I agree, Wendy, that doctors are not really to blame. The problem is that doctors generally know as much about reversing obesity as their patients: Not much. The reason for that seems to be that nutrition advice took a serious wrong turn in the 1970s: unfortunately, the resulting low-fat, high-carb, pro-sugar diet looks to have been the main driver of ballooning global rates of obesity and diabetes (http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html?pagewanted=all&src=pm ).

Locally, the University of Sydney and the Australian Diabetes Council have been strong advocates of Australia's highest-profile low-fat, high-carb, pro-sugar diet. Unfortunately, if Gary Taubes - the former science writer at The New York Times and author of "Good Calories, Bad Calories", the best-available history of nutrition science - is right, the hi-carb, pro-sugar "Low GI" diet is rather unhealthy, to say the least: http://www.gisymbol.com/cmsAdmin/uploads/Glycemic-Index-Foundation-Healthy-Choices-Brochure.pdf

Moreover, the two scientists and food-industry service providers driving the low-fat, high-carb, pro-sugar low-GI industry in Australia have a dark cloud over the quality of their scholarship:http://www.australianparadox.com/pdf/22Slideshowaustraliangoestoparadoxcanberrafinal.pdf

When a Group of Eight university finds itself publishing - and worse still, defending - an obviously faulty "finding" on nutrition science - there is "a inverse relationship" between sugar consumption and obesity - in a supposedly "peer reviewed" pay-as-you-publish E-journal - in which the influential lead author also was the "Guest Editor" - is it any wonder that millions of everyday people - and thousands of Australia's doctors - have little idea how they got fat or how to reverse the process? (http://www.smh.com.au/national/health/research-causes-stir-over-sugars-role-in-obesity-20120330-1w3e5.html )

Doctors need to be as accountable for their advice and treatment as other professionals . There is a "duty of care" after all. Unfortunately, not all patients are informed of the full implications of their test results. If, for example people were made aware that even slightly raised GGT - could eventually lead to liver disease/cancer if action isn't taken or that fat cells produce oestrogen that is linked to a host of cancers - they would be in a position to make informed decisions about their health. Seeking medical advice is a sensible course of action when you have a serious health problem and it is the GP's responsibility to refer you to the appropriate specialist, if they can't treat the disease, and be prepared to admit to the limit of their knowledge.

I agree Dr.
I would like to see, but how would you feel if you were given the legal right to sue your Pts. for non-compliance. Say every doctor who advised the patients to stop smoking and drinking could sue and win if patients had not stopped before their next visit to any doctor. After all it would only take 5 minutes to explain that almost every condition known to woman/man is exacerbated by smoking and drinking (drinking not so much)..Very easy money …after all we all know the chance of someone giving up at the request of someone else. Cheers

Here's Mr Robertson again, perpetuating the myth that the nutrition profession promoted a "pro-sugar diet". They never did, and never will.

If individuals misinterpreted "reduce your saturated fats and balance with complex carbohydrates" into "consume as much added sugar as you want", should the nutrition profession be held accountable for their error?

Dr Maria Hill - I guess you are not a medical practitioner, because your assertion that "even slightly raised GGT - could eventually lead to liver disease/cancer" is simply not true.

The most common causes of slightly raised GGT, in the absence of a rise in the other hepatic enzymes, are excess alcohol or occasionally gall bladder disease (the latter more commonly associated with other raised enzymes).

One of the reasons that the Almario vs Varipatis case is anomalous is that progression from fatty liver to liver cancer is a rare complication (although progression to cirrhosis is well-known).

One review of non-alcoholic fatty liver stated that " In one prospective study of defined cases of NASH-cirrhosis, no cases of hepatocellular carcinoma were found during 5-year follow-up, in striking contrast to 1% to 3% per annum with hepatitis C. In an earlier study of more than 20 years' follow-up of histologically defined NASH (varying severity), only one case of liver cancer was reported."

This discussion is not just about the responsibility of health care providers to give appropriate advice - it should also be about the legal system making appropriate judgements.

What do DMARDs do to your liver in this regard (if anything)?

DMARDS are not a single class of drug, so some may be hepatotoxic, others not. You need to analyse each drug, and look at it's mode of metabolism and detoxification.

Arava and methotrexate then.

If you are taking these medicines, then the information insert in the packet should tell you all you need. Otherwise, there are, literally, hundreds of medicines databases, on line, which are easy to navigate.

Putting aside the specifics of this case, one can't help but think the medicos are reaping what they themselves have sowed. They have tried to enrich and empower themselves by claiming authority of all human behaviour. They have made themselves rich by "medicalising" everything from alcoholism to depression to shopping, and now obesity. I don't think many tears will be shed for them.

"the medicos" have "tried to enrich and empower themselves by claiming authority of all human behaviour."

"They have made themselves rich by "medicalising" everything from alcoholism to depression to shopping, and now obesity."

So depression is not an illness, Kim Darcy? Let's send depressed people back into dark stigmatisation, shall we?

For a self-described analyst, not much of an analysis.

No Sue. It is not that "depression" is or is not an "illness"; it is the complete dominance that medicos have over it. Unless an accurate diagnose of a form of "biological" depression (like melancholia) can be diagnosed, a GP is useless, except to the extent this temporarily down person is so down she can't get out bed. Sure, then the GP can bring the guns out - SSRis, etc - and bring the depressed back to life. But beyond that 'depression' is as much a spiritual experience, which medicos have a hopeless reputation for dealing with. Just have a look at the world's top 10 selling blockbuster drugs. In the 1990s, it was the anti-depressant SSRI, Prozac. Now that Prozac has gone off patent, there is not even one SSRI-type anti-depressant blockbuster drug, let alone in the top 10. But in 2012, TWO of the top were drugs to treat Schizophrenia (Zyprexa and Seroquel). Now, the GPs are pushing anti-schizophernia drugs onto the temporarily low and down in the dumps.

Greg Boyles - they're trying that approach in the USA, where doctors are telling overweight patients not to come back until they've lost weight. No matter what it is the patients are seeing the doctor for, and no matter how tangentially their weight might be related to the condition in question.

As someone who is fat (I'm not going to use terms like "overweight" or "obese", because they're frankly unscientific - over WHOSE weight, for crying out loud), and who has spent over ten years of her life attempting to lose weight (I went from being about 50kg to being about 100kg in that duration... in the 20 or so years since I quit dieting, I've gained about 5kg) and found it didn't work for her (just like it doesn't work for about 90% of the human race) I find the notion to be abhorrent.

It's abhorrent because it's treating a person's weight as an indicator of their moral status, rather than as a physical characteristic. As someone who is fat, I am labelled as being lazy, as being self-indulgent, as being slovenly, as being physically repulsive, as being unworthy and as being unintelligent. What I actually am is someone who inherited the genetics for a short, stocky build from most of her ancestors, and who has a thyroid condition which prevents her from losing weight. I should not have to jump through a series of moral hoops in order to receive medical treatment, or to even get a medical certificate because I'm sick with the flu.

Yes, I am willing to admit that my weight may well contribute to a higher chance of a prematurely terminated lifespan. However, given three out of my four grandparents survived past ninety, I suspect a "premature" death in my case won't really knock the stats about too much. Oh dear, I might drop dead at seventy. How tragic. Let's add in my chronic depression, and the ongoing suicidal ideation which crops up from time to time, and let's be honest: I don't want to live forever.

If it comes right down to it, I am more than willing to hand my GP a written declaration that I am aware my weight is over the recommended maxima, that I am aware there is a popular perception of excess weight being related to certain disease states, and that being aware of these and in my capacity as a mature and responsible adult, I have asked my doctor not to discuss weight-loss with me unless, in their medical opinion, it is immediately and critically necessary as a means of urgent treatment for an acute situation. If that's what they'd need to cover their backside legally, I'm willing to do it.

But I don't want to be badgered constantly by my GP about my weight, particularly when I've gone in there seeking something like a medical certificate because I've been sick with the flu for a week and haven't been able to go to work.