Obesity Intervention from Your Doctor

Monday, July 02, 2012

GYI0000522214.jpg A wait for free health care, obesity is common in Appalachia.(Getty)

How would you react, if during a regular doctor’s checkup, your physician told you that you were obese? That’s what the U.S. Preventive Services Task Force has suggested in a new set of recommendations. It says all adults should be screened for obesity and patients with a high body mass index should receive intervention.

This intervention could involve behavioral management activities, like setting weight loss goals or talking about ways to improve the patient's health through diet and exercise.  

Art Caplan, an expert on the subject, is a bioethicist and head of division of medical ethics at NYU Langone Medical Center. 

"It really gets involved with how far can a doctor go, ethically, to persuade you to try to lose weight," Caplan says. "We really want to make sure that we do something about this obesity crisis, and your doctor's on the front line trying to do that, but in a way the question is how far can they go and what weapons can they use to get behavior change." 

The bioethicist explains what he calls a shift towards a more "directive style", where doctors take more initiative in prodding their patients towards healthier choices, rather than simply relaying medical information from a neutral point of view. He sees this as a favorable change, and points to his own struggle with weight. "I think having more directive, a more ethically charged relationship with a doctor is important," Caplan says. 

Substantia Jones is the founder and photographer of Adipositivitiy, a body acceptance campaign to demystify the fat body. "There is a definite threat of harm if the doctor's relationship with the patient is interrupted with shaming language or judgment that can put the patient's health in jeopardy," she says. 

"The explosion in weight and the toll that it's taking is beyond dispute," Caplan says. "There's no doubt that you can be thin and sick and fat and healthy, but fat is not good in the long run. The damage that [being] overweight does is not necessarily to your 20 or 30-year old, but you see it in the exploding rates of diabetes, arthritis, and heart disease." 

Guests:

Dr. Arthur Caplan and Substantia Jones

Produced by:

Robert Balint and Paul R. Smith

Comments [21]

anonyme

http://www.womentowomen.com/adrenalhealth/adrenalglands-stress-weight.aspx?
More about stress hormones and weight from the practice founded by Dr. Christiane Northrup.

Jul. 03 2012 06:13 PM
StudentSclWrkr from San Antonio

Previous studies have shown that discrimination against fat patients is rampant from doctors and this causes negative consequences to thos patients in terms of their quality of care. This also makes fat patients, especially woman, avoid seeking a doctor's care when they need it, putting fat patients in even more danger.

I do not think encouraging the doctors to be more discriminatory is a good idea. People who are fat know they are fat, they do not need anyone to tell them.

Jul. 03 2012 08:37 AM
Darliene Howell from Las Vegas, NV

Since weight does not equate health, tracking a person’s BMI as a “vital sign” doesn’t make sense and only goes to make the person feel pigeon-holed or stereotyped. If HEALTH is the real concern, I recommend that you investigate Health At Every Size®. NAAFA has created a free brochure geared toward healthcare workers that treat fat patients that can be found at: http://tinyurl.com/7gbevd6

For more information on Health At Every Size, you can find the guiding principles at the Association For Size Diversity and Health’s website (http://www.sizediversityandhealth.org/content.asp?id=5) or find in-depth research-based information in the book Health At Every Size - The Surprising Truth About Your Weight by Dr. Linda Bacon (http://www.lindabacon.org/HAESbook/).

Jul. 03 2012 12:20 AM
anonyme

You can use acupressure points to balance spleen and triple warmer meridians - if you do this once or twice a day you will lose weight in all the right places because what you are doing is balancing stress hormones. Fifteen pounds in two months. Try it. Allopathic medicine is only one option and it is failing us as far as nutrition or "weight management" are concerned. (As for nutrition I am far more apt to trust anybody's great-grandmother than whatever science thinks it knows. Most people's great grandmothers lived before industrial food. They used whole foods and they cooked at home - family meals which were eaten together. As for exercise - movement is important no matter what. Start with a walk! This is not rocket science.

Jul. 02 2012 04:06 PM
Drew from East Village, NYC

This segment was as bad as any Tea Party debate on ObamaCare.

It was like listening to tobacco executives disassemble about how there’s no proof of a link between cigarette smoking and cancer or heart disease, or birthers discuss The President’s citizenship.

There is HARD scientific evidence linking obesity with untold numbers of health problems and it is a national emergency.

Your segment placed hard science on the same footing as psychological theories and unfortunate shifting social norms.

Awful.

(I still like your show.)

Jul. 02 2012 03:56 PM
John A

Got my attention.
People, please steer yourselves away from self-indulgence and delusion.
Myself I recall being advised on weight by a doctor as far back as 40 years ago. Whenever I near the obesity line I do indeed feel the need to change, and do so.
-
A symptom missed: joint damage.

Jul. 02 2012 03:39 PM
Jennifer Wilson from Boston, ma

Don't talk to patients as if they are just a set of numbers and statistics. That might be the secret to improving the doctor patient relationship. When my doctor talks to me about my numbers I go deaf. I think that is what Substantia is talking about. And for the record, I'm not obese, even by the numbers.

Jul. 02 2012 11:41 AM
Alan from Bay Area California

One guest contends obesity is a problem with significant impact on overall health such as adult onset diabetes. The other guest simply disputes this as an unproven assertion. As reporters and interviewers you make no attempt to sort this out. Both cannot be true. This is horrible work on your part. You are permittung yourself to allow the news to be he said/ she said. How is anyone in your audience to learn from this.? You can do better.

Jul. 02 2012 11:36 AM
Burton from Miami

I was appalled listening to this show as the host allowed the guest "expert" to compare obese people to serial dieters. So basically the guest took a sample of people who have weight issues and another sample of people who had weight issues and have now adopted an even more unhealthy lifestyle. Where is the representative sampling of those of us who actually make lifestyle choices to eat healthful food, exercise and monitor our health on a regular basis.

I agree that BMI is not a good indicator of health but body fat percentage certainly is a great one. I understand not wanting to be vilified by one's doctor for being a bit overweight. But to champion obesity as a healthy way of life is dangerous. To allow that type of rhetoric to be nationally broadcast is irresponsible.

Jul. 02 2012 10:48 AM
Burton

I was appalled listening to this show as the host allowed the guest "expert" to compare obese people to serial dieters. So basically the guest took a sample of people who have weight issues and another sample of people who had weight issues and have now adopted an even more unhealthy lifestyle. Where is the representative sampling of those of us who actually make lifestyle choices to eat healthful food, exercise and monitor

Jul. 02 2012 10:29 AM
Kimberly from Upper West Side

Doctors have to realize that fat patients are more than just fat. I've found that many doctors will attribute any and every problem that a fat person has to their weight, without doing any further tests. It certainly has happened to me. After numerous visits to my doctor for gynecological related symptoms (which she insisted were related to my weight), I had to practically beg for an ultrasound. Surprise, I had a very large fibroid tumor. Because of the delay in diagnosis, I ended up with numerous (non-weight related) complications during my treatment. Doctors have to treat the patient they have and not the ones they wish they had. Standards of treatment for fat and thin patients shouldn't be different.

Jul. 02 2012 10:08 AM
Laurie Mann from Pittsburgh, PA

I don't have a problem with a doctor saying "Your weight is X, it should be in a range between Y and Z, here are some suggestions for diet and activity" as that's merely descriptive. Doctors should always state the patient's condition. I do have a problem with shaming and nagging. Different weight loss/activity programs work better for different people. I'm using a go slow approach and have had some success (50 pounds over 16 years).

In retrospect, it's probably a good idea for pediatricians to discuss eating habits and activity levels with parents when kids are young. Pediatricians, internists and gerontologists need to have more training in these areas and need to be able to discuss them with patients openly.

Jul. 02 2012 10:02 AM
K Martin

Seriously, my doctor does not need to tell me I am overweight. I see the scale and have a mirror. What we need if weight loss methods that work and health care that pays for weight loss programs.

Jul. 02 2012 10:01 AM
Hanson from Pittsburgh

Why is obesity any different from smoking or excessive drinking? Good doctors know how to engage patients in conversation w/o shaming, guilt tripping, etc.

Jul. 02 2012 09:59 AM
SSandersMA from Chicago

This is nothing but marketing on the part of Pharma. The members of the task force are either extremely ignorant, or on Pharma's payroll. That they would not take into consideration all evidence makes them the worst kind of slime, no different than any politician on the take. Health comes in all shapes and sizes. Everyone has the right to look at the evidence for themselves and determine a correct weight for them. The real agenda behind this is to sell more pills, which are far more dangerous than being fat!

Jul. 02 2012 09:55 AM
victorialee from Miami Beach

I expect my doctor to tell me the status of my health, and if she or he didn't tell me something because I might be "uncomfortable," then she is not doing the job I depend on her for. I am listening now to the part of the interview in which weight is not a dependable barometer of health, and that is exactly why we need our doctors to talk to us. We cannot always make our own call, we need the seasoned and educated determination of a health professional.

Jul. 02 2012 09:53 AM
Scott Kay from Florida

The BMI is stupid !!!
I am about 5'10 man. According to the BMI I should weigh between 130 and 175 pounds. I might be able to get down to 175 pounds if I eat very lightly but anyone my height who weighs 130 pounds should be dead!

Jul. 02 2012 09:51 AM
Packy from Chicago

Yes! The doctor should inform the patient that they are obese and need to lose weight. Having an authority figure inform the patient carries moral weight (no pun intended) in today's world.

Also, I believe I read recently of a report/study where many overweight Americans believe they are "normal" weight since so many people around them are overweight? Someone on your staff can probably find the info....

Jul. 02 2012 09:35 AM
sandy from Queens, N.Y.

I am 68 yrs young. It has taken me most of my life to find doctors who are sympathetic to overweight people.
Along this journey I've had dr's insult me, call me names, and tell me I'd be dead before 50. Most of my weight gain was with my first pregnancy; no matter what diet I tried the weight didn't leave.
Yes I am a diabetic, but I didn't stand a chance, both sides of my families were.
We have to target the children, at school with the lunches, get gym back every day, and teach nutrition including alternatives to junk food. The mayor has the right idea,but, targets the wrong area...start with the schools.
It's counter productive to hear your Dr. say OBESE, peers name calling, parents complaining.

Jul. 02 2012 09:28 AM
Elaine from Southfield, Michigan

I have been fat all my life with bouts of extreme effort to lose weight. Doctors have told me I need to lose weight all along, including telling my mother when I was six weeks old. I have lost about 60 pounds over and over. The thin periods last less than a year, and eventually all the weight plus more comes back. It does me no good to have the doctor tell me I am obese. When I ask what can I do about it, I get either a shrug, or something like "Push yourself away from the table." Handholding by a wonderful dietician was helpful but the results lasted no longer than the others. I know what works to get it off, but not how to keep it off. So how does it help again to have the doctor tell me?

Jul. 02 2012 09:03 AM
Fran from New York City

In August 2010, my doctor told me I should lose weight. When I squirmed, like another listener's doctor, my doctor answered, "Well, if I don't tell you, who's going to tell you?" Initially I thought I would not go back to her. But she had planted the seed, and in May of 2011, I changed my eating habits and have since lost 40 pounds. I knew I had to do it, but hearing her say it out loud had a positive influence on me.

Jul. 02 2012 08:38 AM

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