More Misleading Information for Patients

February 15th, 2015 by MorganDowney Leave a reply »

So, “misleading” is a pretty strong term. Unfortunately, misleading advice to patients, the public and policy makers is so widespread in the obesity field as to acceptable as the norm, not the exception. For example, recently several obesity researchers (David Allison, Diana M. Thomas and Steven B. Heymsfield) commented on a “Patient Page” in JAMA. In the page, Dr. E. Guth w rote, “A total of 3500 calories equals 1 pound of body weight…This means if you decrease (or increase)your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day X 7 days= 3,500 calories.)”

Allison et al pointed out that “over time the calorie deficit slowly closes as energy expenditure gradually declines with the loss of body mass and metabolic adaptations. Unlike the linear weight loss pattern described by Guth, actual weight loss follows a smooth curve and then plateaus at the new energy requirement level…For example, if a 5’6”, 30-year-old woman weighing 180 lb and consuming 2622 calories daily reduced her intake by 500 calories per day, the 3,500 calorie rule would estimate her weight loss at 1 year to be almost 52 lb. The validated dynamic model predicts a weight loss of 12 lb. At 10 years, the 3,500-calorie rule would yield a negative body weight, whereas the weight loss prediction of the dynamic model would stabilize at a 31-lb loss after 3 years.

(The validated dynamic model is available at http://www.pbrc.edu/researc-and-faculty/calculators/weight-loss-predictor.)

Interestingly, Dr. Guth replied with a curt toss of this point, stating that the Patient Page was intended to provide “easily understood information and accessible guidelines for the majority of patients.” Dr. Eve Guth acknowledges that since most patients regain their weight after loss, “it is unlikely that an individual would continue to restrict calories for 10 years, ultimately resulting in a negative weight.” (ED: also known as death.) After dumping on patients too ignorant to starve to death, Dr. Guth dumps on primary care providers who are seeking to meet patient demands for simple advice involving minimal effort on their part, oh, and by the way, there isn’t good reimbursement either for misleading patients.  Dr. Guth’s perception is that this is all between the physician providing simplistic advice to an overweight or obese patient too dumb or ill-informed to know better. Small wonder that physicians don’t counsel and patients don’t think doctors know what they are talking about. Moreover, these  simplistic strategies spill into policy-making, implying that weight loss is easy and, with the right incentives, maintainable over the long-term.

For more information on

More accurate weight loss calculators:

http://www.downeyobesityreport.com/2012/02/the-calorie-out-math-is-all-wrong/

http://www.downeyobesityreport.com/2012/05/the-new-math-of-obesity/

Adaptive thermogenesis effect on weight loss:

http://www.downeyobesityreport.com/2014/01/where-is-your-new-years-resolution-or-where-did-i-put-my-adaptive-thermogenesis/