Tuesday, March 29, 2011

Doctors Don't Discuss Weight Loss With Patients

Patients are more likely to lose weight when physicians tell them they are overweight and advise weight loss.  Despite this, fewer than half of overweight patients and fewer than 2/3 of obese patients say they have been told by their physicians that they are overweight.  The current obesity epidemic has made higher weights and larger sizes seem more normal.  Patients who don't perceive their weight accurately also don't recognize the health risks, so physician intervention is a key component to encouraging weight loss and lower risk of disease.

Data from the 2005-2008 National Health and Nutrition Examination survey (which looked at 7,790 patients)  found that overweight and obese patients who were not told by their physicians to lose weight, continued to consider themselves to be of normal weight.  Of the overweight subjects (BMI>25), only 45% reported their physicians told them.  Those that were told by their doctors were much more likely to identify themselves as overweight than those were not informed.  They also reported they wanted to lose weight and attempted to do so.

So we have an opportunity here to influence patient behavior, but physicians are letting it pass.  Why is this?   The study did not assess why physicians fail to identify patients as overweight and obese (BMI>30).   Here are some guesses:
  • Physicians think patients already know it and it won't make a difference
  • Physicians think the patient lacks motivation to change
  • It takes a long time to address lifestyle changes, weight and diet
  • Physicians think the patient might be insulted
  • The doctor might be fat and feel personally embarrased to bring it up
  • Physicians have no training in weight management and how to lose weight
  • The doctor has no advice to give
The fattening of our population is one of the biggest health risks we face.  Our health system will surely collapse if we don't get a grip on the potential increase in diabetes, heart disease and joint disease from the collective weight gain of Americans.  When you look at groups of kids and teens, you can see that this is a problem than we can no longer ignore.    And except for shows like "The Biggest Loser", not much is being done about it.

The blame cannot be placed only on physician's shoulders.  It is a societal problem that requires solutions to come from many areas. But doctors can play a vital role in letting patients know their health is at risk and their weight is not normal.  It is not an insult to point out concern about health risks.


KathleenMD said...

Patients also practice selective listening. Sometimes we don't hear what we don't want to hear. Or we hear about it and forget about it as soon as possible. It seems like this could be more about denial than lack of physician encouragement.

I've also had a patient or two take offense. They were insulted that the "skinny" doctor mentioned their "few" pounds too many. You have to be careful with this one - tone of voice, condescending manner, etc.

Anonymous said...

This is very interesting, thanks for this post. I think there is a lot of variation along income and racial/ethnic lines. Someone did a study a while back and found that a preponderance of lower income groups think that "larger is healthier", also some ethnic groups seem to at least show the same thing, that a larger person, who is usually overweight, is healthier. I have a nutrition background and arm my family with information about healthy eating, reading food labels, identifying healthy size portions, etc. The kids, in turn, share with their friends. --Barbara

kitty said...

It's interesting. Difficult to imagine a woman, wouldn't know she is overweight. A man - maybe.

I got into the overweight range a few years ago, and the moment I realized that I look better with my shirt over my skirt then tucked into my skirt and that tight tops and clothes that underline the waist are a no-no, I understood that it's time to lose weight. The doctors haven't yet started to even notice it.

Dallas Search Engine Optimization said...

Obese persons are not awesome to look at. Why do persons look like this? Do they eat something which turns them in to huge one? I don't have the idea why people get overweight. Probably they turn into like this because of the genes or some hereditary factors.

BrainDame said...

Great post-I have started a real campaign with my patients-especially those that have spine problems. The weight on their back joints is terrible. I sometimes make a "deal" with them that if I do their surgery, they need to do their part and drop the weight. It doesn't always work but I have been amazed how many do respond when you take the time to help them.
PS: Having battled weight issues my whole life helps me to relate to them, too.

AnneV. said...

This post brings up a problem with many components to it. As a medical provider, I do try to talk to my patients about weight. I suspect most overweight people know they are overweight. If their provider fails to say anything, they feel their weight is not a problem for them. It unfortunately takes a lot of time to discuss meaningful lifestyle changes. Insurance often does not cover a visit for dietary counseling, or for a referral to a dietitian. Still, we medical providers need to do more. Selective listening is a big problem as a prior post brought up.

Anonymous said...

As a person constantly fighting weight gain, I know simply telling a patient he/she is overweight is not very helpful. There is more to obesity than the act of shoveling food to mouth. There are other issues involved as well.

Unlike alcoholism, gambling, et al, one can't stop eating completely and thus it's a continuous battle for the overweight patient.

I assure you that most overweight patients want to lose weight. Pointing out they are obese without offering GOOD solutions mixed with compassion is one way patients might succeed over time. Berating patients will not be helpful.

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lisamarieelliott said...

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