I'm pretty sure healthcare providers everywhere inform people who need to exercise and lose weight that they need to exercise and lose weight. Not really fair to ding them for making money on other treatments for people who can't bring themselves to do it the natural way.
In my experience this is actually rare. I've heard many similar stories to mine here from friends and family, but briefly, my own recent experience with this kind of thing:
I saw four doctors across two states trying to resolve a certain medical condition, which happens to be very common, has very negative effects, and has low recovery rates.
They prescribed a couple different medications, and mentioned that the disorder is "associated with" a list of a bunch of things related to lifestyle and diet. (These items were never brought up again by any doctor after their initial brief mention: it was a kind of "going through the motions" with each doctor—part of the obligatory informative synopsis of the disorder.)
The medications did practically nothing, and experimenting with briefly removing different items on the list from my life did practically nothing. Meanwhile my life was severely negatively impacted by this for ~4 years.
Eventually I decide to "get healthier" in a general way with an improved diet, insistence on regularly getting sufficient sleep, reduced alcohol consumption, and regular strength training.
A few months later the condition was at about 50%, and now it's at a point where I'm barely bothered by it.
I'm also a Type 1 diabetic and ran into a similar thing there: the recommendations given to me by doctors were incompatible with the blood sugar ranges they described as desirable. So I did my own research and discovered that basically everyone who had really good numbers was doing massive carbohydrate reduction in addition to taking insulin.
What it came down to in both cases: doctors will not prescribe lifestyle changes. They may mention them, but their core solution is likely to be a medication + tweaking dosage—even if this is by comparison far less useful.
I do think there's a legitimate reason, though: most people are simply not willing to make these kind of lifestyle changes. However, for those who are willing to do it, there's a good chance they'll lack the info on how effective it can be, because it's not what their doctor is going to emphasize.
(I'd urge anyone who thinks my cases may be uncommon to try this: if you know someone who resolved a medical condition by general lifestyle improvements like diet, sleep, exercise etc.—see if they made the changes because a doctor recommended it or if the motivation come from somewhere else.)
Its not actually less useful, because typically very few people follow through on lifestyle improvements. When I went through medical school they did not skip this -- we were all taught well how much of an impact lifestyle change would affect outcomes across various diseases, and even then how little change was required (e.g. 10 lbs lost makes a drastic difference for those overweight). There is simply a very low uptake of lifestyle change and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight). Its a cultural thing in that, in America at least, we don't have good cultural norms around food and activity that promote a healthy lifestyle. Which is unfortunate, given that is the primary influence (that we can control, obviously genes matter more) of many chronic health conditions.
Interesting to hear that confirmed. (I do mention that it was my best guess in my original comment ;).
It still seems problematic to have it just missing from the presentation of options[0] merely because most people won't follow through, though. The ones who are willing to follow through (probably the ones who care most deeply about resolving the thing) aren't given a fair opportunity.
Additionally, it seems like a self-perpetuating problem: I would bet a significant part of the unwillingness to make lifestyle changes in order to treat medical conditions is a consequence of Americans' expectation that illnesses are treated by medications (which comes in a large part from doctors emphasizing this). The entire situation has a kind of consumerist framing: you get sick, you purchase a thing which you then consume which treats you. That kind of perspective was strongly instilled in me until my experience with type 1 diabetes. Growing up in the U.S., I just thought that's how things worked: our medicine was that good, and it covered most illnesses.
If you go into it with that kind of expectation, it comes off as a very tall order to say, give up pizza. There's this feeling of, "I took my time and money and paid for a doctor, they didn't give me anything, and now they're asking me to do work?"
So maybe it's just a kind of a broken, self-reinforcing cycle. But I suspect it's a little more insidious than that too: there is an obvious financial incentive for things to be structured this way. I have a hard time imagining that has no impact.
[0] Not that it wasn't "brought up," it was in both of my cases. But: not only was it relatively un-emphasized, it was described as "possibly having an effect". The accurate presentation would have been: this can be much more effective than the medicine I can prescribe—but it will also require much more effort from you.
One of medical practitioners' patient compliance problems is you've built an aura around your profession as miracle workers with magic bullets. And while sometimes you swing and hit a grand slam, more often than not you hit the ball foul. Which is okay, as long as you keep working with the patient to find a solution to their complaint.
Slow and steady usually wins the race, but magic bullets pay better.
Look at the rebellion that doctor started in New York, with his youtube videos about how futile and absurd it was to ventilate lucid/non-distressed SARS-CoV-2 patients, solely on the basis of their oxygen saturation meter readings. Later reports from the front line said 'hey we're doing much better not ventilating our COVID-19 patients even when their oxygen saturations are super-low...'
> and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight).
/methinks it is simplistic and wrong to decree that a calorie is a calorie.
My working hypothesis is that bad medical advice is the primary etiological factor behind most cases of morbid obesity. Decades ago the medical industry decreed saturated fats as the cause of heart disease, and advocated fat-free diets, or low-saturated-fat diets failing that.
Butter has been vindicated of the charges against it, but I have yet to see an official apology for giving bad advice. Indeed, the heart profiteers are still [1] flogging a dead horse [2].
My retired-MD uncle recently came to visit, and shared that he now makes his own salad dressing to avoid the cheap oils in commercial salad dressings. He had some great stories of patients he'd helped (trauma from car accidents and knifings), but also of exercises in medical futility (e.g. cancer).
Why doesn't conventional medicine warn patients of the hazards of cheap oils? Now is the perfect time. You could refer to Wikipedia's article on Prostaglandins [0], and speculate that minority America's overconsumption of Omega-6 oils is one factor in their susceptibility to the SARS-CoV-2 (emotional stress is another factor).
I recently discovered a health problem and must have been told by five different doctors that there are longterm drugs that can help but I should focus on eating well, exercising and losing weight.
You may be right, I've never been diagnosed and put on CPAP personally and can't say whether that is true or not. But in general the western medicine has come to a point that it tends to offer solutions that are quite good at reducing the symptoms and generally don't address the underlying cause. It may be incompetence of the system or it may as well be financial incentives, slightly steered towards not providing a cure and but milking the patients for more money with symptom reducers. But on you're right on one thing though, a lot patients are lazy and would choose the quick fix over doing some of the work themselves.
