Preventative Healthcare and Obesity: 2018 Scholarship Shortlist (BC)

Devyn Parsons

University of British Columbia – Doctor of Medicine – 2019

The importance of compassionate, preventative health care in the era of obesity and overweight

Medicine has been waging a ‘war on obesity’ for decades, and we’re clearly losing. Year after year, the rates of overweight and obesity continue to rise, along with their complications. Countless fad diets and extreme exercise programs have arisen, taking advantage of a desperation to lose weight. The prevalence of disordered eating has increased among both children and adults, and children have been increasingly affected by weight-related health problems. It’s apparent to me that our war on obesity has had many casualties, and seemingly few victors.

Worse still, a significant number of health professionals seem to have forgotten that our enemy in this war is obesity, not our obese patients. Weight-based stigma is rampant in healthcare. Many patients tell me of frustrating experiences in which their symptoms have been dismissed without investigation due to their weight. Nurses express to me their dislike of caring for patients with obesity. Physicians advise me not to counsel patients with obesity on nutrition because they’ll ‘never change’. Those who do counsel their patients on these topics sometimes simply that obesity is the result of laziness, gluttony, or a disregard for health.

Many of these patients have devoted more time and effort to weight loss than to any other area of their life. Numerous patients have told me about following strict low carbohydrate diets, restricting themselves to less than a thousand calories per day, or pushing themselves in workouts to the point of vomiting, all in an effort to lose weight. Considering the immense efforts devoted to attempts at weight loss, it’s clear that laziness or lack of motivation is not the problem in most patients’ struggles with weight loss.

Yet, in medical school, we are taught to counsel patients to simply “eat less and move more.” This advice significantly underestimates the complexity of the choices individuals make regarding diet and physical activity. When we ignore the substantial barriers to weight loss that patients face, we fail to respect our patients and we fail to help them achieve a lifestyle that promotes their long-term sustainable health.

As a medical student, I am deeply troubled by what I have seen of the medical approach to overweight and obesity. However, I choose to see the problems with our current approach as opportunities to improve our delivery of preventative health care. These opportunities have inspired me to work towards transforming the way that patients with overweight and obesity experience health care. Significant changes must be made to decrease weight-based stigma and to improve the efficacy of our weight management interventions. I intend to devote my future
career as a family physician to bringing about these changes.

My commitment to promoting preventative health and abolishing weight-based stigma began in my undergraduate years. Since 2013, I have maintained a blog, Health for Positive Bodies, promoting evidence-based preventative medicine and healthy living at every size. With a readership exceeding 70,000, this blog allows me to share these ideals with a broad audience. I have also worked in partnership with the National Eating Disorders Association as an author for Proud2BMe, an online community fostering self-esteem for youth.

While working towards my medical degree at UBC, I founded the Health Advocacy For Marginalized Women committee. Through this group, I have organized annual speaker series on body positivity in health care, with the goal of educating medical students on how to decrease weight-based stigma in clinical practice. Prior to clerkship, I also organized a placement at Ottawa’s Bariatric Medical Institute, where I learned about their multidisciplinary approach to non-stigmatizing weight management. This experience further ignited my passion for preventative medicine and cemented my decision to enter family medicine.

In my career as a family physician, I intend to apply my passion for preventative medicine to enact meaningful change in clinical weight management. My primary goal is to establish a multidisciplinary family medicine clinic with a focus on non-stigmatizing weight management and health promotion. I hope to provide my patients with access to medical and surgical weight loss interventions, but also to the services of allied health professionals including dietitians, physiotherapists, and social workers. I aim to address nutrition and physical activity as meaningful tools for health promotion in their own right, and not merely as weight-loss interventions.

Outside my clinical role, I plan to continue my health education efforts through social media and public outreach. I also hope to become involved in medical education in order to further support the development of evidence-based, non-stigmatizing weight management approaches in health care. In the long term, I aim to be involved in public health policy-making to support preventative health measures, health education, and the reduction of societal
factors contributing to obesity.

Preventative medicine is a complex and challenging field, but one with the potential to achieve immense health benefits for our patients. In my experiences as a medical student, I have seen significant opportunities for improvement in how we approach preventative care, particularly for patients with overweight and obesity. As a future family physician, I look forward to seeking out these opportunities to implement preventative medicine in our health care system and to improve care for overweight and obese patients.