Bravo, Dr. Rob. I couldn't have said it any better.
I'll include my reply below.
Powerlessness about sums it up.
So many people struggle with this issue. The occasional patient ‘makes it’ and loses the weight and keeps it off. But they are the exception.
I have begun to progress beyond powerless to feeling disingenuous. When I see a 50 something patient 150 pounds overweight who has tried every diet there is, doing my ‘eat less move more’ speech borders on insulting. They know it’s not going to work. I know it’s not going to work.
I’m not sure where to go with it next. It’s my responsibility as a primary care doctor to point out their health risk factors and advise them on changes.
But research has proven time and time again that my advice is worthless.
So many factors at play: society, genetics, self-control, economic pressures, time pressures, self-esteem, education.