell their patients to exercise more and eat better in order to lose weight. What Moore tells her patients is that exercise and healthy food are good for them, regardless of whether or not they lose weight. She says that focus on the inherent benefits of exercise can help people start and stick with a routine.

MOORE: We recommend moving your body in a way that's sustainable, which hopefully is joyful, eating food in a way that nourishes.

O'NEILL: Moore says if, after those conversations about exercise and nutrition, a patient still really wants to lose weight, she cautions them they're likely to regain it in the long term. A meta-analysis of 29 long-term weight loss studies found that more than half of the weight participants lost was regained within two years, and more than 80% of the lost weight was regained within five years. But doctors with a more traditional approach to weight are pushing back against the weight-neutral providers.

ELLEN SCHUR: For some folks who have a condition like diabetes, weight loss in combination with some lifestyle changes could be an option that they would choose.

O'NEILL: Dr. Ellen Schur is an obesity medicine doctor and researcher at the University of Washington. She agrees with weight-neutral providers that exercise and healthy food on their own are good for health, but she says for some patients, weight loss can have additional benefits. Studies have shown that even a modest amount of weight loss in people whose BMI is classified as overweight or obese reduces their risk of diabetes, for example. Schur says when weight loss might help, doctors should say that. It comes down to how they have the conversation.

SCHUR: When a physician is approaching it in a nonjudgmental manner and not assuming that a person hasn't made changes, it can be discussed as a treatment option in a way that's supportive.

O'NEILL: Schur says increasingly, weight loss drugs like Wegovy are her primary tool for managing patients' weight.

SCHUR: To be totally honest, what we've been asking them to do, you know, with just lifestyle alone has been unrealistic.

O'NEILL: Critics of the newest weight loss drugs point to their limitations. They're expensive and in short supply, and their long-term effects are still unknown. And weight-neutral providers say even in a world with these new drugs, people with larger bodies still need to feel heard and respected in the doctor's office and have their primary health concerns addressed. For NPR News, I'm Eilis O'Neill in Seattle.

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Eilis O'Neill/KUOW