How can doctors counsel obese patients why they themselves struggle with their own weight?
That’s the question pediatrician Perri Klass discusses in a recent New York Times column. On one hand, doctors who are obese may better connect with patients when they “understand their frailties.”
But on the other, patients also ignore advice from physicians who can’t follow it themselves. Indeed, that’s what pediatrician Julie C. Lumeng, an expert in childhood obesity, finds: “The advice we’re supposed to give in pediatric clinic, it boils down to ‘Eat less, exercise more.’ This is such blasphemy, but when I deliver this advice to families, my heart’s not in it, because I just feel like so often the families are just glazing over, and when that advice is delivered to me, I glaze over, too.”
Patients are all too familiar with the worsening obesity epidemic. And, it appears that many doctors are finding out first hand how difficult it is to conquer it.
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- Doctors who exercise . . .
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{ 13 comments }
Same thing goes for Doctors who smoke! Any doctor who smokes should not be helping patients with cancer.. This quote is spot on:
“patients also ignore advice from physicians who can’t follow it themselves”
If I go to the gym and the personal trainer there is overweight, I am not going to have much ambition at all..
We glaze over because education does not equal behavior change. Behavior change is a complex process. Much current advice seems to be predicated on the belief that patients don’t do these things because they don’t understand how important they are, or they don’t know that what behaviors are bad for them. But patients understand that they should not eat one gallon of ice cream at a sitting, or have fast food for lunch every day, just like obese physicians do. We just don’t have effective behavior change tools at our disposal.
How can doctors counsel obese patients when they themselves struggle with their own weight? Because they are human. Try to stop being so judgmental and condemning of overweight people. No one is perfect– we all have our problems and imperfections, whether or not they are readily apparent to others as in the case of overweight people. And if you insist on judging and want to punish them, you don’t need to — believe me they are punishing themselves enough.
Like how can our new surgeon general (Regina Marcia Benjamin) possibly help stamp out obesity in this country???
Having had direct experience with this issue I can definitely say that dealing with a doctor with similar weight issues is very allows the patient to feel that s/he is less likely to be judged by the doctor. Therefore advice from the doctor is MORE credible than from a thin person. There is an unspoken empathy between people with weight issues and this strengthens the bond between doctor and patient. So the matter of weight loss becomes a shared experience or goal. The patient feels that the doctor will have direct experience to impart rather than textbook shoulds and shouldn’ts.
When it comes to obesity I’ve learned to withhold judgment at every level. Everyone has a story and it’s not always a clear cut issue. I think it’s fine when a fat doctor speaks about obesity with a patient. It’s not hypocrisy if that is what you’re driving at – everyone has their struggles.
For obese doctors, I suggest a pact. Let’s lose weight together!
I’m making popcorn. We have a President who smokes and nominates an overweight physician for surgeon general. Yet he proclaims he’s for “prevention.” I won’t believe it’s a crisis until they start acting as if there’s a crisis.
This is something I relate to as a fat doctor. I have hovered between the high end of overweight and the lower limit of obesity (BMI 29 to 30) most of my adult life. I don’t eat that much. I don’t work out as much as I need to – yes, I always hated gym class, even as a kid. Everyone in my family has weight issues as adults – no one is morbidly obese, but we all look like we could lose a good 25 pounds. I know that if I ate as much as I wanted to, I could easily become morbidly obese. Fortunately, all of the fat people in my family live until their upper 80s and lower 90s. I don’t have hypertension or diabetes, have a great lipid profile, etc.
When I counsel patients about their weight, I preface my advice with “Most of us who struggle with our weight already know what we need to do, but lets review some specific things that can help with your current situation…”. At times, patients have been so grateful to have a bit of non-judgmental counseling, that they have had tears in their eyes. I have been able to help many patients lose the 10 to 20 pounds necessary to help control their blood pressure and diabetes. And, in truth, that’s about all that can be expected for most people. The only way for most people to have the big weight losses needed to get people into a “normal” BMI range is bariatric surgery. And, most people who have bariatric surgery still don’t get into a “normal” BMI range.
I know that the gym rats among you will snort in derision at yet another fat person making excuses for themselves. But if you really want to help people, you need to step back and get a little more empathetic.
One significant parameter that we all should factor out (before criminalizing the numerical values of body mass index) are the known significant genetic factors that influence the BMI (of even) a person who does exercise and have a sensible diet. Therefore, a person’s inborn genetic factors and their chosen behaviors are two separate factors that both influence BMI. Thus (in a rational world), we would avoid attaching stigmata to a person’s BMI per se, and strive to (rightfully) decouple BMI from personal (or other people’s) perception of themselves. It is faulty to assume that higher BMI equals a poor state of health due to diet and/or exercise.
Throughout history and worldwide in societies – people generally live their life as they choose, and look to physicians as technicians who (might) be able to “fix” their physiology when it falters and/or breaks. Thus, people (in general) may listen to our sagely advice – then proceed to do what their own free wills guide them to do, anyway.
Therefore, it seems wise to avoid the delusion that the physician can (or perhaps should) attempt to assume the dubious additional titles of “priest and policemen” (as that Doctor Rocktor fellow perceptively pointed out where it comes to personal choices surrounding psychotropic endeavors).
The only other option would seem to be to (over) “medicalize” and (over) “moralize” the patients’ personal choices regarding diet and exercise. While it might be very profitable monetarily for the medical profession to impose “nanny status” to these personal choices, too …
We can (at least, in these matters of diet and exercise) hopefully see the futility of making foods “controlled substances”, and the similar futility of making exercise mandatory. Or can we? A little humility as to the limits of our power over human choices and behaviors that our medical degrees have imparted us seems a both wise and realistic stance.
Throughout history, worldwide – people have and do eat, drink, smoke, and self-medicate pretty much the way that they choose – despite all the social mores and pressures that various “life coaches” and “moral nannies” may attempt to impose.
The (actual) deep truth (despite all our desires, ways, and means of attempting to “save people from themselves” when they are not amenable to listening to our advisories) is that human beings will continue to freely make choices that are in the long-term ones that will shorten both the length as well as quality of their lives. Then they will look to physicians to try to “fix” their failing physiologies after the fact …
Just as patients should not imagine that their personal responsibilities to educate as well as to autonomously engender their own wellness can or should be foisted onto paternalistic authority figures (either paid or unpaid),
it appears that physicians (those unencumbered by avarice surrounding the assumption of such paternalistic roles) might be wise to recognize the realistic limitations of their influence (as well as responsibility for) physiological outcomes resulting from autonomous personal choices.
In the rest of the civilized-industrialized world, societies progressively tax their members to pay for physicians in the employ of government, and simply do what they are realistically able to do post-facto to address issues of the populace’s eventual physiological degradation and demise – without (what are essentially futile) efforts to extend an educational and informational role to the dubious (and ultimately pragmatically absurd) realms of paternalistic “life coaches” and “moral mentors” – unless the patient specifically *invites and agrees* to allowing other adults to initiate and direct their own prerogatives.
Societal “sin-tax” approaches to attempting to legislate and regulate human behavior (such as extracting additional fees in taxation, insurance premiums, or direct billings) – or administrative controls imposed upon the distribution and possession of tabooed foods or drugs for what the scientific state deems may be (statistically) harmful to a populace that (whether or not they may know or like it) bears ultimate responsibility for their own choices – is (ineluctably) a dubious and futile endeavor.
Removing all monetary incentives for the medical profession to realize (inordinate) profit from attempted treatments of states of sickness – as well as removing all societal incentives for patients to aspire to a “coddled victimhood” that seeks to absolve the patients themselves from their true responsibility for their long-term physiological outcomes and corresponding quality of life – would actually make common sense.
Life is short, and we know (statistically) that cardio-vascular and cancerous scenarios will in the end likely take us all – it is a matter of how long individuals can mantain and sustain quality of life, and how much they may be willing to sacrifice short-term gratifications for long-term longevity and quality of life within that time.
The (absurd) idea that – in a privately-based for-profit medical system) – anyone but the very wealthiest will ever be able to even dream of being as svelte and vivacious as a child for over one century of life is an unrealizable goal by which to fashion social (including medical) policies.
Correspondingly, should the US ever find the pragmatic wisdom to join the rest of the civilized world in providing and administering (at least the option of) state-managed health care, there are obvious resource limits by which we as a society can address the long-term health issues of all of it’s members (save only the wealthiest and most fortunate among us).
It’s not as if the “Titanic” of the private insurance-based and for-profit medical industry makes such limitations any less avoidable. In fact, we know that Medicare’s 3% administrative overhead would have a long way to go to present a devolution from the seven-times inflated (around 21%) profit-taking of private medical insurers.
Patient – (with the assent and assistance of the medical profession), “heal thyself” as you can best manage – and do not complain when autonomous behaviors shorten the quality and duration of life.
Doctor – (with the assistance of your *salary*, and possible assent of the patients that you attempt to treat), “heal thyself” as best you can (if your advise is to be more than lost on its listeners), and afford yourself the same humanity (with all its frailties) that all mortals possess.
The rest just seems like illusions arising more out of the false promises of modern science coupled with our society’s highly over-privileged and unreasonable expectations within the US where it comes to technology conquering and supplanting the deep mysteries that human physiology and “wellness” largely remain to this day (to lay-person, physicians, and researchers alike).
To engender and promote false illusions otherwise for the purpose of monetary gain (and at the expense of the quality and availability of health care for all members of our society), and that (malignantly) inflate at double-digit percentage rates annually, seems venal and morally unsupportable. “We” (may perhaps) “never/avoid doing harm”, but the aggregate effect of private insurance-managed for-profit as it exists today is surely a prescription for societal harm and bankruptcy transcending any individual actions or inactions.
Should we not perhaps consider and accept salaried compensation in a system that actually makes long-term sense for the survival (and quality of life therein) of the populace? After all, if/when they are all dead from physiological and/or financial ruin at the hands of the the existing system in the US, there won’t be any patients to “treat”. And what will we have become in the process? Funeral Directors for a populace who could not afford to live after food, shelter, clothes, and insurance premiums?
If we as a society expect quality human beings to train for and assume the role of healer in the future, it would seem that such folks would genuinely value serving humanity over concerning themselves with the accumulation of large amounts of liabilities subsequently offset by the accumulation of large amounts of assets. Very troubling.
None of the players (other than the bankers) will win in this game. Perhaps we should all become bankers …
Did you know Thomas Jefferson owned slaves?
One things Docs can do to help their own and their staff’s obesity is to stop the drug lunches grought in by the drug reps. This has been a real issue in my 10 provider practice. Apparently when the food is free there is a feeding frenzy. Even when “healthy” lunches are brought we will have staff leave and go get a “good tasting lunch”. Bottom line is you are fat you will pay a higher price in terms of health so we need to go ahead and use the price factor up front to drive healther individual choices.
I’ve had obese patients with medical issues they choose to see me for that were directly related to their “morbid obesity” tell me that I couldn’t talk to them about their weight because I was thin.
People are quite talented at finding excuses for their behavior.
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