By Maria Fleet
So, you’ve finally gotten up the courage to ask your doctor to help you with your weight, but you’re not getting anywhere…what now?
If you feel you’re getting stuck, Dr. Tasneem Sajwani has some advice: Don’t give up. It may require some self-advocacy on your part. “Doctors have varying degrees of knowledge and experience with the growing body of medical evidence in the area of obesity and weight management,” she says. “Some patients are fortunate to have physicians who feel comfortable with managing this in their practice. If that is not the case for you, then advocating for a referral to an expert is a reasonable request.”
Dr. Sajwani specializes in weight management at her clinic in Edmonton. As a specialist, she can give her patients a range of options to help them lose weight that go beyond the normal prescription of monitoring one’s meals and exercising more. Patients generally come to her through a referral from their primary care physician, but they sometimes need tips on how to get that crucial referral.
She tells the story of one of her patients, who happens to be a nurse. We’ll call her Debbie. Debbie was diagnosed with pre-diabetes – her lipid levels were rising, and her doctor discussed weight loss with her so she could head off a diagnosis of diabetes. Debbie had heard of Dr. Sajwani’s weight management program through a colleague who’d been successful with it, so she asked her doctor for a referral. But Debbie’s doctor wanted her to try and get her weight down by exercising and adjusting her diet first. Dr Sajwani picks up the story, saying Debbie really tried, but wasn’t getting too far. “There was this yo-yo [effect] that we see all the time, not due to lack of effort, but that’s just… how our bodies work.”
An expanding body of research shows that when we cut back on food, our bodies make adjustments. A constellation of hormones slows our metabolism, makes us feel more hungry, and even affects how much we think about food. All that to say that our bodies can actually work against us when we try losing weight by “eating less and moving more.” This relatively new science of weight management has been embraced by specialists like Dr. Sajwani who partner with patients to help manage excess weight while taking all the latest science into account. Debbie did try to lose weight, but after a year, her lab work showed that her condition had worsened. She had developed diabetes, and at that point she was, finally, referred to Dr. Sajwani.
Dr Sajwani laments that Debbie wasn’t referred to her earlier, because she believes a timely weight management intervention could have staved off Debbie’s diabetes diagnosis.
Such reluctance to refer a patient to a weight management specialist isn’t uncommon, but primary care doctors are beginning to be more receptive to the idea. For example, just in the last twelve months, Dr. Sajwani says, there has been a flood of information in the media about new medical treatments available for weight management. But what if your doctor, like Debbie’s, doesn’t seem willing to consider these options? Until the day it’s just second nature for primary physicians to refer their patients to weight management specialists, patients need to advocate for themselves, and Dr. Sajwani has some tips on how to be politely persistent.
Share your history.
In most cases, patients have already tried to lose weight through healthy eating and regular exercise, so it’s important to let your doctor know what you’ve already tried. Dr. Sajwani suggests making a personal appeal, saying you really need help that includes ongoing support and structure, which is what a weight management specialist will provide. If your doctor has suggested restricting calories and getting more exercise, try saying that you’d like to do that at the same time you work with a specialist.
There is a wealth of information about treating excess weight on the Obesity Canada blog. You may remind your doctor that the Canadian Medical Association recognizes obesity as a chronic disease that requires long-term treatment. Dr. Mary Forhan, the scientific director of Obesity Canada, suggests saying something like, ‘I’ve learned from reading… that obesity is actually not that simple and that there are more complexities. And as a patient, I’m really interested in learning a bit more about those complexities, as challenging as that may be.”
Ask about treatment.
Another tack to take is to directly ask your family physician about medication. Do some reading up on the medications available, so you’re familiar with how they have been working for other people. And then, Dr. Sajwani suggests, “Straight up ask, ‘Hey, I heard that there’s this medication that is effective for weight management. How do you feel about that medication for me?’”
Practice… and have back-up.
It can be intimidating to bring up these topics with your doctor, so practice what you want to say beforehand. Another suggestion Dr. Forhan makes is to bring along a friend or family member to your appointment. Their mere presence will bolster your confidence, and they can also help remind you of points you want to make. Having someone else there for you can shift the doctor/patient dynamic just enough to give you the courage to broach a subject that may be difficult.
Bring up the evidence.
If your doctor still isn’t on board with the idea of working with a specialist, you could speak more specifically about the evidence. Dr. Sajwani suggests saying something like: “It seems like doing the behavioral changes and considering medications together has the best rate of success. I’d like to give myself the best opportunity possible. So, if that’s what’s going to get me where I need to be, then that’s what I’d prefer to try.”
For Dr. Sajwani’s patient Debbie, the prognosis is good. Since coming to the weight management clinic, Debbie’s metabolic markers have improved greatly. Her diabetes is in remission. In fact, her numbers aren’t even in the pre-diabetes range anymore, Dr. Sajwani reports.
For people living with obesity, Dr. Sajwani stresses that getting the right care is a delicate balance between advocating for what they need and being respectful of a family doctor’s own experience.
Doctors are people, too. They’re people working in a fast-moving, high-stakes profession that’s continually evolving. Optimal medical care is a moving target and doctors are educating themselves to keep up with the latest science. In the case of weight management – the science has grown exponentially in just the last 10 years. Some gentle reminders of the new ways to manage weight may just be the nudge your doctor needs to get them to refer you to a specialist who can partner with you long-term, because managing your weight is critical to managing your overall health.
Good luck – you can do this…and you should do this! It’s your health at stake.
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