When reader Vivian asked me what I thought of a piece from Medscape called “New US Obesity Guidelines: Treat the Weight First” I geared myself up to read something terrible. I didn’t imagine just how horrible it would be.
In the article Dr Caroline M Apovian discusses a paper, of which she was the lead author, that suggests guidelines about how to care for fat people who have actual health issues:
The guidelines advise treating the weight first with lifestyle modification and medication and then managing the remaining comorbidities that have not responded to any weight loss, including hyperglycemia, hypertension, and dyslipidemia.
She also recommends that if patients are taking medication that has a side effect of weight gain (including those for depression, epilepsy, and schizophrenia) including “insulin, sulfonylureas, thiazolidinediones, beta-blockers, or certain specific selective serotonin-reuptake inhibitors (SSRIs) like paroxetine” they should be tapered off of them – even if the medication is working for their health issue and even if the tapering process may cause unnecessary physical and mental health issues – and put them on “alternative agents that don’t increase weight.”
So what these guidelines are actually saying is that only thin people should get evidence-based treatment for their health issues. But don’t worry, because according to Dr. Apovian, they’ve really got a handle on this whole weight loss thing:
In the end, you’re going to give the best guess of which drug the patient should go on….If the patient doesn’t lose 5% of their weight in 12 weeks, stop the drug and try another. Unless you can really get a clear idea of what you think the patient is going to do best on, you’re going to be prescribing by trial and error….This is the question I get asked the most often. Unfortunately, the research isn’t there to help us beyond that.
Oh yes, this definitely has the ring of good evidence-based medicine, and doesn’t sound at all like completely uncontrolled experimental medicine. Not to mention that weight loss drugs cause everything from uncontrolled anal seepage to addiction and death and all for a minimal weight loss (4.5 pounds in a year!) which their own studies show patients begin to regain almost immediately.
She goes on to lament that the drugs aren’t covered by insurance and that doctors aren’t prescribing them enough (I’m thinking that’s perhaps because doctors know about their lack of efficacy and horrible side effects, but I’m just spitballing here.)
“Certainly, insurance coverage will help tremendously, but if we don’t have doctors out there who are trained to deliver the treatment in the manner we indicate in [both the 2013 and the current guidelines], we are not going to be able to utilize them even if they are covered by insurance….We’re trying to get a cadre out there of doctors who can use these medications. Once that happens, insurers will start covering them. The disadvantage now is the price.”
I would think that the disadvantage is the uncontrolled anal seepage, addiction, death, and total failure of the drugs but hey, what do I know? If you’re wondering how in the world a trained doctor could put people’s health and lives at risk while trying to sell them expensive dangerous drugs that don’t work, then you might consider this:
Dr Apovian serves on advisory boards for Amylin, Merck, Johnson & Johnson, Arena, Nutrisystem, Zafgen, Sanofi, Orexigen, and Enteromedics. She has received research funding from Lilly, Amylin, Aspire Bariatrics, GI Dynamics, Pfizer, Sanofi, Orexigen, MetaProteomics, and the Dr Robert C and Veronica Atkins Foundation.
Hmmm, she’s on the advisory boards of companies that make weight loss drugs, and she’s written guidelines that recommend a massive increase in the use of weight loss drugs. That’s curious. I think that this is what happens when healthcare for profit and a cultural hatred of fat people collide. This is the real “war on obesity” they want us thin, but they don’t mind if we die, as long as we’re not fat and they stay rich.
If these guidelines are adopted it means that fat people will have to fight even harder to get evidence-based medicine instead of “interventions” that are bought and paid for by diet companies. We’re going to have to wonder if our doctor is prescribing us a subpar medicine because they are following guidelines that tell them they should be more concerned about our body size than our actual health.
We’ll have to worry that they are withholding treatment that a thin person would be offered, unless and until we are able to manipulate our body size to their satisfaction.
Those who agree to take the diet drugs will have to worry that their ability to get actual healthcare rests on expensive, dangerous drugs with a poor track record that are being prescribed to them on a trial and error basis, and that 12 weeks from now when the drugs don’t work they will be prescribed a different expensive, dangerous drug, and again 12 weeks later, all while still being refused the evidence-based healthcare that they would have been prescribed 24 weeks ago if they were thin.
Those who agree to take the drugs will have to wonder what will happen when, as all the research shows is a near certainty, they regain the weight – will their doctor cease any evidence-based interventions to start another yet another trial and error weight loss drug? We’ll have to wonder how many weight loss drug companies have our doctors on payroll (unless, of course, Dr. Apovian is our physician, then we know that it’s basically all of them.)
To me this is justification for my approach to dealing with healthcare practitioners, which is to constantly ask questions, ask for the research upon which their treatment suggestions are based, ask to be given the same interventions that a thin person would be given, and doing my own research. I claimed the leadership role position in my personal healthcare and treat doctors as people who support and work with me on that, and not as gods who are above providing me with an explanation.
Of course my being in a position to do that is also a reflection of my various privileges. As long as I can do that I will, and I will continue to fight for those who aren’t in a position to question this sort of bought and paid for medical malpractice, because the alternative is just far too terrifying.
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