Is recommending dieting unethical?

[Quinlan]

Doctors will often tell their fat patients to eat less but is this ethical? Given recent evidence that dieting cannabilizes your brain cells, has a terrible success rate, is linked to weight GAIN in the long term and will likely cause shame and avoidance of medical help if they don't lose the weight.

Dieting

Likely outcomes of a doctor recommending dieting:

-Weight gain over the long term
-Obsessive behaviours/possible eating disorders triggered
-Lower self esteem (due to high failure rate)
-Shame/guilt
-Cannabilisation of brain cells
-Avoidance of doctors leading to undiagnosed serious conditions becoming worse
-Stress leading to further health problems

Unlikely outcomes:

-Long term weight loss

Would we allow any other medical treatment that fails so often, actually makes the condition it's supposed to cure worse and results in your brain eating itself to be recommended so often and so casually?

Shouldn't we be telling people specifically NOT to treat their own obesity so that they don't make things worse?

Maybe instead of telling people to fight their body and their instincts we should tell them to love their bodies as they are.

 

[Billy]

I think that it would be unethical to advocate a starvation diet, but advocating a balanced diet would cause weight loss as well.

 

[Such Irony]

Doctors will often tell their fat patients to eat less but is this ethical? Given recent evidence that dieting cannabilizes your brain cells, has a terrible success rate, is linked to weight GAIN in the long term and will likely cause shame and avoidance of medical help if they don't lose the weight.

Dieting

Likely outcomes of a doctor recommending dieting:

-Weight gain over the long term
-Obsessive behaviours/possible eating disorders triggered
-Lower self esteem (due to high failure rate)
-Shame/guilt
-Cannabilisation of brain cells
-Avoidance of doctors leading to undiagnosed serious conditions becoming worse
-Stress leading to further health problems

Unlikely outcomes:

-Long term weight loss

Would we allow any other medical treatment that fails so often, actually makes the condition it's supposed to cure worse and results in your brain eating itself to be recommended so often and so casually?

Shouldn't we be telling people specifically NOT to treat their own obesity so that they don't make things worse?

Maybe instead of telling people to fight their body and their instincts we should tell them to love their bodies as they are.

I think part of the problem so many have with dieting is they become overly strict and obsessive about it. People are impatient, they expect to lose several pounds a week and want to see drastic results right away. They restrict food too much. Cut calories too much. It wreaks havoc with the body's metabolism and sets someone up for failure because its very difficult to sustain over a long term.

It's best to lose weight gradually- about 1-2 lbs a week. Just eat food in moderation- know how many calories you need a day to maintain your weight and go a little below that to lose. If you choose healthier foods to eat, you'll likely lose some weight simply because they are likely to be lower in calories. No need to eliminate foods entirely, although if you want to succeed dieting, you'll have to eat alot less junk than you used to.

In general, weight is just a number and how healthy you are and feel should be what's most important. Do you feel healthy? Do you have enough energy to do normal activities? However, if you are seriously overweight and the weight is to the point where it seriously impacts your health and your ability to get around, then its time to lose the weight. In that case, I don't think it's unethical for a doctor to tell someone to lose weight, since it could be the difference between life and death.

On the other hand, I don't think doctors should be telling slightly overweight but otherwise healthy people to lose weight. You can recommend someone eat healthier or exercise more without having to bring up weight.

 

[Quinlan]

I think part of the problem so many have with dieting is they become overly strict and obsessive about it.

If it were any other kind of treatment would we encourage people to go it alone if we knew full well that people are likely to obsess over it and do it wrong?

People are impatient, they expect to lose several pounds a week and want to see drastic results right away. They restrict food too much. Cut calories too much. It wreaks havoc with the body's metabolism and sets someone up for failure because its very difficult to sustain over a long term.

It's best to lose weight gradually- about 1-2 lbs a week. Just eat food in moderation- know how many calories you need a day to maintain your weight and go a little below that to lose. If you choose healthier foods to eat, you'll likely lose some weight simply because they are likely to be lower in calories. No need to eliminate foods entirely, although if you want to succeed dieting, you'll have to eat alot less junk than you used to.

1-2lbs a week actually sounds quite rapid to me, I think most dieters would be more than happy with that. In my opinion a modest approach will only ever achieve modest results, look how extreme bariatric surgery is and the results of that are modest in the long term.

In that case, I don't think it's unethical for a doctor to tell someone to lose weight, since it could be the difference between life and death.

But we know in that in practice they are more likely to put on weight with their weight loss attempts than lose it. People who try and fail to lose weight usually end up bigger than those that never try at all. Should the doctor just leave them to treat themselves or should they be carefully managed/supported?

 

[Thalassa]

You know there's a difference between suggesting people go on starvation or other "diets" and that people change their diet to something healthier. Trying to pit being "fat positive" against tormenting people to eat less calories or nutrients than is healthy is a false dichotomy.

Such Irony is right.

 

[nanook]

well, doctors recommend more unethical things than dieting. like shitloads of harmful drugs. given that many diseases are caused by nutrition (although doctors have no education about this link), pointing a client to think about changing his 'eating' is at least in the ballpark of ethical healing. what may make the dieting recommendation 'unethical' are more specific suggestions, if those are just plain unhealthy. not only are doctors uneducated about what is healthy, the education of what is healthy (that of nutritionists) is it self uneducated. so if you have to ask about ethics, than this is has to be an ethical dilemma. much or all treatment of ill people has been such a dilemma. we still don't know much about the body or health. therefore doctors can not know, what they are doing. but they have to do something ... that's the common sense.

it would be nice if doctors would be more up to date on science. it's a difficult job, even without being up to date. there are not enough smart enough men, too much doctors are needed. few can embody the best, that a doctor could be, at the current state of science.

 

[Quinlan]

You know there's a difference between suggesting people go on starvation or other "diets" and that people change their diet to something healthier.

...and what is that difference specifically?

Diet = short term calorie restriction, "Lifestyle change" = chronic calorie restriction.

Either way, the results are unimpressive and the side effects bad.

 

[Rail Tracer]

Obesity has a link with getting heart-attacks.
Obesity also has a link with getting type 2 diabetes.
Losing some fat has shown to reduce the likelihood of both.
The thing that truly decides whether you get none of these, one of these, or both is based on your lifestyle choice.

Besides giving medicine that only temporarily reduces the likelihood of heart-attacks or diabetes, the doctor can only recommend what the patient should do to prevent these scenarios from happening. The medicine will not work unless the patient is willing to do some lifestyle changes.

The doctor is giving you a choice, lose some weight, or you may end up with one of these scenarios in the near future. It is not unethical, it is stating the truth.

 

[CrystalViolet]

Actually, I have read that it is Yo-Yo dieting that does the damage, and to be honest, I think smoking and drinking have far more impact myself. My reasoning being, unless you are main lining fat, and most people really don't, and avoid soft drinks etc (which in my opinion, are the real culprits), and squeeze in excersise...There isn't much more you can do really.
My honest evaluation is people don't exercise enough, and yes, I'm guilty of that. I feel much better when I excersise.

 

[Quinlan]

Obesity has a link with getting heart-attacks.
Obesity also has a link with getting type 2 diabetes.
Losing some fat has shown to reduce the likelihood of both.
The thing that truly decides whether you get none of these, one of these, or both is based on your lifestyle choice.

Besides giving medicine that only temporarily reduces the likelihood of heart-attacks or diabetes, the doctor can only recommend what the patient should do to prevent these scenarios from happening. The medicine will not work unless the patient is willing to do some lifestyle changes.

The doctor is giving you a choice, lose some weight, or you may end up with one of these scenarios in the near future. It is not unethical, it is stating the truth.

The thing is we know, with great predictablity, that most of them will fail. This is a well established fact, regardless of what they should do in an ideal world whatever it is they do in practice fails in most cases.

So the high failure rate is predictable and the negative side effects of failure (shame/stress, brain cell autophagy, avoidance of medical treatment, weight GAIN) are predictable, yet we tell them to do it anyway?!

Doctor says eat less>patient fails>patient feels shame and stress> cortisol levels rise> cortisol causes heart disease> patient dies fat

Doctor says eat less>patient fails>patient feels shame and stress>patient avoids medical treatment> patient is diagnosed with heart disease too late> patient dies fat

 

[Thalassa]

...and what is that difference specifically?

Diet = short term calorie restriction, "Lifestyle change" = chronic calorie restriction.

Either way, the results are unimpressive and the side effects bad.

Um, no...lifestyle change means choosing healthier foods and doing things like eating when you're actually hungry instead of overeating or always eating crap.

It's not chronic calorie restriction, it's telling you to stop grossly overeating, which is an eating disorder TOO.

It's fine to enjoy food, and I think it's important to eat a variety of foods to fully enjoy life, and I personally love to cook...so I'm not disputing that at all...however, there's a difference between what you're talking about and maintaining a more balanced and healthy diet.

It's not idealistic, either. People do it all the time all over the world.

You're creating a false dichotomy, and I usually see this with "fat positive" people, which I frankly don't think is healthy.

 

[CrystalViolet]

People are far more likely to keep the weight off, if they join say a 12 step program, or what ever.
Part of the problem is being fat isn't just physical thing, it's a mind set. You literally have to reprogram your self. Many health professionals fail to recognize this.

 

[Quinlan]

Um, no...lifestyle change means choosing healthier foods and doing things like eating when you're actually hungry instead of overeating or always eating crap.

What you're recommending is calorie restriction (eating less than you'd like).

It's not chronic calorie restriction, it's telling you to stop grossly overeating, which is an eating disorder TOO.

It's incorrect to assume that all/most fat people grossly overeat, mostly because it's just not necessary, the calorie surplus required to make someone fat is tiny, barely noticeable day to day. 1lb of fat = 3500 calories, so you could go from normal weight to obese in ten years with just an extra half a banana a day. Not exactly gorging yourself. Not all obese people binge eat and not all binge eaters are obese.

It's not idealistic, either. People do it all the time all over the world.

Yes, but they're only a small fraction of those that try, why pretend that the ones that fail don't exist or that they do not experience negative outcomes from their weight loss attempts?

Dieting is a treatment with a very high failure rate with negative side effects if it does fail, we should not treat it so lightly.

 

[Rail Tracer]

The thing is we know, with great predictablity, that most of them will fail. This is a well established fact, regardless of what they should do in an ideal world whatever it is they do in practice fails in most cases.

So the high failure rate is predictable and the negative side effects of failure (shame/stress, brain cell autophagy, avoidance of medical treatment, weight GAIN) are predictable, yet we tell them to do it anyway?!

Doctor says eat less>patient fails>patient feels shame and stress> cortisol levels rise> cortisol causes heart disease> patient dies fat

Doctor says eat less>patient fails>patient feels shame and stress>patient avoids medical treatment> patient is diagnosed with heart disease too late> patient dies fat

The only person that can control his/her eating is the patient his/herself. The doctor can only recommend what he think is the best choice. That choice can range from eating less, eating healthier foods, or talking to a nutrition to follow the nutritionist's advice on what kinds of food to eat.

Not telling the patient that he/she is at risk is withholding information otherwise. Like it or not, people do sue doctors for possible cases like these for withholding information that could of prevented the patient from having diabetes or an impeding heart-attack just because the "doctor knew about it but wouldn't tell me."

What you're recommending is calorie restriction (eating less than you'd like).

You can eat 1,200 calories of fruits, vegetables, grain, and a little bit of everything else and meet most, if not all, your daily vitamins and minerals. You can eat 4,000 calories and meet none of them.

Generally speaking, protein fills you up while food containing insoluble fiber has a similar effect. Both of these can be found eating nuts, grains, vegetables, and fruits.

 

[Quinlan]

The only person that can control his/her eating is the patient his/herself. The doctor can only recommend what he think is the best choice. That choice can range from eating less, eating healthier foods, or talking to a nutrition to follow the nutritionist's advice on what kinds of food to eat.

Not telling the patient that he/she is at risk is withholding information otherwise. Like it or not, people do sue doctors for possible cases like these for withholding information that could of prevented the patient from having diabetes or an impeding heart-attack just because the "doctor knew about it but wouldn't tell me."

Shouldn't that apply to withholding information on the risks of the treatment (dieting) aswell?

A single IWL (Intentional weight loss) episode increased the risk of becoming overweight by age 25 almost three-fold in women and two-fold in men. In fact, women who reported two or more IWL episodes had an even higher (5-fold increased) risk of becoming overweight at age 25.

These findings not only confirm previous studies that dieters may be more prone to future weight gain but also provide evidence that, this obesogenic effect of dieting is apparently independent of genetic factors.

All the more reason to warn against the widespread obsession with ‘cosmetic’ weight loss - as I have said before, all weight loss attempts should be medically indicated and anyone attempting to lose weight needs to be warned that they may in fact be increasing their long term risk of becoming (even more) overweight or obese.

On the other hand, in cases where weight loss is indeed medically indicated, considerable effort and long-term follow up will be required to prevent relapse - not only is weight loss not a ‘cure’ for obesity but, in many cases, losing weight can actually make the problem worse!

http://www.drsharma.ca/obesity-will-losing-weight-make-you-fat.html

The analogy that comes to my mind is telling someone stuck in quick sand to struggle harder, rather than telling them to stop fighting and ask for help.

 

[Rail Tracer]

Shouldn't that apply to withholding information on the risks of the treatment (dieting) aswell?


http://www.drsharma.ca/obesity-will-losing-weight-make-you-fat.html

Again, that area is the patients choice. The doctor only said to lose weight. He didn't say to go on a diet like drinking more water than there is food to lose weight. He didn't tell you to lose 45 pounds in one month. He didn't tell you to stick with some diet system. All he told you was to lose weight.

A nutritionist point of view? Losing 2-4lbs and keeping off those 2-4lbs is a lot healthier than having those 2-4lbs stuck on your stomach. There is also mounting evidence that if you lose only a few lbs, you can stand to decrease your likelihood of diabetes and heart-attack especially if you can keep off those 2-4lbs.

http://healthvermont.gov/prevent/diabetes/documents/DIA_Diabetes_WeightControl_2pg.pdf
http://www.defeatdiabetes.org/Articles/obesity2040604.htm

 

[Thalassa]

What you're recommending is calorie restriction (eating less than you'd like).

Eating less than you'd like is pretty arbitrary. Maybe in some cases that would be wrong, because you'd like to eat more because you're actually hungry and need more nutrition.

On the other hand, eating what "you'd like" could mean eating so much that you're killing yourself...I mean heroin addicts might "like" to do heroin, but it doesn't mean it's good for them.

It's incorrect to assume that all/most fat people grossly overeat, mostly because it's just not necessary, the calorie surplus required to make someone fat is tiny, barely noticeable day to day. 1lb of fat = 3500 calories, so you could go from normal weight to obese in ten years with just an extra half a banana a day. Not exactly gorging yourself. Not all obese people binge eat and not all binge eaters are obese.

You're the one who is incorrect. Health, nutrition, cooking, and diet are one of my favorite subjects, to the point of debating becoming a nutritionist or going to culinary school...and I can tell you plainly that a person who becomes obese in ten years from an extra half a banana per day must be completely immobile and strapped to their bed, because your suggestion is ludicrous in someone who is at least somewhat active and not entirely sedentary.

Yes, but they're only a small fraction of those that try, why pretend that the ones that fail don't exist or that they do not experience negative outcomes from their weight loss attempts?

Dieting is a treatment with a very high failure rate with negative side effects if it does fail, we should not treat it so lightly.

I don't treat it lightly - but I also don't create extremist false dichotomies either.

 

[Quinlan]

Again, that area is the patients choice. The doctor only said to lose weight. He didn't say to go on a diet like drinking more water than there is food to lose weight. He didn't tell you to lose 45 pounds in one month. He didn't tell you to stick with some diet system. All he told you was to lose weight.

Why assume the people in that study used unusual methods?

A nutritionist point of view? Losing 2-4lbs and keeping off those 2-4lbs is a lot healthier than having those 2-4lbs stuck on your stomach. There is also mounting evidence that if you lose only a few lbs, you can stand to decrease your likelihood of diabetes and heart-attack especially if you can keep off those 2-4lbs.

http://healthvermont.gov/prevent/diabetes/documents/DIA_Diabetes_WeightControl_2pg.pdf
http://www.defeatdiabetes.org/Articles/obesity2040604.htm

I'm well aware of that, pity that doctors will often refuse to treat patients untill they are no longer fat. I'm also aware of studies showing that engaging in more exercise and eating better quality food will improve health markers/outcomes regardless of whether you lose a few pounds or not.

 

[Rail Tracer]

Why assume the people in that study used unusual methods?

It is the unusual methods that most people tend to go by. After all, there wouldn't be a huge market in the diet industry. 2006 alone, Americans spent $35 billion on the diet industry

 

[Quinlan]

Eating less than you'd like is pretty arbitrary. Maybe in some cases that would be wrong, because you'd like to eat more because you're actually hungry and need more nutrition.

On the other hand, eating what "you'd like" could mean eating so much that you're killing yourself...I mean heroin addicts might "like" to do heroin, but it doesn't mean it's good for them.

You prove my point, a heroin addict must engage in "heroin restriction" just as an obese person must engage in "calorie restriction".

As far as I know though, a heroin addiction relapse does not make the condition worse whereas it does seem to with obesity.

You're the one who is incorrect. Health, nutrition, cooking, and diet are one of my favorite subjects, to the point of debating becoming a nutritionist or going to culinary school...and I can tell you plainly that a person who becomes obese in ten years from an extra half a banana per day must be completely immobile and strapped to their bed, because your suggestion is ludicrous in someone who is at least somewhat active and not entirely sedentary.

We are talking about overeating, eating more than your energy expenditure (regardless of whether you're active or sedentary). The half banana is the surplus OVER energy burned.

If you eat the extra half banana without engaging in extra activity to compensate you'll get fat, it's simple maths. A lot of people might understandably not think to compensate for such a meager amount. My point is the actual energy surplus required on a day to day basis is trivial, this is a mathematical fact. You don't need to gorge to get fat, just eat slightly more than you burn. If you are genuinely interested in the subject I suggest reading more of the scientific literature, this might be a good place to start:

http://www.nutritionj.com/content/pdf/1475-2891-10-9.pdf

I don't treat it lightly - but I also don't create extremist false dichotomies either.

I'm not being extreme, I'm quoting well known research findings and experts.