February 2001 • Volume 7 Number 2
Obesity discussion is incomplete
To the editor:
The obesity discussion in the November and December issues of FP Report accurately reflects much of what is currently being said and written on the topic. Unfortunately, the trend is to present a plethora of data and opinion that obstructs clear thinking, meaningful communication and maximal benefit for overweight patients.
Although the articles contain some useful nuggets, I'm uncomfortable with the advice to include "mental health professionals who can deal with associated psychosocial problems, if present" in the obesity care team. Few obese persons utilize such services because they imply stigmatization, are often inconvenient and/or unreimbursed, and because patients don't see themselves as psychologically disturbed. If doctors don't consider their patients' thoughts and feelings, they overlook opportunities to provide empathetic support and guidance. What about helping patients who are not going to succeed in losing weight? When should we stop futile treatment and help people be comfortable with themselves as they are?
Finally, is it really so bad that third-party payers are reluctant to pay for weight reduction programs, considering the lack of evidence of long-term benefit? Everybody complains about the high cost of medical care, but nobody seems willing to admit that he or she may be part of the problem.
Robert Gillette, M.D.
Poland, OhioError in 'weight-loss drugs' sidebar?
To the editor:
FP Report is to be commended for publishing the two-part series on obesity in its November and December issues. Too many physicians have ignored their patients' obesity problems for too long; consequently, the United States finds itself in the midst of a growing obesity epidemic. Hopefully, your articles will encourage AAFP members to become more active in helping their patients lose weight.
However, the December issue contained one glaring error when it listed dextroamphetamine among the appetite suppressants in the "weight-loss drugs" sidebar. Amphetamines have not been recommended for weight loss for some 15 to 20 years due to their side effects and potential for addiction. The appetite suppressants diethylpropion and phendimetrazine have been in use for many years but were not mentioned in the sidebar. Also, only one trade name for phentermine was listed, when in fact there are several proprietary versions of phentermine.
Regrettably, your list of obesity resources did not include the American Society of Bariatric Physicians. (Bariatricians specialize in treating overweight, obesity and associated conditions.) Since 1950, the ASBP has been teaching physicians how to safely and effectively treat their overweight and obese patients. Each year, the ASBP offers two accredited CME programs on obesity treatment. We would welcome AAFP members at these meetings.
J.P. Smith
Director, Public Relations
American Society of Bariatric Physicians
Englewood, Colo.
Editor's note: Information presented in FP Report reflects material gathered from the sources consulted and does not imply endorsement of a particular course of treatment. Regarding phentermine, Mr. Smith is correct: Our coverage should have listed either no trade names or all trade names.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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