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WHY DID I CHOOSE THIS TOPIC?

I have utilized different types of mass-market/commercial solutions. I have also utilized conventional medical solutions by a doctor / dietitian.�
My doctor referred me to a mass-market/commercial solution instead of a referral to a medical professional or dietitian.�
I was ultimately curious as to which approach is more beneficial to improving overall public health. A big question that I have had is WHY was I referred to a mass-market/commercial solution instead of a medical professional?

Framing term: Medical Care vs Health Care

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SCOPE/SIGNIFICANCE OF PROJECT

It is estimated that one in two Americans will be obese by the year 2030 (Thomas).
In 2013–2016, 49.1% of U.S. adults tried to lose weight in the last 12 months (“Attempts to Lose Weight Among Adults in the United States, 2013-2016).
Approximately at least eight weight loss cycling efforts will be made by each person trying to lose weight (Quinn, Diane M., et al).
The diet industry is a $254.9 billion dollar industry (PRNewsWire).
Only 37 percent of people who embark on a weight loss journey by using a commercial weight loss program are successful in losing at least 5 percent of their body weight or clinically meaningful weight loss.

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

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THEORETICAL FRAME: �HEALTH CARE VS �MEDICAL CARE

“Medical Care”, which is providing treatments for diseases that a person already has, instead of “Health Care”, which is providing preventative treatments for diseases that a person does not currently have but it likely to develop in the future.
The U.S. Preventive Services Task Force has recommended that clinicians provide intensive counseling and behavioral interventions (LeFevre, 2014); however, “barriers exist to implementing this practice due to limited time and counseling skill” (Mehta et al. 97).
It can be hypothesized that due to the overwhelming effects of the obesity epidemic, doctors are having to spend more time on “medical care” versus “health care”. This means doctors are leaving preventative services (like losing weight to improve health outcomes) to the mass-market solutions, while they are dedicating more time to medical services after the fact like a heart attack.

CHRISKRESSER.COM

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PROS AND CONS OF THESE SOLUTIONS

These programs are often very restrictive at an over 1,000 calorie deficit per day.

For example: Nutrisystem permits a 800-1,000 calorie deficit without exercise. With added exercise, this number exceeds the recommended 1-2 pounds of healthy weight loss.
Severe restriction results in weight cycling, resulting in depressive symptoms, internalized weight stigma, body dysmorphia.
Biologically, they result in increased hunger hormones and a decreased metabolism.

Biggest Loser: All of the participants from the study lost significant metabolic capability, and in fact, one of the participants within the article now burns 800 fewer calories a day than an average man with the same height, weight, and age (Kolata).

These programs are often successful in achieving health benefits.

“[In commercial weight management programs], blood pressure and/or blood lipid levels had improved after at least 12 months of participation (Mehta, Ambereen K et al).

Blood lipid levels include LDL cholesterol, HDL cholesterol, and triglycerides within the blood.

Not all programs result in positive health changes – it depends on the particular program (see chart).

MEHTA, ET AL.

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INTUITIVE EATING WITH A REGISTERED DIETITIAN

Based on ten principles. It may lead to weight loss; however, it does not utilize caloric measurements.
The intuitive eating approach focuses on using food as fuel for the body and proper macronutrient ratios for optimal health and rejects tying food to a person’s individual self-worth.
A study measuring the effectiveness of intuitive eating on over 2,000 adolescents found “aspects of intuitive eating are associated with lower BMI. In both young adult males and females, the report of each aspect of intuitive eating was less common in higher BMI categories” (Denny, et al).
In twelve weeks, BMI was lowered by 2.7% on average, and blood pressure was lowered by 1.7% by utilizing intuitive eating (UNC Health).
Dieting to lose weight has been found to be associated with future weight gain through a variety of cognitive, physiological, and behavioral mechanisms” (McEvedy et al. 1623).

”10 PRINCIPLES OF INTUITIVE EATING”, NUTRITIONIST-RESOURCE.ORG

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WHY ARE DOCTORS REFERRING�PATIENTS TO THESE SOLUTIONS?

Heart disease has increased by 20% in the past decade. More time is needed for medical care!

“Globally, nearly 18.6 million people died of cardiovascular disease in 2019, the latest year for which worldwide statistics are calculated” (“Heart Disease #1 Cause of Death Rank Likely to Be Impacted by Covid-19 for Years to Come.”)

Weight loss takes time!

Physicians are contractually bound by insurance companies to spend only a limited amount of time with a patient, usually 15 minutes of less, in order to ensure that they are caring for the appropriate number of individuals to meet a specific quota (Solomon 1).

Physician Shortage!

“The United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care” (“AAMC Report Reinforces Mounting Physician Shortage.”).

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DIETITIANS ARE THE SOLUTION

Doctors are not referring patients to the nutrition experts for further support.

A study evaluating the prevalence of physician to dietitian referrals found that “the percentage of patients referred for medical nutrition therapy from the total number of patients diagnosed with corresponding diseases was, on the average, 3% for diabetes mellitus, 1% for hypertension” (Madden, et al. 1).
“Doctors are taught an average of 1 percent of their total lecture time in medical school learning about nutrition” (Ldanziger).

There is a general belief by many healthcare providers that dietitians simply have not had the amount of extensive training on the medical side of obesity. Prior to 2024, only a bachelor’s degree was needed.

As of 2024, all dietitians are required to have a masters degree in order to practice medical nutrition therapy, in addition to 1,200+ hour dietetic internship, licensure examination, continuing education, and completion of a didactic program in dietetics.

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THESIS / CONCLUSION

Commercial weight loss programs are beneficial to individuals in reducing their weight and improving blood lipid, sugar, and blood pressure levels in the short-term; however, long-term success is highly unlikely due to severe restriction which leads to weight regain, decreased metabolism, and increased evidence of psychological harm.
Mass-market/commercial weight loss programs should be avoided. An approach from professional psychological behavior change, social support, and medical nutrition therapy should be utilized like Registered Dietitian (RD) for long-term success.
Further outreach from dietitians are needed in order to educate doctors on the extensive amount of nutrition training that they have, so for the obesity epidemic, doctors can focus on medical care, while dietitians can focus on health care. Together, a partnership between a dietitian and doctor can help reverse the obesity epidemic, improve public health, and lead to an overall healthier nation.

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WORKS CITED

“FastStats - Overweight Prevalence.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Sept. 2021, https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. �

Ldanziger. “Doctors Don't Learn Nutrition. One MD Is out to Change That.” The Beet., 25 Nov. 2020, https://thebeet.com/doctors-dont-learn-nutrition-in-med-school-heres-how-that-effects-you/. ��

Markets, Research and. “Global Weight Loss Products and Services Market Report 2021: The Business of Weight Loss in the 20th and 21st Centuries.” Global Weight Loss Products and Services Market Report 2021: The Business of Weight Loss in the 20th and 21st Centuries, 13 Aug. 2021, https://www.prnewswire.com/news-releases/global-weight-loss-products-and-services-market-report-2021-the-business-of-weight-loss-in-the-20th-and-21st-centuries-301354957.html. ��

McEvedy, Samantha M et al. “Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis.” Journal of Hhealth Ppsychology vol. 22,12 (2017): 1614-1627. doi:10.1177/1359105317705983��

Mehta, Ambereen K et al. “Benefits of commercial weight-loss programs on blood pressure and lipids: a systematic review.” Preventive Medicine vol. 90 (2016): 86-99. doi:10.1016/j.ypmed.2016.06.028��

Quinn, Diane M., et al. “Trying Again (and Again): Weight Cycling and Depressive Symptoms in U.S. Adults.” PLOS One, vol. 15, no. 9, PUBLIC LIBRARY SCIENCE, 2020, pp. e0239004–e0239004, https://doi.org/10.1371/journal.pone.0239004.��

Sreenivas, Shishira. “What Is Intuitive Eating?” WebMD, WebMD, https://www.webmd.com/diet/what-is-intuitive-eating. ��

Thomas, Dr. Liji. “Almost One in Two Americans Will Be Obese by 2030.” News, 20 Dec. 2019, https://www.news-medical.net/news/20191219/Almost-one-in-two-Americans-will-be-obese-by-2030.aspx. ��

Watt, E. “The Weigh to Wellness: RDN Effectiveness at the Forefront of Lifestyle Management.” Journal of the Academy of Nutrition and Dietetics, vol. 119, no. 9, Elsevier Inc, 2019, pp. A64–A64, https://doi.org/10.1016/j.jand.2019.06.185.��

“5 Steps to Become a Registered Dietitian Nutritionist.” EatRightPro, https://www.eatrightpro.org/about-us/become-an-rdn-or-dtr/high-school-students/5-steps-to-become-a-registered-dietitian-nutritionist.

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