Blog | Friday, October 25, 2019

How most doctors miss a trick when it comes wellness and preventive medicine

It's no secret that America (and indeed a lot of the Western world) faces an unhealthy lifestyle crisis. Shocking statistics suggest that over 70% of the United States population are overweight or obese (defined as a BMI over 25). The consequential health effects are well known, and don't need further explaining. As a country and health care community, we simply cannot allow ourselves to get to a place where we normalize this, or accept it as “people just being themselves.”

There's a simple reason why there's been a BMI explosion over the last 50 years, and it's not just because of people being dealt a bad genetic hand or having underlying medical conditions. These cases may exist for some people, and make weight loss extremely difficult, but represent a tiny minority. The fundamental reason why the majority of the country is overweight or obese is because, in layman terms, we eat rubbish and sit around too much! On that note, we as the medical community really miss a trick when it comes to promoting healthy lifestyle habits, especially as yearly health care spending approaches a staggering $4 trillion, with a large percentage of this directly related to poor lifestyle choices.

During our interactions with patients, physicians should never underestimate the power of the words that come out of our mouths. A simple comment like: “Have you tried any weight loss strategies?”, “Do you eat a lot of fruits and vegetables?”, or “How often do you exercise? This can have a profound effect, even if it's just a quick statement prior to discharge. Not necessarily lengthy detailed advice, but just something to get our patients thinking more about their habits. It may be far from a magic bullet, but at least a sincere attempt has been made to get our patients heading in the right direction.

From what I have observed right now, very few doctors actually do it, especially in the acute care setting. Remember, this doesn't mean being insensitive (I've worked with some doctors who are almost afraid of addressing weight loss for fear of causing offense, which I believe is a big mistake). It's absolutely our job to talk sensitively about these issues. That's why I encourage every doctor to throw in the odd bit of lifestyle advice every now and again.

To give a simple example from my own experience. Apples and blueberries are two of the healthiest fruits out there, with studies consistently showing beneficial health effects of eating them regularly. They are packed with anti-oxidants and other great nutrients (I've talked previously about how amazing blueberries are—from cardiovascular effects to potentially improved memory, you can view the video here). I often make comments when patients are eating lunch or when I'm sitting down talking with them, about how they could eat an apple a day or sprinkle some blueberries on their cereal—and many have seemed genuinely surprised, as if they didn't know it was good for them.

Ditto with walking more briskly or going for a run in the mornings. When I meet some of them again at a later stage, they've told me about how they've implemented those changes or done something else, because of what I said, and they seem genuinely pleased to report that back to me. It also makes me happy as a physician, knowing that a patient has done something very positive for themselves after I've encouraged them to do so.

These may be small incremental pushes against the health care avalanche that is in front of us, but if physicians aren't at the frontline of getting our patients to eat better and exercise more, nobody else will be. Consider this too: we know that being out of shape drives a multitude of other health problems. So much of the time, doctors are fully aware that the main problem they are treating is present simply because of the patient's lifestyle. Period. If we as a profession have got to the stage where we are just treating the superficial condition that has arisen as a result of this, and completely pass over the fundamental issue that is staring us right in the face (or given up on it), what does that say about us?

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.