I recently gave a talk to a group of around 100 doctors as part of a “Masterclass on Weight Loss Surgery” held at the Royal Society of Medicine in London. I was interrupted early in my presentation by a visibly irate member of the audience who was clearly incensed by my apparent dismissal of dieticians in the management of overweight and obesity. So why do I not think that dieticians are an essential resource when it comes to weight management?
Although I have been working with overweight and obese people for decades, the fact is that I cannot recall a single occasion on which anyone said that they found referral to a dietician to be of any help in losing weight. The problem is that most dieticians – and most health professionals – seem to think that what the overweight patient needs for successful weight management is information. They need to know the details about various foods, the fat levels in various snacks and the calorie content of almost everything. The belief seems to be that if only we can educate the person about food, they will then make healthier choices and lose weight. This is an absurdly simplistic argument which self-evidently doesn’t work.
The reason it doesn’t work is because most people with weight problems already know what they should be eating; indeed many have an encyclopaedic knowledge of the calorie content of various foods. Knowledge isn’t the problem; what’s difficult is actually doing it. Put simply, weight gain is primarily due to what people do (or don’t do), not what they know. This is why it’s so pointless just giving someone a diet sheet and expecting them to stick to it for more than a week or two. To be successful in losing weight, individuals need to exercise weight management by making sustained changes in food choices and physical activity patterns over many years, and most dieticians simply don’t have the experience or the skills to provide this. Until they begin to understand the nature of the problem they have so conspicuously failed to address, their real contribution to combating the current obesity epidemic will continue to be marginal.
Dr David Ashton
19th October 2010
