Time to Weigh In
This post appeared on KevinMD back on June 4th. Similar items have appeared elsewhere from time to time, with varying opinions. After much thought, I'm ready to weigh in, if you'll pardon the pun.
The issue is that of overweight doctors counseling overweight patients about diet, exercise and other lifestyle issues. The article quoted concludes that overweight and obese physicians are less effective than their slimmer counterparts in providing this kind of counseling and care to their patients.
The article discusses overweight physicians "feeling like hypocrites" advising their patients to exercise and lose weight. The feeling is that "heavy doctors who attempt to counsel their patients to lose weight may find their advice falling on deaf ears." In addition to everything else we are supposed to do and be for our patients, we are now also supposed to be role models.
Interestingly, three of the doctors interviewed for the article "found help at the Obesity Treatment Center, a for-profit operation (emphasis mine) run by internist John Hernried [another physician quoted in the article.]" The article continues:
The program, which in its most intensive phase costs as much as $700 per month, combines a very low-calorie diet and medical monitoring with intensive education around nutrition, exercise and awareness of behaviors that lead to weight gain.The role model thing may be a valid argument, but this particular article now seems more than a little self-serving.
At any rate, I still disagree with the essence of the argument. At least as important as modeling behaviors for our patients is empathy with them. Frankly, I don't think an overweight patient is going to be particularly attentive to a skinny-minny little doc exhorting her to lose weight with platitudes like, "Just eat less and exercise more." Talk about falling on deaf ears! I can read that patient's mind: "What the hell does that little twerp know about how hard it is to lose weight!"
Disclosure: My BMI is in the range of "obese". My weight has yo-yo'd over the years, most recently ballooning upwards because of painful, treatment-resistant plantar fasciitis curtailing my exercise regime. Despite the article's claim that:
A study published in the journal Preventive Medicine in 2003 found that when doctors watch their own weight, they are more apt to counsel and encourage their patients to lose weight and improve their diets.I regularly bring up the issue with my patients. I talk about diet and exercise all the time, however I am able to do so with true empathy. "Of course it's hard. Just look at me!" And then on to discussions of Weight Watchers, portion control, thirty minutes of walking daily and all the other lifestyle modifications that I once did and know I have to get back to.
I believe strongly that empathizing with patients counts for a helluva lot more than plain "role-modeling." Having "been there" -- whether it's trying to lose weight, undergoing a procedure (I've had both upper endoscopy and colonoscopy) or suffering the loss of a family member -- and therefore being able to offer genuine empathy is tremendously valuable, and patients appreciate it. In fact, in many cases it's the essence of credibility. I know for a fact my practice of pediatrics underwent a tectonic shift once I had kids. I'm not saying that one can't be a good pediatrician if one isn't a parent; but there's no denying it's a definite boost for credibility.
I know I need to lose weight. I've done it before and I know I can do it again. But I know that shame and fear and humiliation do not work as motivators for me. Just the opposite; depression about inability to lose weight leads to emotional eating. In fact, I'm only able to lose weight once I accept myself at the current weight. (Murphy's Law of Shopping, too: once I buy all new clothes in the bigger size, that's when the diet finally starts working.) So what I offer my patients is loving support: "How can I help?" I've done all the diets; I know all the tricks. Let me help you brainstorm.
But if your BMI is under 21, don't come trying to talk to me about weight loss!