By Sally Squires
Tuesday, January 29, 2008
Broaching the subject of weight can be difficult.
"Honey, does this make me look fat?" is one of the most loaded questions around. In this era of rampant obesity, it's a question that has become such a part of the cultural lexicon that it is used in everything from television commercials to greeting cards.
If it's tough for those who love each other to talk straight about weight, imagine how hard it can be for near strangers to point out the obvious. Study after study shows that doctors are often uncomfortable in telling their patients that they need to lose weight.
Sometimes, they also struggle to find the right words to convey concern without blame. And as one physician confessed at a conference I recently attended, they can simply feel exasperated at the yo-yo dieting that is frequently the norm. This doctor, who treats many people with weight-related complications, was chagrined to describe how he lost his temper with a 39-year-old man. The man had shed 18 pounds -- and normalized his blood pressure -- only to regain all the weight a few months later.
"I don't usually get angry with patients," said the physician, who said he worried that the man, a new father, might not live to see his child grow up. "This one just got to me."
That got me thinking: How many other doctors get mad at their patients about weight? And does this tough approach help or hurt?
Who better to comment than Lean Plate Club members? So in a recent e-mail newsletter, I solicited comments on the weight-loss advice they have received from health professionals and asked what approach is the most helpful. Not surprisingly, a number of club members weighed in about the topic in a recent Lean Plate Club Web chat.
A member from Ohio wrote that doctors "are being paid to render a service for which they have been trained. They are no better than their clients/patients, they are just educated in health care. They also . . . need to be taught how to deliver their message to their clients/patients in a diplomatic manner, no condescending, holier-than-thou attitude. They would definitely get better results by pursuing better ways of conveying their diagnoses and decisions."
Others thought health professionals have a right to lay it on the line and to "be tough with their patients," as a Lean Plate Club member from Pasadena, Calif., noted. "It also depends on the tone and delivery of the message. Very few people respond well to being yelled at or scolded. They also do not respond well to being demeaned or put down. Providers also need to remember that the patient's behavior is not a reflection on them and that it isn't personal. Lastly, providers need to, at all times, stay professional with their patients."
Some thought doctors could be more successful in delivering weight-loss advice if they attained a healthy weight themselves. Doing otherwise "discredits their advice," as a Lean Plate Club member from Alexandria wrote. "I lost 28 pounds in a year and on my annual visit found my doctor had lost the same amount. . . . My aunt's doctor told her to lose 25 pounds and she informed him that he needed to lose at least 50. Neither have lost weight and now he doesn't mention her weight, which is not a favorable medical practice for an internist dealing with older patients. So, docs, get skinny and talk about the weight."
Being too strident, on the other hand, doesn't seem to work, either. A Lean Plate Club member from South Portland, Maine, noted that the doctor who lost his temper "is exactly why so many overweight people avoid going to their physicians. Doesn't this doctor realize that most people regain the weight they lose? They need support, not recriminations. The doctor's temper tantrum didn't do anything except make him feel better. He wasn't helping his patient at all. Shame on him."
It's that kind of reaction that some members said made them reluctant to visit a doctor unless absolutely necessary. "I dread seeing my primary care physician because I have heart disease and I am 60 pounds overweight," wrote a member from Fairfax. "Every visit is about how I must lose weight or else I will have a heart attack or stroke. I lost 25 pounds in one year only to quickly gain almost all of it back. I am now trying to quickly lose it again before I must visit my doctor and have him find out that I have regained instead of losing more weight."
That's where the carrot, rather than the stick, may help. Imagine an honest discussion between doctor and patient that acknowledges the struggles -- as well as the rewards -- of shedding pounds. Now, that could really be the start of something new.