The punishment inherent in a physician saying, "You need to lose weight"

[sue_frantz]

I knew someone who didn’t want to see their primary care physician about knee pain because, “They’re just going to tell me to lose weight.” I couldn’t blame this person for not wanting to see physician. This person had gotten that message previously—more than once; going to their physician had become aversive. Operant conditioning predicted what was going to happen. Needed healthcare was avoided because they didn’t want to be chastised yet again.

The biggest problem with the “lose weight” advice is that if it were that easy, we would have already done it. Also, “losing weight” is not a behavior. It’s not something we can just do. “Let’s see what’s on my to-do list today: reply to email, wash clothes, shop for groceries, lose weight.”

We’re less than a month out for the next round of New Year’s resolutions. I bet “lose weight” will be on a number of resolution lists, and not necessarily because physicians have told us to lose weight. Because everyone has told us to—through words and looks. Losing weight is a poor choice for a resolution, though. Resolutions should be actionable. I can eat more vegetables, less salt, and less red meat. I can lift weights four days a week (although exercise will not help you lose weight; it just keeps you from gaining). Losing weight, however, is not actionable; it’s not a behavior.

Side story: I had a husky mix who had the husky wanderlust. He got very good at escaping from our backyard. I would go out into the neighborhood to round him up. He’d come to me, I’d take him home… and put him in his kennel as punishment. Had I spent any time at all thinking about this, I could have predicted the result. He’d still escape the yard, and I’d still go back out to round him up. But now he wouldn’t come to me. That was my big DOH! moment. Why would he come? He knew he was going to be put in his crate. To reverse this dynamic, I had to pull out the special treats. These were treats that were only used for special occasions. Without too many repetitions, I could yell “special treats!” and he’d come running.

Some physicians have had a similar DOH! moment. “I keep telling my patients to lose weight.” “Wait. Why aren’t my patients coming in for routine care? Why are they waiting longer to have their healthcare needs addressed when sooner is better?” “Could it be because they don’t want to talk to someone who is nagging them?” Could be.

The physicians who seem to have had this DOH! moment are turning their practices into weight-neutral practices. One physician who has adopted this approach said, “We don’t recommend weight loss as a way of treating medical conditions… We recommend moving your body in a way that’s sustainable, which hopefully is joyful [and] eating food in a way that nourishes” (O’Neill, 2023). This approach is about reinforcing behaviors that contribute to good health. Weight is irrelevant.

Weight-neutral medical practices may also feel more welcoming to Black women who perceive thinness as a “white” thing (Hughes, 2021). I would imagine that every time a physician tells a Black woman with this perception to lose weight, she may hear, “I want you to be more white.” It’s not hard to see why she wouldn’t be in a hurry to see this physician again.

Our future healthcare professionals are taking our Intro Psych classes. Let’s help them understand the power of operant conditioning.

Now, what to do about family members who feel free during holiday visits to comment on our weight (and relationships, or lack thereof, and everything else that’s not their business)? No, I don’t want to see those relatives, either.

Reference

Hughes, E. (2021). “I’m supposed to be thick”: Managing body image anxieties among black American women. Journal of Black Studies, 52(3), 310–330. https://doi.org/10.1177/0021934720972440

O’Neill, E. (2023, December 2). Some doctors are ditching the scale, saying focusing on weight drives misdiagnoses. NPR. https://www.npr.org/sections/health-shots/2023/12/02/1216455346/doctors-weight-loss-neutral-inclusiv...