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Doctors need to be truthful about obesity

Posted by Administrator on Jul 27 2015
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Elaho Medical Clinic posts weekly articles from Squamish BC

Shannon Linden / Times Colonist
May 23, 2015

Recently, a physician I know treated a patient with multiple complaints. After a thorough exam and several tests, which proved negative for anything serious, the doctor delivered the good news - and a little bad. “You need to lose weight,” he told the 300-pound woman. Offended by the doctor’s callous comment, she responded with a letter of complaint. Was the heartless doctor guilty of fat-shaming or was an acutely sensitive woman unwilling to hear the truth?

A study published in the Archives of Internal Medicine found one-third of obese patients (with a body mass index of 30 or higher) and more than half of those deemed overweight (with a BMI of 25-30) have never been told they have a weight problem. Coronary heart disease, high blood pressure, diabetes, hypertension, depression and other mental-health issues associated with carrying too much weight can significantly shorten life spans. Why then the silence from so many doctors?

The author of the study, Dr. Robert Post, suggested to Health.com that dealing with the complex issue of weight, particularly when it is added to a list of ailments to discuss, is time-consuming for physicians, causing them to fall behind in scheduled appointments. Moreover, many doctors admit to negative feelings about their heavy patients, frustrated by an inability to help those who seemingly don’t help themselves by sticking to diet and exercise programs. Patients, for their part, can be highly sensitized, having been told by society they have a problem. Advice from a health-care professional highlights that. Still, isn’t it a doctor’s duty to advise his or her patients of concerns?

Dr. Robert B. Baron, director of the weight management program at the University of California, says, “Yes.” Baron said: “We need to be as aggressive as we are with smoking cessation.” He pointed to a study showing smokers reminded by their doctors of health hazards associated with the habit, and thus encouraged to kick it, were more successful than patients whose doctors didn’t get involved. He suggested BMIs should be calculated and recorded, just like blood pressure, at every appointment. Reminders and support should be offered to assist patients tackling weight issues. No good comes from keeping quiet, as studies show 20 per cent of obese patients who have not discussed the issue with their doctors see themselves as having healthy weights. Meanwhile, those who did have that discussion were more than twice as likely to do something about it.

Part of the problem is how doctors tackle it, which brings us back to the original story. Who wouldn’t feel the sting of that slap? It’s crucial physicians frame delicate discussions in a non-judgmental and caring way — or they could take the route a surgeon did when she visited my friend’s mother post-op. At the spry age of 82, “C” sailed through open-heart surgery. Her two youngest children, my fit girlfriend and her morbidly obese brother, were seated on either side of their mother’s bed, elated at the outcome. Sharing the family’s enthusiasm, the surgeon suddenly turned to my friend’s brother. “Would you like me to schedule your surgery now?” she asked. “If you don’t change your lifestyle, you’re going to be right where your mom is, only a lot sooner.” His feelings might have been hurt, but he wasn’t offended. He went on to lose 150 pounds.

Sadly, he couldn’t keep the weight off. “He was virtually a shut-in. He had to use oxygen to walk the living room of his apartment,” my friend explains. “I convinced him he would die if he didn’t do something drastic.” It took a structured medical program at a weight-loss clinic and devoted family support to help him address a complicated addiction he will likely battle all his life.
I don’t know the exact context my physician friend found himself in when he blatantly told his patient she was too heavy. Perhaps his bedside manner could use a dose of diplomacy, but ultimately we all bear the weight of responsibility for our own health.
Sometimes it hurts to heal.

Shannon Linden writes a humour and health-issues column for the Kelowna Daily Courier

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