<p>@ shrinkwrap- </p>
<p>I appreciate the battles doctors have with patients, patients who see an ad for celebrex and think it is going to have them running around like an 18 year old (why they allow prescription drug ads I don’t know…). I also respect a doctor telling a patient who is overweight, especially when they have all kinds of risk factors, what the issues are. What I question is doctors giving nutrition advice, speaking as someone who has fought weight battles for years (not morbidly obese, not diabetic, but still) and being told nutrition advice like “walk away from the table” is not exactly helpful, or telling me to stay away from meat and dairy products because “it clogs the arteries”, I am talking a blanket ban when even the American Heart association at its most stringent is not like that…I respect a doctor that is suggesting talking to a nutritionist, because nutrition is their specialty, as versus what doctors are trained in. I will add that part of the problem is medical training, nutrition is critical to good health, and you as a doctor probably know better than most people that many of the problems you see are lifestyle, that diabetes and heart disease and cancer are often directly tied to lifestyle, and diet is a big portion of that…yet last I checked, only 50% of Medical schools require doctors to take a course in nutrition (as in 1), and that is pretty sad, so much of medicine seems to be in treating things rather than preventing it. We do a good job with innoculations, but a terrible job with other things.</p>
<p>But at least when they refer them to a nutritionist, hopefully they will be up to date with things and can help the person tailor a program for the person. Sorry to say, but a lot of doctors treat obesity or being overweight as some sort of moral failing and come at it that way, rather than as what it is, a health risk. There are a lot of people who won’t go to a doctor when they are sick, who are overweight or obese, because they feel like instead of working with them, they feel like they are being judged, and sadly, more than a few doctors do judge patients (what is ironic is that a lot of doctors you see aren’t in such great shape, either, reminds me of those scenes from Doctor’s offices in “Mad Men” where the doctors are smoking:). </p>
<p>There are a lot of doctors who seem to have picked up on nutrition, integrative doctors like Dr. Weil and others seem to be open to looking at new ideas and such and a lot of mainstream doctors seem to get the idea as well. One of the things that most of the fitness sites get right is that nutrition is 80% of getting healthy and in shape, that all the exercise in the world won’t do it, and they also tend to understand that certain forms of exercise work better. My own cardiologist claimed that the only exercise that is effective in fat loss and losing weight and helping the heart is cardio, but that simply isn’t true, and there is serious research on that, that strength training with or without cardio may be a lot more effective,and what he is saying was conventional wisdom but is no longer true…problem here is he is outside his area of expertise, and is giving advice that may be crap <em>shrug</em>. </p>
<p>That doesn’t mean what every idiot is saying on the net is true, either. A lot of personal trainers knowledge of nutrition makes what I have experienced with doctors look solid gold, some of them are incredibly ill informed. The whole “lots of little meals versus regular meals” , for example, is not universal, it doesn’t work for all people, and can hurt some people, yet they spread it as gospel. Extremely low carb diets like Atkins have terrible drawbacks, and high carb diets loaded with grains can end up increasing LDL in the blood and causes a huge increase in the number of the wrong type of particle (I believe it is the big, fluffy ones as my cardiologist described it) that has been shown now to be the prime cause of buildup, so there is simply a lot of bad advice out there.</p>
<p>And again, my intention was not to denigrate all doctors on all things, when it comes to treating illness and such most doctors I have run across are good at what they do, I just think when it comes to diet and nutrition information medical training and culture doesn’t seem to put an emphasis on it yet at least in my experience, the information doctors are giving on nutrition and diet often is not helpful, handing a patient a 1000 calorie a day diet or telling them to ‘eat less’ or treating meat and dairy as poison is not helpful (and also not true, they aren’t, in moderation), I would prefer doctors note the risks of someone being overweight and referring them to someone who can work with the person to change lifestyle. Someone on here said diets work, they don’t, if you look at the stats on people losing weight on diets, over a period more than a year, most people gain back what they lost and often more, and worse, bounce up and down, dieting, losing weight and gaining it back. The only way to effectively lose weight and keep it off isn’t weight watchers, or Jenny Craig, or nutrisystem, it is changing the way someone eats, and also is in introducing other lifestyle changes, like regular exercise, that will do it. If anything, someone is far better off being overweight and staying steady state with weight, then bouncing up and down. </p>