Blog | Monday, May 2, 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 two-thirds 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 (body-mass index [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 embarrassed to bring it up;
--Physicians have no training in weight management and how to lose weight; and
--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.

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.