Evidence, Who Needs It – Doctors Gone Wild Part 2

WTF are you doingA couple of days ago I wrote about the absolutely horrible medical guidelines that suggest that doctors should try to make fat people thin with diet drugs, and only then treat our actual health issues.  In response many people asked me why I don’t trust doctors (you know, besides the fact that the doctor who wrote the guidelines in on the payroll of multiple companies that sell diet drugs.)

Now the Task Force in Canada has come along and made my point for me. The Canadian Task Force on Preventive Healthcare has issued a “strong recommendation” that primary care physicians should measure body mass index (BMI) at every visit.  If you know anything about the deeply problematic nature of BMI, you might wonder why in the world they would make a strong recommendation to do that.  No problem, Dr. Paula Brauer (a Ph.D and Registered Dietician) was happy to explain the strong evidence basis that drove their strong recommendation:

“There’s no evidence [for BMI-based screening] But we made a strong recommendation anyway.”

Wait… What?  I… I just… Okay, let’s play healthcare madlibs shall we:

There’s no evidence for [purported medical intervention] but we made a strong recommendation anyway.

For example:  There’s no evidence that giving people a pony will make people thinner, but we made a strong recommendation anyway.

Now you try.  Or not, on the off chance that you happen to be someone who – unlike the  Canadian Task Force on Preventive Healthcare – supports the practice of evidence-based medicine.

How do these people still have jobs?  Oh, right, because they’re talking about fat people and we are perfectly comfortable as a society making fat people the non-consenting lab rats in experimental medicine.

The other “strong recommendation” that they made on “moderate evidence” is to treat obese adults at high risk of type 2 diabetes with structured behavioral interventions aimed at weight loss (and not structural behavioral interventions to, say, prevent type 2 diabetes, the interventions with which they treat thin people). Despite, as the good doctor pointed out, “there’s also a lack of knowledge in terms of outcomes for people who do lose weight.”  So even if the weight loss programs are successful, they don’t know what that will mean for the person’s risk of acquiring Type 2 Diabetes.  And this warrants a strong recommendation.

And the hits just keep on coming.  They also made a “weak recommendation” that, should their BMI “test” (for which there is no evidence) come up with a number that is “too high” then that person should be referred to a weight loss program, but they don’t know which one.

“From reviewing the evidence, we can’t pick out particular programs that seem more successful. Programs that provide the behavioral components, the physical activity, and dietary changes all seem to be similarly successful.”

And by “similarly successful” let’s be clear that she means “not at all successful.” But let’s examine the overall situation: This group gave two strong recommendations with no  evidence, and a weak recommendation that was supported by evidence. What the hell are they smoking at those Task Force guideline meetings?

But they are still one upping the Americans since they aren’t recommending diet drugs (could this be because drug companies can’t buy off Canadian doctors the way they can American doctors?) because “patients in these trials had more adverse events, particularly gastrointestinal adverse events, than those in control groups.”   But at least they aren’t recommending that fat people take dangerous, addictive drugs that don’t work, so fair play to the Canadians I guess.

Let’s be clear that there are evidence based ways to provide healthcare to people of all  sizes, which put a focus on actual evidence-based medicine and not body size interventions, which is what Health at Every Size is all about.

So if you’re one of those people wondering why don’t I just trust healthcare recommendations and after reading this you’re still not sure, let me try to make it super clear:  It’s because I’m a fan of logic, evidence, and informed consent, and when it comes to the way doctors are treating fat people, they’ve thrown all three of those out the window.  In the current state of obesity epi-panic and hysteria when it comes to fat people trying to get healthcare, to me it’s very clearly buyer beware.  If you are heading to the doctor’s office and concerned about getting evidence-based medical care, here are some ideas that might help. If you’re looking to get drunk and write some medical guidelines, I think you might have pretty good luck in Canada.

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Published in: on January 28, 2015 at 12:33 pm  Comments (21)  

21 CommentsLeave a comment

  1. Reblogged this on move the dog fitness and commented:
    Some fabulous points from Regan at Dances with Fat about evidence based medicine. I could so easily reblog everything Regan writes, but this wouldn’t be my blog anymore if I did. I chose to reblog this one because I am Canadian and Regan points out somthing really stupid that some Canadian task force is doing.

    • Excellent blogging, akihotori. By the way, her name is Ragen.

  2. Way too much of our science these days involves theories presented as absolute facts, and we are reaching the point where science is becoming its own religion. If you question the currently accepted dogma, you are a heretic who needs to be silenced and ostracized.

    Ah, but what do we know? They’re the ones with the sheepskin on the wall that declares their irrefutable authority on the subject…

    • It’s all sciences too. In astrophysics they tell you in undergrad straight out that you won’t be allowed to graduate or get any job if you don’t believe in a single Big Bang and Big Crunch, that the Moon was formed from a chunk of Earth that was broken into space by another body, and that the Universe is expanding. None of these made sense to me, and have never been proven, but since I didn’t believe them, that made me unhirable material.

      I got out of there fast. That and the sexism. One guy was particularly vehement about women: “you’re trying to take away all our jobs”.

  3. I live in Alberta Canada and I am extermely proud to say my doctor not only thinks that is utter bullshit but has refused to measure BMI at every visit. As he puts it “It wastes everyone’s time when we could be looking at the actual problem.” In 21ish years of him being my doctor, I have never had to worry about the “You’re fat, lose weight and the problem will go away.” Which is why I fear his retirement greatly.

    I also understand why people don’t trust doctors as well. Every ER visit I have had minus the one I bit my lip in two during swimming class when I was like 8, I have been told the issue is my weight or a “per-existing condition” the only one I have is a back injury from 08 when I was hit in the neck to lower back with a 40lbs box of chickens at work… So no the bladder infection I had wasn’t caused by a muscle problem, it was caused by the low dose steroids I was on after having my wisdom teeth out, which I found out later had a side effect of secondary infections…

    • I want your doctor. I’ve been mistreated by all docs I’ve ever had. My last one was the worst, whose first treatment was to recommend bariatric surgery, and oh, did you know a normal weight is BMI 18.5-24.9????? Like I didn’t know about that before!!!!

      Now this new ruling makes me more scared to go out.

      • I got lucky with mine, I really did. Which is why I fear him retiring, which he is at that age to retire of he so chooses too.

        The new ruling makes me even more afraid of my doctor retiring but I am also so used to getting to a fat person’s standard amazing health care that I am also not afraid to tell a doctor to shove it and treat my actual problem and not my weight which has been stable (again) for the last 4/5 after having major surgery.

  4. As a Canadian, I do find this rather worrying. Thankfully, I have an excellent primary care physician who does not try to sell me the so called panacea of weight loss. It has come up with other doctors though and it pisses me off something fierce!

  5. “What the hell are they smoking at those Task Force guideline meetings?”

    With all the new evidence surfacing about the wacky weed, I kinda wish they would smoke it. Maybe they would leave us the hell out of it.😎

  6. It’s not that I don’t trust “doctors” – it’s that I specifically don’t trust doctors who are getting rich off the weight loss/fitness complex’s cartoonishly unethical practices when they tell me I have a manufactured “disease” that can only be treated with said complex’s products, which only work for 5% of the people who use them and sometimes come with side effects like “schizoeffective disorder, followed by death,” but they *promise* will *totally* work for me if I’m “good.”

    “There’s no evidence [for BMI-based screening] But we made a strong recommendation anyway.” – Dr. Paula Brauer

    And this right here is why. This isn’t one “bad apple” in a sea of otherwise flawlessly honest professional weight loss gurus, *this is the whole industry.* And make no mistake, it IS an industry, one that makes money from oppression, not a nonprofit that cares only for the integrity of its research and has only the best interests of us evil, unruly, ungrateful fatties at heart.

    • I’m willing to give a new doctor a chance. I had excellent luck with the surgeon who removed my gallbladder. One of his specialties is bariatric surgery, but neither he nor his staff ever brought that up to me before or after surgery, instead focusing on the matter at hand.

      That said, if my PCP started pushing the weightloss-industrial complex on me, I’d have no problem walking out.

      • I probably should have clarified my second paragraph after the quote was specifically about the weight loss industry and professionals who enjoy a symbiotic fiscal relationship with it, not general practicioners. Mine is also very good, and I’ve even encountered a few pro-weight-loss PCPs who still did their jobs and didn’t participate in the Obesipanic Circus. The ones who are invested in that, though? Of course I don’t trust them. They get caught falsifying information on a regular basis. But I do apologize if my crappy wording gave the impression “the whole industry” meant “the medical industry” and not, as I actually meant, “the psuedomedi wing of the diet industry.”

    • As Salman Rushdie said on the Bill Maher show recently in another context, but his words are applicable here: “It’s not just a few bad apples, it’s the entire orchard”.

    • I just want to say to those docs, “Can’t I just give you a check instead? Money is all you are really after-right?”

  7. Wrote about my issues with doctors today too. Im noticing a trend, even in the ones who I thought would never do this to me.

  8. I thought of your post as I read this:

    http://www.washingtonpost.com/news/morning-mix/wp/2015/01/28/how-a-fake-doctor-made-millions-from-the-dr-oz-effect-and-a-bogus-weight-loss-supplement/

    And especially this:

    “Duncan and his companies have been ordered to pay $5 million within two weeks of the court’s approval. The order also requires Duncan and his companies to substantiate any weight-loss claims in the future with at least two “well-controlled” human clinical trials — and it bans them from making false claims about the benefits of a product by claiming that they are scientifically proven when, in fact, they are not.”

    It’s a start. But we need to have Weight Watchers, Nutrisystem, et al. also “substantiate any weight-loss claims … with ‘well-controlled’ human clinical trials …” Not holding my breath, however.

  9. This was an epic rant. Loved every word.

  10. This “Task Force” sounds an awful lot like some military special ops unit.

  11. This was amazing and brilliant. Basically the doctors are saying, ‘We have no evidence that this will work but we are doing it anyway.’
    Somebody, please, help these people.

    Oh and btw, I have heard somewhere else (I can’t remember where) that the number of people who have actually managed to maintain weight loss for 5 years is even LESS than 5%. I’ve seen figures as low as 0.003%. Yet this number which is basically zero is counted in the medical community as being ‘limited evidence’.

    • I’ve calculated the “success” of weight loss at 0.0004% using the National Weight Control Registry. I was also reading the “Fat Studies Reader” and it said that if everyone who is considered overweight or obese, right now, to lose weight, it would take 40,000 yrs to achieve this goal.

  12. A post on Twitter by @toscareno, whom I love, prompted me to share both of these blog links in reply to the Tweet. We are both Canadian. While happy to see there was some confessing of lack of evidence, validation on BMI and other things, I was still unhappy to see this statement on the coattails of the American report. Thank you for sorting through the bullshit.


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