There is no doubt that Obesity is an epidemic, not only here in Philadelphia, but across the United States. The reasons are many and now that the American Medical Association, as of June 2013, has classified obesity as a “disease”, physicians are even more compelled to address this complex issue in their practices. How they go about doing this is up for debate.
A recent study out of Johns Hopkins highlighted the issue of physicians judging their overweight patients, adding to the shame obesity can cause and making it difficult for patients to engage in partnership with their doctors to assist in medically supervised weight loss. In the study, which surveyed 600 overweight and obese adults in the U.S., 21 percent believed their doctor judged them because of their weight. And of those people, only 14 percent went on to actually lose a significant amount of weight.
Unfortunately, it's not all in their heads. When I was a medical student, I recall a surgeon telling a patient who required her gallbladder removed that she had to lose at least 40 pounds before he would operate on her. No assistance was offered, no empathy shown for the challenge of losing weight, and certainly no bedside manner in delivering the recommendation with compassion. I saw this patient’s face fall and never found out if she went back to that surgeon for further follow up or the procedure. Somehow, I doubt she did.
I recall another instance as a resident where my attending took a look at the patient seated behind a curtain who was morbidly obese, in heart failure, with a tremendous amount of abdominal fat hanging to the floor, and sitting in a pool of her own urine. The attending rolled her eyes before proceeding to the patient. It's hard to know if this reaction colored the way in which the attending approached the patient, but even personal biases can manifest themselves subtly. Regardless, the patient was clearly impacted by her weight, in a state of medical distress and needed real help. Although help was provided, eye-rolling was not an appropriate or professional reaction.
No one likes to feel judged. We often get enough of that from our families, friends, co-workers or strangers on the train; we don't need it from our doctors.
This was over 15 years ago and hopefully we, as a profession, have improved our approach, given the tools we have available to help patients with weight loss (i.e. food journals, online resources, evidence-based weight-loss programs, support through coaching, and surgical and medical options). However, in my opinion, helping patients lose weight is next to smoking cessation in the top two clinical challenges in practice. So to our patients, doctors generally share the frustration around weight loss and obesity management: We know it’s tough, but a patient should not feel judged. He or she should feel supported in their health achievement goals. This comes down to basic patient-centered medicine, something most medical schools teach.
Obesity isn’t just looking visibly overweight or reaching a certain BMI; it can coexist with very serious health issues such as heart disease, debilitating osteoarthritis and diabetes, all of which come with a host of potentially life-threatening outcomes. Physicians need to consider the whole patient and all their illnesses, and patients need to consider obesity as a modifiable contributor to their larger health issues. Education is critical, and support and creating a plan that involves the physician as much as the patient is paramount to tackle this public health issue.
Bindu Kumar, M.D., is a Philadelphia-area physician with expertise in primary care and occupational medicine. She maintains her family medicine board certification in both the United States and Canada.