This past summer, I followed a doctor as he did his hospital rounds, and one particular patient visit shocked me. The doctor had warned me beforehand that this woman was morbidly obese, over 400 pounds, and had many resulting complications. When we walked in, after introductions, she began to complain about her many problems —among other things, she had trouble breathing and her legs hurt. The doctor and her spoke for some time, but weight was never mentioned.
After we left he explained her case further: she had come into the hospital for overall poor health. She was able to stand and go to the bathroom, but she didn't like to because it was difficult, so they inserted a catheter. Her legs hurt because of the huge infected bedsores due to her lack of movement, and she couldn't breathe while laying on her back because the weight was crushing her chest. If she lost weight, all of these problems would disappear.
Weight was never mentioned in his discussion with the patient, but before and after we got into the room that was all we spoke about. Naturally, I asked why weight wasn't discussed with the patient. The answer was something along the lines of “she can’t lose weight now.” This may be true, however, this patient wasn't born obese, and it seemed to me like it was a product of years of neglect from her and her doctors.
A study published in the Archives of Internal Medicine analyzed data on 5,500 individuals to determine how often weight was discussed in the doctor’s office. Of the obese participants, 1/3 had never been told by their doctor they were overweight, and 55% of the overweight participants were also never told of there medical condition. For those that were told they were overweight, these individuals were more than twice as likely to attempt to lose weight in that year.
Both heart disease and diabetes are among the highest causes of death in the United States and obesity plays a large role in both conditions. Doctors are aware of this but are still reluctant to discuss weight loss for many reasons. Some doctors are pessimistic and don’t think they can make a difference. Some are busy and don’t have time to sit with patients and discuss weight loss. Others are concerned that their patients will be offended and look for another doctor. Still others want to tell their patients to lose weight, but feel they can’t give professional advice on how to begin.
Our society has made it uncomfortable for some people to discuss weight, but this should not stop doctors from giving professional medical advice. The New York Times did a piece on “The Dreaded Weigh-in” at the doctor’s office, discussing how people don’t like to be weighed by the nurse in a busy hallway where others could look on. As the article points out, weight is a task of the nurses and often not addressed by the doctors, but this must change. If a patient is in for an illness related to their weight or the doctor is worried about their weight for future health, a conversation should be had. Giving medication for high cholesterol and diabetes, while avoiding a weight loss discussion, is like treating lung cancer without ever mentioning cigarettes are bad.
Although it is promising that doctors who do speak to their patients about weight loss see more patients attempting to lose weight, this is insufficient. Medical schools may want to consider educating family practitioners on ways to address weight loss in a compassionate and effective way. Whatever we do, we must change. Obesity is one of the largest killers and a growing epidemic in America, and the health care field cannot ignore it any longer.