Doctors know what works — and it isn’t the guidelines!

A new study published in Obesity Medicine shows that “physician heal thyself” may mean ignoring common guidelines. The investigators performed an online survey of female physicians inquiring what weight loss strategies they use for themselves and what they recommend to their patients.

Did they stick to the low-fat, reduce calories, and eat multiple small meals throughout the day advice?

Not even close.

72% of the subjects listed intermittent fasting (between 14-24 hours) as their weight loss strategy of choice, 46% listed a ketogenic diet, and 26% a calorie-restricted low-carbohydrate diet. No other strategy reached a 15% response rate.

Interestingly, the recommendations they made to their patients differed from their own choices. Although they still recommended intermittent fasting, ketogenic diets and low-calorie carb restriction, the percentages fell to approximately 30%, 35% and 40%. They recommended the Mediterranean diet, commercial weight loss programs, DASH diet and Diabetes Prevention program much more often than they used these methods themselves. This could be due to the difference in the baseline health of their patients — for instance, if more of them had diabetes or hypertension — or it could be due to a reluctance to suggest interventions to their patients that could be considered “fringe” or going against the guidelines.

However, we should all realize that carbohydrate restriction is not fringe and does not contradict recommendations of major medical societies. The American Diabetes Association acknowledges that carbohydrate restriction is the most effective dietary intervention to control blood sugar, and the Obesity Medicine Society includes carb restriction as part of their extensive treatment algorithm.

However, other guidelines still promote the “eat less, move more, low-fat” approach. Based on this survey of female physicians, it seems the writing is on the wall. These strategies don’t work. Instead, it is time to institute the “new” (they are not new, but perhaps newly popular in medicine) strategies of intermittent fasting and carbohydrate restriction as first-line therapy for weight loss in most patients.

Looking to get started with a low-carb diet? You can start with our introductory guide. Or are you a physician looking to implement therapeutic carbohydrate restriction with your patients? See our guide for clinicians.

The tide is changing, and physicians can lead the way. What’s good for us is good for our patients.

Thanks for reading,
Bret Scher, MD FACC

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