Several years ago, I was meeting a young woman in my clinic for the first time. She was healthy but had been obese most of her adult life, even though she had tried many methods of losing weight. We spoke for a few minutes about diet and exercise, and she agreed to see the nutritionist.
A few months later, she came back to check her progress. She had lost weight, about five pounds, but was concerned because her heart “felt like it was racing.” After I questioned her extensively, she told me she was using a weight loss drug she bought from a friend. She wasn’t sure what was in it, but I knew similar drugs had been found to contain amphetamines. She agreed to throw the drug away. She regained the weight.
Since then, I have worried that telling patients to lose weight is harming them. These conversations fail to acknowledge how rare weight-loss success is: Fewer than 1 in 100 obese people will achieve a normal weight. We also continue to equate normal weight with good health in spite of mounting evidence that this is not true. In fact, in some studies, patients who are classified as overweight live longer than those who are a normal weight.