That is the title of a speech that I just
made at the Obesity Society Annual Meeting in Orlando, FL. In my
speech, I talked about how physicians need to take a more active
role in addressing the weight of their patients. However,
physicians have not done a very good job so far. Physicians tend
to avoid that conversation, having it in only 20% of patient
visits, even though professional associations urge doctors to
engage in these discussions.
It is well documented that healthcare
providers have the same prejudices as anyone else against those
who are affected by obesity. Even those who specialize in
working with the obese are prejudiced.
There currently is a Medicare proposal that
would cover patients when discussing their weight. However,
doctors need to do a much better job with their overweight
patients, especially if the role of physicians might be
There was a very interesting study that
showed how patient perceive their doctor's attempt to counsel
them on their weight. Some very interesting comments were made
that I shared at the Obesity Society, and I want to share those
you. You may recognize and agree with the comments here.
1. Patients hate the use of the term
"obese," finding it insulting even though it is clinical term.
They much preferred "heavy," or even "fat" to the word "obese."
2. Attitude counts! It is as important how
something is said, as what is said.
3. Doctors need to be respectful,
non-judgmental, and encouraging. If you have lost 2 pounds, they
want doctors to notice, and be pleased.
4. Everything isn't weight related.
Patients reported that even if they go in for a sprained wrist
or a skin rash, doctors want to relate it to their weight.
5. Timing and assessment are important.
Patients need to be ready to deal with their weight, and doctors
need to determine if that appointment is the time.
6. Advice needs to be appropriate to the
individual's needs. If someone has a very bad back, don't talk
about joining a gym.
7. Patients want specific strategies and
goals. They don't want to be told they need to lose weight. They
want to know how much weight, and how they can lose it.
8. Connect weight to their individual
health. Patients want to know specifically how their weight can
cause type II diabetes, respiratory problems, or cardiac
problems. They want it to be realistic, and explained in common
9. Scare tactics don't always work. If you
are told, "If you don't lose weight, I'm going to put you in the
hospital," this will only lead to people staying away from their
This study was reported in the May 2009
issue of The Journal of General Internal Medicine and is
one of the few studies that looks at how patients feel when
talking to their doctor about their weight. Doctors have a long
way to go in understanding obesity and dealing with it. I'm sure
all of us hope that this will improve.