I'm starting to see this trend of podcasts and articles that seem to be raising the white flag for childhood obesity. We should all agree with doctors that these conversations should be had with care and thoughtfulness. We should agree that there are clear reasons to advocate regular exercise and a healthy diet. We should all agree on the obvious health benefits of maintaining a healthy weight. There are clear mental health benefits, too. I don't think I will see a day when these points are debated.
Suddenly, I see an argument that we should “give in to what we want” and its message is that any diet, and therefore, weight, is acceptable. Even for those who successfully lose weight, there are concerns about the risk of long-term eating disorders and mental health problems. Recently, a guest on the Michael Smerconish podcast even went so far as to say that doctors are to blame for poor outcomes in obese patients because we treat them differently and ineffectively. After all, we make assumptions based on their size.
What about the stigma of doctors not having their best interests at heart? That's a battle we fight every day; we don't care, lack empathy, and just want to make money. Those who try to help our pediatric patients lose weight do so because we want our patients to be healthy. We battle the chronic diseases caused by obesity every day, and we know that losing weight is not realistic for most patients due to complications of the condition, orthopedic issues, etc. I almost had to ignore their obesity because there were so many other issues to address: so it's outrageous to say I'm focusing on obesity.
I fear this is another example of a doctor giving in to what a patient wants to hear. They don't want to be told they can do better. There is not enough personal responsibility in every corner of society. Our job is to guide patients honestly and thoughtfully toward goals that will improve their quality of life. If we're going to give up helping them eat better and exercise, we might as well give up our careers altogether.
Personally, I see both sides of mental health issues here. As a child, I was overweight and had low self-esteem from an early age. I remember I used to pull my shirt out so my belly wouldn't stick out so much. Impossible to talk to the opposite sex. My whole life turned when I went to college and was successful academically, but I also lost about 40 pounds. I have a confidence I never thought possible.
Fast forward to 2020 and the pandemic hits. Like most of us, I had a lot of anxiety to deal with, and surprisingly, I had extra time now that our appointments were canceled to keep everyone at home. I started running—a lot of it. The resulting 50-pound weight loss and the marathon I completed was something to be proud of, but I realized I didn't know when to give up. Seeing the weight drop is one of the few things in my life that gives me contentment in a chaotic world.
Did my dieting in college put me at risk for an eating disorder as an adult? Maybe. Did my obesity as a child cause the anxiety and underlying depression that has been lurking somewhere ever since? This is also possible. I actually consider myself lucky that my anxiety manifested itself in sports rather than controlled substances like alcohol, gambling, or even physical harm to my family. After the deal, I'm healthier than ever and I have a lot of running medals in my basement.
Much of my anxiety comes from all the work I do being a doctor, completely ignored during the pandemic. When things go well, it's because unqualified people “did their research”. When times are tough, doctors are mean and don't know what they're doing. My anecdotal story above should mean nothing to most people because it wasn't a random study of thousands of people. Sadly, anecdotes make more sense than evidence-based medicine these days. That sense of inadequacy and helplessness in my profession probably hits me more than anything else.
I have to watch my reactions to this new war — or set of excuses — on childhood obesity.
Nathan J. Hemerly is a family physician.
