Tuesday, August 7, 2012

Obesity

Despite what it might seem, "weight" is a four letter word.

Doctors don't bring it up as often as they should. Patients also rarely bring up how their weight bothers them - embarrassment, denial or other factors might cause them to sit quietly in the office chair. I will often talk to patients about it, if it factors easily into their disease - people with high blood pressure or diabetes, for example. Then, I feel I have a legitimate reason to call attention to their obesity. Even then, many patients do not want to engage in a conversation about it. They start making excuses about how they are too busy to work out, or about how things are really stressful right now, but they have a plan to fix things in the future.

I am not trying to make light of these very real scenarios. In my experience, patients usually do not take responsibility for their weight. Some external force is keeping them from being healthy. It is very difficult to talk to people about weight loss in a 15 minute office visit, when there are other things to talk about. I always like when patients make appoints to talk only about their weight. It gives me more time to find out about their eating habits. But, more often than not, I am the one trying to talk about their weight. It's actually very frustrating to see someone come in every few months and not see their weight drop. I end up not talking about it any more, because it doesn't seem to be helping. I understand that it's hard to lose weight. I don't think it's as expensive as people think. I do think it's easy to make small diet changes that can have a big impact. I need to not get frustrated with my patients when they struggle with their weight. Perhaps if I keep bringing it up, something will stick and they'll actually make some changes.

2 comments:

Angie said...

This is a great issue. I am obese. Most conversations with doctors about my weight are: you are heavy. that is bad. Eat less move more. Read this book about this diet.

The most effective doctor led conversation I had was where the doctor was very real about risks associated with the increased weight. She asked me if I wanted to be healthy and how long I wanted to live. And then pointed out how my choices did not correspond with that decision. But she did it in a way that wasn't condescending or shaming. She pointed out that every time I chose what to eat I was making a choice about the health risks I wanted to take. This was particularly enlightening because we had just had a very long discussion about the risks of a course of treatment. She pointed out gently that I was very concerned about some minor risks and not concerned about the big risks I was taking on by overeating.

The other thing I wish doctors would do is tell me to come in every month to get weighed - for free - no appointment. Just stop by on x date every month and get weighed. This is an incredible first step in accountability and demonstrated an ongoing committment on the doctor's side to monitor this important health fact.

Lastly, the emotional component of overeating is a big one for many people. Having a doctor work with me to figure my insurance or free resources in the community (Overeating Anonymous) to help address the emotional piece can also begin to spur a big change. Even having a one-pager with resources would help.

I also recommend the book Instant Influence by Michael Pantalon. It was very enlightening to me about how to motivate people to make changes by focusing on what (very little) motivation they already have.

Just a Doc said...

Thanks for such a candid response. You said a few things that really hit home for me. First, you made a connection between obesity and addiction (ie, Overeating Anonymous). Perhaps, as with alcohol abuse, doctors need to do gentle nudging and educating until the patient has a point of clarity where they understand how their behavior is adversely effecting their health. I have definitely offered free weigh ins, but no one has taken me up on it. Thank you for reminding me that some one might want that option; I shouldn't cut it out yet. Second, your doctor seems to have done a great job in discussing a sensitive topic in a real and meaningful way. I am definitely going to incorporate some of her approach in my practice. Thank you again!