Reminders While Scrolling

Parents of newborns have a similar routine. Every 3 hours, you can find us feeding our babies, aimlessly scrolling through our phones as our sleepy babes drink away. Our phones are smart, listen to us complain about the baby weight, and realize that some of us are closer to middle age than to our quarter-life crisis. I am one of these parents with a very smart phone. Every advertisement I get on my phone it seems is about a new app to optimize my metabolism or calculate my calories. As an internist, I was caught off guard by ads with words like “metformin,” “buprenorphine,” and “GLP-1 agonists.” It felt like the secret language of physicians had been revealed to the world. Then I wondered, what does this mean for our patients? Are ads like these the counseling on weight management our patients will receive? What is our role as physicians?

The authors of “Preventing Obesity in Midlife Women: A Systematic Review for the Women’s Preventive Services Initiative” evaluate evidence on the effectiveness and harms of behavioral interventions to reduce weight gain and improve health outcomes for women aged 40 to 60 years without obesity (1). I have written before in Annals Fresh Look about the challenges of recommending lifestyle changes without concrete evidence. I give talks on weight management to medical students, trainees, and practicing clinicians. A common thread in my audience is that talking about weight is uncomfortable for patients, and even for physicians. Physicians like evidence, and when there is not clear evidence on lifestyle interventions, it is sometimes easier not to say anything at all. However, this study shows that counseling on weight can prevent obesity and the chronic conditions that can come with it.

The paper shows that “results of counseling trials are consistent in showing beneficial effects on weight outcomes, whereas exercise trials are only suggestive of benefit. On the basis of study limitations, consistency, directness, precision, and reporting bias, the strength of evidence is moderate for the effectiveness of behavioral counseling interventions to prevent obesity in women aged 40 to 60 years without obesity and low for harms” (1). This is enough to show that discussing weight is worth it. And the physician’s office is a safer and more familiar place for that discussion than a social media advertisement.

Reference

1. Cantor AG, Nelson HD, Pappas M, et al. Preventing obesity in midlife women: a systematic review for the women's preventive services initiative. Ann Intern Med. 2022;175:1275-1284. [PMID: 35914258] doi:10.7326/M22-0160