Overcoming Shame and Guilt

Posted: Apr 20 in Weight loss, Weight Management Strategies by

In my 25 years practicing medicine, I have never seen a medical problem associated with more shame and guilt than obesity.

If a person is diagnosed with high blood pressure, they usually accept that this is a medical problem and are willing to take medications, schedule follow-up visits and have the blood pressure monitored. The hypertension is treated. Similarly, if one is diagnosed with type 2 diabetes, the individual tends to accept this is a medical problem. They will attend diabetes education sessions, learn to eat healthier, take medications, check their blood sugars and labs, and schedule follow-up visits. Their diabetes is treated. With treatment, the hypertension and diabetes are less likely to cause heart attacks, etc.

Why is it then with obesity, which has been recognized as a medical problem similar to hypertension and diabetes, people generally are not diagnosed and universally are not treated. Rather than seeing an obesity medicine physician, people with obesity are told “You are heavy – this is your own fault, and your weight is high due to lack of willpower, laziness, eating too much and exercising too little.”

The reality couldn’t be further from the truth.

Obesity is the result of a complex interplay between our genetics / biology and the environment. As the fat mass becomes higher, the body vigorously defends the fat mass against changes and regulates our food intake with a multitude of hormones, and also regulates our metabolism to protect against fat loss. That’s why losing weight and keeping it off is so hard: it’s not that we run out of willpower – it’s that our bodies fight against these changes. Our bodies protect our fat mass.

Instead of similar instructions as hypertension and diabetes, the person with obesity is left feeling their disease is their own fault and will try countless weight loss attempts followed by regain. The end result is that they feel that treatment is futile. Yet, they have never been offered any of the evidence-based tools that can help them sustain a healthier body mass index.

We are reinforcing the message that weight loss equals success, and that weight gain equals failure, while both weight loss and weight gain are a natural part of the disease.

Instead of talking about “Successful weight loss” and “Weight maintenance,” we should be using a different vocabulary similar to diseases like hypertension and diabetes. Really, there are only two types of hypertension / diabetes type 2 – treated and untreated. A person who is treated is on medication, having their numbers monitored, and is regularly seen by a qualified doctor. In fact, it is estimated that 86% of people with type 2 diabetes are on prescription anti-diabetes medication.

A person with obesity should at the very least:

  1. Receive a diagnosis.
  2. Receive a 4-component treatment program including intensive lifestyle intervention, structured food plan, physical activity prescription, and anti-obesity medication / weight-friendly management of other medical problems.
  3. Receive follow-up visits.

Unfortunately, most of the time these things don’t happen. It is estimated that in the primary care setting, only 1/2 of people with obesity know whether they have it or not. Two-thirds do NOT receive a follow-up visit. And, only 1.4% are offered an FDA-approved anti-obesity medication.

Like diabetes and hypertension, there are really only two types of obesity – treated and untreated. Those who have their obesity treated will achieve and sustain more weight loss than those who do not get treated. Treatment is chronic – there is no “Weight loss” and “Weight loss maintenance.” There is just “Treatment.” If treatment is stopped, the weight goes back to where it would have been without treatment – again, the same as hypertension and diabetes!

There is no shame, no blame, and there should certainly be no guilt in receiving proper evidence-based treatment for obesity.

If these feelings have been holding you back, why not call us at (303) 750-9454. Our office has always had a “No shame / no blame” policy, and we are happy to see people no matter their body weight / shape / size. By getting your obesity treated, you will feel better, have more energy, have less joint pain, and be free to again do the things you love to do.

Why weight?

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