Guest guest Posted December 20, 2003 Report Share Posted December 20, 2003 Jodie, How refreshing to read an opinion based on factual information and experience rather than beliefs and prejudices. Nice job. Conflict of interest? Having worked in Optifast programs in the '80s and '90s, I think I have a pretty thorough grounding in the plight of the person who is morbidly obese (Class III obesity, BMI 40 and above). According to several treatment algorithms I've seen (NIH, for one), such individuals should be/must be referred for surgery or VLCD, precisely because traditional behavioral modification/diet/exercise programs have no impact. They are in great peril to their health because of their weight--this risk is estimated to be far greater than the risk of harm from surgery or VLCD (which indeed is there). In my view, it is unethical for a person like me to continue to see such a person for nutritional counseling when the data show I may have nothing to offer them except a pleasant relationship and the illusion that somehow I can fix their problem. Wish the people at ADA would talk with so me of us in the field who've had some experience!Jodie Roth______________________________________Johanna H. Roth, R.D., L.D.Dietitian and Nutrition TherapistNutrition Counseling * Consultation * SupervisionBethesda, lande-mail Jrothrdld@...Telephone 301-654-5214Fax 301-654-3765 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2003 Report Share Posted December 20, 2003 Jodie, I agree with you about the risk of not having the surgery for individuals who have tried many diets, BMI over 40, etc. I think the problem is that there are no real guidelines. For example, how many times should someone have tried to diet; how long did they stay on the diet(s)? Out of the patients I have seen, sometimes there have not been many trials. A patient I saw recently for her pre-surgery eval and diet education was only 26 years old. She had always been heavy and in college had gotten down to 130# by a combination of going to the gym 5 X a week and watching what she ate. Then, for whatever reason, she became depressed, stopped exercising and started overeating. Tried Atkins and Weight Watchers for a short time. It seems that she wants it to happen quicker. I offered support if she wanted to try the exercise/healthy eating again and she wasn't interested.She did get a little upset however, when I told her she might lose her hair. If we consider the surgery as the last resort, I find it hard for me to see the surgery as a last resort for her. Just my thoughts. Krantz, MA, RD private practice Somers Pt., NJ skrantzrd@... --- jrothrdld@... wrote: > Having worked in Optifast programs in the '80s and > '90s, I think I have a > pretty thorough grounding in the plight of the > person who is morbidly obese > (Class III obesity, BMI 40 and above). According to > several treatment algorithms > I've seen (NIH, for one), such individuals should > be/must be referred for > surgery or VLCD, precisely because traditional > behavioral > modification/diet/exercise programs have no impact. > They are in great peril to their health because of > their weight--this risk is estimated to be far > greater than the risk of harm > from surgery or VLCD (which indeed is there). In my > view, it is unethical for > a person like me to continue to see such a person > for nutritional counseling > when the data show I may have nothing to offer them > except a pleasant > relationship and the illusion that somehow I can fix > their problem. Wish the people > at ADA would talk with some of us in the field > who've had some experience! > > Jodie Roth > ______________________________________ > Johanna H. Roth, R.D., L.D. > Dietitian and Nutrition Therapist > Nutrition Counseling * Consultation * Supervision > Bethesda, land > e-mail Jrothrdld@... > Telephone 301-654-5214 > Fax 301-654-3765 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2003 Report Share Posted December 20, 2003 - I agree with Jodie and she is obviously a seasoned professional, as well as articulate in ger thoughts...BUT- anybody who has been in the healthcare field (for any length of time ~5yrs or more) knows that it is far from void of peoples' subjectivity. Physicians and health professionals pre-judge all the time, and bring their own beliefs and prejudices to work with them every day. I speak from being in the field for 17 years in the areas of teaching hospitals, community hospitals, and home infusion. Eva H. RD, LD, CNSD 443-745-4257 Conflict of interest? Having worked in Optifast programs in the '80s and '90s, I think I have a pretty thorough grounding in the plight of the person who is morbidly obese (Class III obesity, BMI 40 and above). According to several treatment algorithms I've seen (NIH, for one), such individuals should be/must be referred for surgery or VLCD, precisely because traditional behavioral modification/diet/exercise programs have no impact. They are in great peril to their health because of their weight--this risk is estimated to be far greater than the risk of harm from surgery or VLCD (which indeed is there). In my view, it is unethical for a person like me to continue to see such a person for nutritional counseling when the data show I may have nothing to offer them except a pleasant relationship and the illusion that somehow I can fix their problem. Wish the people at ADA would talk with so me of us in the field who've had some experience!Jodie Roth______________________________________Johanna H. Roth, R.D., L.D.Dietitian and Nutrition TherapistNutrition Counseling * Consultation * SupervisionBethesda, lande-mail Jrothrdld@...Telephone 301-654-5214Fax 301-654-3765 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2003 Report Share Posted December 22, 2003 The NIH consensus statement from 1991 (12 years ago!!) " Gastrointestinal Surgery for Severe Obesity " states " patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support " . I don't see any statement that these patients should be or must be referred to a VLCD or surgical program just because they have BMI's over 40. , How patronizing to make a statement that infers that professionals don't form opinions, judgements, etc based on factual information and experience!! SR , RD <md-gonzales@comca st.net> < > cc: 12/20/2003 07:18 Subject: Re: Conflict of interest? PM Please respond to BariatricNutrition Dietitians - I agree with Jodie and she is obviously a seasoned professional, as well as articulate in ger thoughts...BUT- anybody who has been in the healthcare field (for any length of time ~5yrs or more) knows that it is far from void of peoples' subjectivity. Physicians and health professionals pre-judge all the time, and bring their own beliefs and prejudices to work with them every day. I speak from being in the field for 17 years in the areas of teaching hospitals, community hospitals, and home infusion. Eva H. RD, LD, CNSD 443-745-4257 Conflict of interest? Having worked in Optifast programs in the '80s and '90s, I think I have a pretty thorough grounding in the plight of the person who is morbidly obese (Class III obesity, BMI 40 and above). According to several treatment algorithms I've seen (NIH, for one), such individuals should be/must be referred for surgery or VLCD, precisely because traditional behavioral modification/diet/exercise programs have no impact. They are in great peril to their health because of their weight--this risk is estimated to be far greater than the risk of harm from surgery or VLCD (which indeed is there). In my view, it is unethical for a person like me to continue to see such a person for nutritional counseling when the data show I may have nothing to offer them except a pleasant relationship and the illusion that somehow I can fix their problem. Wish the people at ADA would talk with so me of us in the field who've had some experience! Jodie Roth ______________________________________ Johanna H. Roth, R.D., L.D. Dietitian and Nutrition Therapist Nutrition Counseling * Consultation * Supervision Bethesda, land e-mail Jrothrdld@... Telephone 301-654-5214 Fax 301-654-3765 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2004 Report Share Posted February 27, 2004 Something to contemplate....... The magic word is the perception of conflict vs a true conflict A conflict is when the CDC gives Masden money and tells him: Go write us a paper that says that MMR did not cause autism in Denmark and he obliges. A conflict would have been if the parents and the lawyers had given Andy the 55k and said :Go invent something and say that MMR is bad . That did not happen, obviously, and the poor guy has lost his shirt. Here no one says anything when Merck or Wellcome give a million dollars to Harvard Medical School to promote Health Programs or such thing. Merck has given large sums to the University Of PA Medical school for research. Obviously it all filters slowly to Offit's programs but no one can prove it Testifying as an expert witness is also a tricky thing because obviously you have to be qualified and have done your own research to be even invited to testify as an expert on any subject. It is also obvious that those experts are not going to give up practice because they got 2,5,or 10 k to testify. Most experts never mention their income from testimony when they submit studies for peer-review. -------------------------------------------------------- Sheri Nakken, R.N., MA, Classical Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK $$ Donations to help in the work - accepted by Paypal account vaccineinfo@... voicemail US 530-740-0561 (go to http://www.paypal.com) or by mail Vaccines - http://www.nccn.net/~wwithin/vaccine.htm Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm ANY INFO OBTAINED HERE NOT TO BE CONSTRUED AS MEDICAL OR LEGAL ADVICE. THE DECISION TO VACCINATE IS YOURS AND YOURS ALONE. ****** " Just look at us. Everything is backwards; everything is upside down. Doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the major media destroy information and religions destroy spirituality " .... Ellner Quote Link to comment Share on other sites More sharing options...
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