Now the Canadians have come along and made my point for me. The Canadian Task Force on Preventive Healthcare has issued a “strong recommendation” that primary care physicians should measure body mass index (BMI) at every visit. If you know anything about the deeply problematic nature of BMI, you might wonder why in the world they would make a strong recommendation to do that. No problem, Dr. Paula Brauer (a Ph.D and Registered Dietician) was happy to explain: the strong evidence basis that drove their strong recommendation:
“There’s no evidence [for BMI-based screening] But we made a strong recommendation anyway.”
Wait… What? I… I just… Okay, let’s play healthcare madlibs shall we:
There’s no evidence for [purported medical intervention] but we made a strong recommendation anyway.
For example: There’s no evidence that giving people a pony will make people thinner, but we made a strong recommendation anyway.
Now you try. Or not, on the off chance that you happen to be someone who – unlike the Canadian Task Force on Preventive Healthcare – supports the practice of evidence-based medicine.
How do these people still have jobs? Oh, right, because they’re talking about fat people and we are perfectly comfortable as a society making fat people the non-consenting lab rats in experimental medicine.
The other “strong recommendation” that they made on “moderate evidence” is to treat obese adults at high risk of type 2 diabetes with structured behavioral interventions aimed at weight loss (and not structural behavioral interventions to, say, prevent type 2 diabetes, the interventions with which they treat thin people). Despite, as the good doctor pointed out, “there’s also a lack of knowledge in terms of outcomes for people who do lose weight.” So even if the weight loss programs are successful, they don’t know what that will mean for the person’s risk of acquiring Type 2 Diabetes. And this warrants a strong recommendation.
And the hits just keep on coming. They also made a “weak recommendation” that, should their BMI “test” (for which there is no evidence) come up with a number that is “too high” then that person should be referred to a weight loss program, but they don’t know which one.
“From reviewing the evidence, we can’t pick out particular programs that seem more successful. Programs that provide the behavioral components, the physical activity, and dietary changes all seem to be similarly successful.”
And by “similarly successful” let’s be clear that she means “not at all successful.” But let’s examine the overall situation: This group gave two strong recommendations with no evidence, and a weak recommendation that was supported by evidence. What the hell are they smoking at those Task Force guideline meetings?
But they are still one upping the Americans since they aren’t recommending diet drugs (could this be because drug companies can’t buy off Canadian doctors the way they can American doctors?) because “patients in these trials had more adverse events, particularly gastrointestinal adverse events, than those in control groups.” But at least they aren’t recommending that fat people take dangerous, addictive drugs that don’t work, so fair play to the Canadians I guess.
So if you’re one of those people wondering why don’t I blindly trust healthcare recommendations and after reading this you’re still not sure, let me try to make it super clear: It’s because I’m a fan of logic, evidence, and informed consent, and when it comes to the way doctors are treating fat people, they’ve thrown all three of those out the window. In the current state of obesity epi-panic and hysteria when it comes to fat people trying to get healthcare, to me it’s buyer beware. If you are heading to the doctor’s office and concerned about getting evidence-based medical care, here are some ideas that might help. If you’re looking to get drunk and write some medical guidelines, I think you might have pretty good luck in Canada.
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