Physician-Assisted Weight Loss

The prevalence of obesity has reached mammoth proportions with over 60 percent of the U.S. population being overweight or obese. It is well known that being obese or overweight increases the chances of developing heart disease, cancer, gallstones, high blood pressure, diabetes, obstructive sleep apnea, and arthritis, to name a few. In fact, more than 400,000 annual deaths can be attributed to obesity-related medical conditions. Obese and overweight people are thus more likely to seek medical care and be hospitalized. Physicians who take care of these patients are best suited to motivate, advise, and follow up on weight-loss efforts of their patients. Several weight-loss therapies also require physicians to monitor patients because of the risk of complications and even death during rapid weight loss.

Historical Aspects of Medical Weight Loss

Historically, several methods have been tried for weight loss. Thyroid hormones and amphetamines both induce weight loss, but there was a tendency to regain weight after these medications were stopped. Moreover, the potential for abuse was high with amphetamines. Thyroid hormones, act by increasing the body's metabolic rate (rate at which body burns calories to provide energy). However, these hormones have side effects and can precipitate arrhythmias (abnormally fast or irregular heartbeat) and heart failure. Phen-fen or phentermine and fenfluramine were two [Page 602]drugs approved by the Food and Drug Administration in 1996. This combination was withdrawn from the market after a number of alarming reports on the incidence of cardiac valve and lung problems among users. Phenteremine alone is still prescribed. Phenylpropanolamine hydrochloride was also withdrawn after reports of bleeding in the brain (cerebral hemorrhage). Gastric vagotomy in which the vagus nerve supply to the stomach was cut, failed to produce appealing results and was abandoned.

Patient and Physician Barriers to Weight Loss

It is a well-known fact that weight loss can have far-reaching benefits. Despite this, overweight and obese patients do not always receive advice on healthy eating and exercise from their doctors. At least 40 percent of obese patients are not told by their physicians to lose weight. Among those patients who are already on treatment for various disorders such as high blood pressure, diabetes, and heart disease, less than half are never counseled on weight loss. It has been shown that being advised by one's physician is a potent stimulus to attempt weight loss. In fact, obese subjects are up to three times more likely to lose weight if advised by their healthcare team.

The reluctance of physicians to counsel and assist in weight loss could be due to several reasons. Obesity was originally considered a social problem resulting from overeating and a lack of willpower. It was not recognized for what it is now—a medical problem with a genetic basis that can be modified by lifestyle factors such as stress, exercise, and eating habits.

Even today, despite the magnitude of the problem, doctors do not receive adequate training in weight-loss management in medical schools or residency. Doctors often feel that patients may not act upon their advice to lose weight. In addition, most insurance companies do not reimburse physicians for time spent on patient counseling.

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