As a physician who treats obesity, I often am asked to provide reporters with patients to interview and as a small business owner, I commonly receive the suggestion to add testimonials to our website, to increase our presence on the internet. And I am often asked for the reason why I am resistant to this, assuming it must be that we are not proud of our patients'
weight loss-- that we haven’t earned our “bragging rights”. Then one of my sisters said, “why don’t you just let people know the reason?” And I thought, good idea.
Have you ever seen testimonials on a physician’s website showing a patient’s response to their treatment for their diabetes? For hypertension? For sleep apnea? There is something different about how we, as a society, consider obesity. We still don’t accept it as a disease, as a biological entity that requires chronic management.
We now know that an individual’s weight stems from an interaction of genetics, physiology, psychology and a complex environment (among a few other things). And the management is complex, requiring identifying and modifying the things that can be changed in one’s environment like activity, nutrition, sleep, medication, optimizing associated medical conditions, modifying stress responses as well as accepting those that can’t be changed (genetics, global environmental stress and pressure, 24/7 lifestyle, general speed of life). It is not simply, eat less and exercise more. Every approach needs to be individualized because not everyone responds to a given intervention, whether that is a particular diet or exercise intervention, use of medication(s) and/or surgery that target biologic pathways involved in weight regulation. Maintenance is also difficult largely because of these biologic pathways that fight the body to regain.
I have worked with people who struggle with weight for 18 years. And it is a struggle. I have seen individuals lose 80+ pounds, regain it (sometimes more), only to lose it again, each time fighting back, saying they learned something new this time, vowing to not let it happen again. The duration of sustaining the weight lost differs for everyone, sometimes it is a year, sometimes 3, sometimes even 5 years or more. The amount kept off varies as well, even if they have regained half, they feel better and have really improved their quality of life. But still the individual feels shame and stigma around the inability to keep it off. Regardless of the intervention and circumstances, the individual always blames themselves, thinking “Everyone else loses weight and keeps it off”. Look around at ads, television, the internet, it appears to be quite easy, fast and sustainable—“all you need is this approach, works for everyone—see the pictures?” But this is not reality.
I struggle with the use of social proof (the psychological use of endorsements that capitalize on the idea that humans are attracted to what other humans are doing or have done (their stories) and they don’t want to be left out), as a marketing tool for medical practices. On one level, reviews are helpful (I read them too) and can give a flavor to a given clinic or may identify a real problem. On another level though, testimonials can be used to manipulate, to compel someone to join a clinic, even if the individual has a sense that what they are offering is “too good to be true”.
Perhaps, the clinics offering testimonials mean well. It is thought to be inspirational and it likely is for the reader. Many of my patients liked watching the Biggest Loser, though I found it incredibly offensive, demeaning and certainly not real.
But what I am really concerned about is the individual who gives the testimony. Is it a set up? How do they feel when they start a cycle of regain, after having given a very public announcement of being “successful”? Do they feel shame? Do they consider themselves a failure? They should not but I have never met a patient who didn’t blame themselves. I believe that the use of testimonials for weight loss puts the individual at a risk for increased feelings of shame and continues to perpetuate the idea that “weight loss is simple and easy”. Spreading this message to the public undermines the science that we are just beginning to understand, making it difficult to separate real from bogus approaches to weight management as well as reinforcing societal shame and stigma for the individual who struggles with weight. Research shows that shaming does not result in weight loss. In fact, it may perpetuate weight gain due to internalization of the shame, increased stress response(s) and modify biological pathways that affect weight.
From a medical perspective, we know individuals benefit from 5-10% weight loss. Patients most often want more than this. We, at WCWMR, use all modalities to support the individual’s goal within the physiologic reality of what can be sustained, with a primary focus on improving their overall quality of life. We, at WCWMR, value the privacy of our patients and respect the totality of how obesity has affected their lives and the daily struggle. “First Do No Harm”, the oath I took as a physician, means caring and treating the whole person, including protecting a patient from potentially aggravating shame on all levels.
Perhaps it is not the best “business” decision but I think it is the best decision.